The SARS-CoV-2 outbreak has caused the medical community worldwide to find ways to ensure appropriate patient care across illness types while protecting patients and staff from contracting the virus. Those focusing on cancer care have had to particularly take measures in light of cancer patients being more vulnerable to COVID-19 infection as their immune systems are weakened due to both their malignant condition and immunocompromising therapies such as chemotherapy and radiation. Let’s look at a few ways that these specialists are mitigating this complicated medical environment.
Deciding between immediate treatment vs. delayed treatment
Due to the increased susceptibility of cancer patients to COVID-19, cancer doctors have had to balance delaying cancer diagnosis or treatment against the risk of potential virus exposureSourceKutikov A, et al. Ann Intern Med. 2020 Jun 2;172(11):756-758. doi: 10.7326/M20-1133. Epub 2020 Mar 27. This act of weighing the benefits of prompt treatment vs. delaying treatment to reduce risk of exposure to the virus is not without reason as, a nationwide Chinese cohort study conducted early on in the appearance of the virus found that COVID-19 patients with cancer had a higher fatality rate than the general population (5.6% vs. 2.3%)SourceZhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan. China. Ann Oncol. 2020. https ://doi.org/10.1016/j.annon c.2020.03.296. This pandemic has caused some doctors to have to make informed judgment calls based on tumor type, stage, and aggressivity. With hospitals overrun with COVID focused urgent care wards for the past year, oncology professionals have had to select patients who urgently need to initiate or continue in-hospital treatment due to their tumor’s more aggressive biology versus those who can tolerate a delaySourceKutikov A, et al. Ann Intern Med. 2020 Jun 2;172(11):756-758. doi: 10.7326/M20-1133. Epub 2020 Mar 27.
Adoption of e-Consultations when appropriate
It is logical that many oncologists have embraced virtual consultations whenever appropriate in order to continue cancer care while limiting exposure risk in the hospital or clinical setting. Although telemedicine had been experimented by some healthcare professionals prior the outbreak, the current circumstances have thrusted even those who were not necessarily tech savvy into the digital world. These increasingly common “e-visits” can include symptom management, genetic counseling, psychiatric support, and follow-up assessments after treatmentSourceCancer Care Goes Virtual in Response to COVID-19. American Association for Cancer Research DOI: 10.1158/2159-8290.CD-NB2020-027 Published June 2020. For patients that do have to come in physically for treatment, the WHO recommends SourceGeneral’s opening remarks at the media briefing on COVID-19. Retrieved from https://www.who.int/dg/ speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---18-march-2020.using a coronavirus screening questionnaire to identify potential cases and to perform thorough hygiene measures in between patient visits.
Recommending psychological support
Learning that you have cancer is already a traumatic experience. But the additional psychological burden of ongoing headline news of the outbreak, unemployment, & isolation due to lockdown can further impact the cancer patient’s mental healthSourceRaymond E et al. Target Oncology 2020 Jun;15(3):249-259. doi: 10.1007/s11523-020-00721-1. Healthcare teams that identify management strategies and support for mental stress and loneliness can help patients and their caregivers through this exceptional time.
As the COVID-19 pandemic appears to be prolonged for an undetermined amount of time, cancer specialists are having taken special measures to avoid late diagnosis, sub-optimal treatment timing, and preservation of mental health. It is clear that specialists around the world are stepping up to the challenge of putting patients’ health first by finding new solutions to quality patient care withing increased risk of virus exposure.