Managing Cancer Care During the COVID-19 Pandemic

Managing cancer is a constant battle. As with all serious illnesses, cancer patients have critical needs that can’t wait. And the COVID-19 pandemic doesn’t change that.

Although the virus surge calls for new approaches to how we deliver care, it will not stop us from doing so. We are working tirelessly to design new protocols that ensure that all of our cancer patients have access to the life-saving treatments they need, in the safest possible environment.

What we know

COVID-19 is caused by a novel coronavirus, meaning it’s brand new in the environment. Medical science hasn’t yet had the time to fully research it, and we’re still compiling hard data on the nature of the virus. Clues to its inner workings are yet to be unlocked.

At this stage, it’s hard to predict exactly how the virus may affect individual cancer patients. But what we do know from experience is that many cancer treatments can suppress the immune system, which may leave patients more susceptible to infection.

The disease presents among cancer patients as it does within the general population: some will experience severe symptoms; some will not, regardless of how advanced their cancer is. Although data are in short supply, our mission is certain: we do all we can to protect every patient.

Taking decisive action

Our Washington Cancer Institute is taking decisive steps to protect our patients. Social distancing is the best tool we all have, and we take it exceptionally seriously here.

For inpatient care:

• We continue to perform critical cancer surgery, with the most pressing cases taking precedence. Some ancillary surgeries are being deferred—for example, breast reconstruction following cancer surgery—although surgery to treat tumors continues.
• Visitors to the Cancer Institute are limited.
• We have created a special sanctuary area for inpatients with compromised immune systems, including cancer patients. Stringent protective and preventive measures are in place to protect this area.

For outpatient care:

• Every cancer outpatient is pre-screened for symptoms before being cleared to visit the clinic.
• Again, other visitors are not permitted. Fortunately, friends and family members have stepped up to embrace this potentially difficult policy. They understand how important it is.
• Exposure to multiple providers is kept to an absolute minimum.
• Walk-in patients are not admitted.
• We have removed some chairs from waiting rooms to allow space for social distancing, and we’re staggering appointments to reduce waiting time and limit exposure.
• We are combining as many services as possible, such as lab work and imaging studies, to minimize multiple visits.
• Masks are strongly recommended for everyone—and offered to providers and patients alike.

And, of course we screen ourselves regularly as well, to ensure our healthcare team stays healthy.

As situations change, many other resources are available including social workers, nurse navigators and financial navigators. For example, the coming months may be difficult for those whose work has been affected by the shutdown. We can help manage access, scheduling, insurance and other details during this “new normal.”

The promise of technology

We are fortunate to have sophisticated telemedicine technology during the crisis. We utilize MedStar eVisit as much as possible throughout the continuum of care. Patients on oral chemotherapy, for example, can be monitored via eVisit from the safety of their homes.

Telemedicine can be especially useful for the initial appointment after a cancer diagnosis. That office visit can be emotionally difficult for the patient under normal circumstances, and even harder to handle during the pandemic when a family member or friend cannot accompany them. But with telemedicine, the patient can include as many people as they would like, to help them absorb the news and process information. Family members are encouraged to write down questions for subsequent eVisit sessions.

Although not perfect, telemedicine works very well and allows the patient to get the attention they need while limiting exposure to others.

If you need treatment

Anxiety over COVID-19 is completely understandable. Each week, I encounter patients nervous about coming to the hospital for their much-needed treatments. Fortunately, in almost every case, their worries diminish when they learn about all the extra measures we take to keep them safe.

We have put stringent protocols in place and are following them to the letter. If you need treatment, evaluation or consultation for a new or established cancer diagnosis, know that we are taking patient safety very seriously. If possible, please don’t consider skipping a treatment—your health depends on it.

If you are participating in a clinical trial, moving forward will depend on the parameters of the trial and your unique situation. Discuss it with your doctor.

If you experience a medical emergency, our healthcare team is on-call around the clock seven days a week, reachable by phone or eVisit. Because emergency rooms throughout our region are busier than ever, your best course of action in an emergency is to contact the team before making the trip. They know what questions to ask to determine if you should come in. Making that call is one more way to keep yourself and your family members safe.

Protecting yourself

In or out of the hospital, everyone should follow the guidelines the healthcare community has been recommending since the crisis began. The rules are the same for cancer patients.

Maintain social distancing, stay at home as much as possible, refrain from touching your face, and wash your hands frequently or use hand sanitizer when you’re away from running water. Covering your face with a cloth or surgical mask in public spaces is also a good idea. If we all follow the guidelines, we will better protect one another.

Silver linings

This coronavirus outbreak will advance our knowledge and increase our readiness for public health emergencies. Many of the scenarios we’ve considered and drilled for at the hospital are the new reality. Every member of the healthcare team stays on top of current research, guidelines and recommendations, and inter-team collaboration is at an all-time high.

In cancer care, the large medical academies and societies issue new guidelines frequently. Our team reviews this guidance carefully, and shares it to keep team members sharp and prepared as the situation evolves.

Oncology and hematology are also at the forefront of research toward prevention and treatment. Modern cancer care is often focused on immunology—the study of how the immune system helps fight cancer. That puts the cancer care team in the pipeline for new information on this disease.

What you can do

During challenging times, healthcare professionals are good at learning new things and multitasking. The current health crisis is putting those skills to the test. We must provide needed care, manage increasing volume, master new technologies, stay up on new developments, and care for our own homes and families.

You can help by following all of the recommended guidelines, keeping yourself and your family safe, and consuming and sharing accurate information from trusted sources. We consider every interaction with a patient or family member to be a new opportunity for teaching—and education is one of the most powerful tools we can use to combat this virus.

Together, we’ll relieve pressure on the healthcare system, get back to normal social discourse, and save more lives.