In a webinar detailing what oncologists need to know during the coronavirus disease 2019 (COVID-19) pandemic, clinicians discussed the ways that their treatment practices have had to change and the ways they should continue to change.
The webinar, titled COVID-19 and Cancer Care: What Oncologists Need to Know Today, was led by Ruben A. Mesa, MD, FACP, from the University of Texas Health San Antonio MD Anderson Cancer Center. Additional panelists included Cardinale Smith, MD, PhD, from Mount Sinai, Amelia A. Langston, MD, from the Winship Cancer Institute of Emory University, and Hope S. Rugo, MD, FASCO, from the Helen Diller Family Comprehensive Cancer Center at UCSF.
In regard to the impact that COVID-19 has had on the workplace, the oncologists agreed that the primary changes have included:
- Limitations to visitors allowed inside the hospital, with visitors only being allowed for special circumstances.
- Patients being screened upon entering the hospital using a questionnaire.
- The addition of separate respiratory screening clinics to test patients suspected of having COVID-19.
- Looking for ways to utilize elderly, pregnant, and otherwise compromised employees so as to protect them from exposure.
- Reducing elective surgeries and in-clinic visits for patients with cancer.
- Video conferencing, or using “telemedicine,” visits if possible to avoid exposing patients with cancer, particularly those who are immunocompromised.
- Conservation strategies for PPE equipment, such as cleaning face shields and re-wearing gowns in cohorted units.
- Only bringing essential healthcare workers into the hospital, and specifically minimizing traffic through the cancer clinic.
- Delaying cancer treatments and surgeries, such as stem cell transplants, as long as possible to avoid exposure for patients with cancer.
- Switching to oral therapies if possible so that patients with cancer can have medications delivered instead of coming in-clinic.
- Accruing for clinical trials in limited ways, and sometimes not at all, but judging changes to clinical trials on a case by case basis per FDA guidelines.
For patients with cancer, the webinar participants suggested that the best practices are above all: social distancing and handwashing. Avoiding other people at all costs, especially through avenues such as public transportation, is crucial for this patient population.
Though a lot of changes have already been implemented to try and combat problems that could arise as a result of the virus, there is still much that remains unknown.
“All of our patients are asking us all of the time, how immunosuppressed am I, how much at risk am I, and I would say given what we’ve seen so far, other than being quite elderly and having multiple medical problems, we really don’t know in the US-based population, where we use a lot of supportive care, a lot of growth factors, etc.,” Rugo said.
Notably, an issue that was presented was, for patients with cancer who present as positive for the COVID-19 virus and recover, how long should clinicians wait until beginning cancer treatments again, such as chemotherapy? Per the CDC, patients should test negative 2 times before being treated again, however with the issue of testing, some clinicians are worried that it won’t be soon enough for their patients to receive potentially life-saving treatment.
According to Smith, her facility was advised that they will no longer be screening for patients to test negative, and therefore there is a lot of unknown in this area. As her clinic moves forward with antibody testing in hopes of gaining more insight, Smith recommended that clinicians wait 2 to 3 weeks for patients who presented with mild symptoms and 3-4 weeks for those who had more severe.
“In addition to the challenges and the burdens faced by patients and their families, it’s taking a huge toll on the health care space and members of the health care team,” Smith said. “Watching patients deal these significant illnesses while they have cancer, and even the metastatic cancer, and not being able to have loved ones participate in that care and watching those challenges has really been hard on healthcare workers.”
Another issue presented was that of burnout in oncologists and other caregivers who are not only faced with trying to care for their patients as best as possible, but who are also still dealing with everyday struggles such as childcare during a time of social distancing and the anxiety of having an elderly family member during this crisis.
The panelists recommended looking for ways to care for yourself, such as meditation, having virtual conversations with friends, exercise, or whatever other outlet can be safely utilized at this time. They also recommended being cognizant of the stress and anxiety of peers and trying to sympathize with coworkers who may be experiencing the same fears.
“This is the most stressful time of all our careers I would say,” said Rugo. “For all of us, without question, we’ve never been through anything like this; I hope we aren’t again, but it’s a whole new world.”