It is a very challenging new world for cancer patients and their care teams. While data on cancer patients with COVID-19 is limited, published reports from China, Italy, and “ground zero” hospitals in the United States show a 3.5x higher risk of needing ventilation, ICU admission, and dealing with mortality compared with patients without cancer. This is a serious problem, which falls on community oncologists and care teams—given that 80 percent of cancer patients are treated in the community.
Patients with cancer are often discussed in a multidisciplinary tumor board. These are complex discussions, involving multiple specialties such as surgery, radiation oncology, medical oncology, pathology, radiology, genetics, and nurse navigators who all meet, mostly in-person, to come up with a tailored plan specific to that patient’s cancer. They review the patient’s clinical information along with pathology slides, lab test results, genetic test results, and radiological images. In light of COVID-19, in-person meetings have been reduced or prohibited to decrease the health risk for treating staff. However, now more than ever, multidisciplinary discussions are critical for cancer treatment decision making in this pandemic.
The COVID-19 outbreak immediately created new obstacles for cancer patient care. “Physicians dealt with patients canceling appointments—mainly due to fear of the unknown,” said Dr. John Howington, MD, MBA, Chief of Oncology Services and Chair of Thoracic Surgery, Ascension Saint Thomas Health in Nashville. “Elective surgeries stopped. Primary care physicians made fewer referrals and initially, there were no telehealth options for providers. For early-stage cancer patients, screening and follow-up imaging exams were postponed.”
Additionally, for many hospitals, the frequency of tumor board meetings was reduced, or meetings were even canceled to decrease exposure between care team members. However, those choices directly compromised multidisciplinary cancer decision making. Many hospitals and cancer centers did not (and still do not) have an accessible and secure platform to virtually review cancer patient cases.
“Initially, we had no immediate virtual option and at the same time, no face-to-face interactions were allowed,” said Dauphne McGavic, CTR, RN, MSN, Director of Oncology Services, Ascension Saint Thomas Health. “Physicians had to reach out to one another via phone or email to discuss patient cases.”
The Virtual Requirement
As the world of cancer care teams changed almost daily, meeting virtually went from an option to a requirement. Many cancer centers were forced to cancel tumor board meetings and were left scrambling for a solution.
Fortunately, Ascension Saint Thomas was an early adopter of a cancer-specific, tumor board platform. They did not miss a single tumor review board meeting. “We worked with the administrative team at OncoLens to quickly transition to its virtual tumor board solution,” said McGavic. “By using the virtual platform, within a month, we’ve seen increased attendance to our tumor board meetings. Care team members can join from anywhere, which is especially beneficial for pathology and radiology subspecialists. It’s less disruptive to participants versus having to travel to meet in person, too.”
The Next New Normal
Our understanding of the COVID-19 virus continues to evolve and improve. For all cancer patients, physicians must keep up with the literature and follow national guidelines that change continuously. Patients are being stratified based on the severity of their cancer. First are those who have a life-threatening condition and for whom even a short delay would significantly alter their prognosis. Second, are patients who do not have immediately life-threatening conditions but for whom treatment or services should not be indefinitely delayed until the end of the pandemic. Third, are patients for whom certain treatment or services can be indefinitely deferred until the pandemic is over without adversely impacting their outcomes.
Care teams work together to individualize the decisions specifically made for each patient, as patient anxiety about not receiving the best cancer care due to external events is a real concern that must be addressed. Patient education is vital. Cancer patients appreciate having a multidisciplinary care team of experts collaborating to determine their best possible options during these unparalleled circumstances.
“Post COVID-19, we will still utilize and benefit from a virtual solution because remote care teams and staff will become the norm,” said Howington. “In terms of telehealth and having online and real-time access to patient treatment plans, Ascension Saint Thomas went live with telehealth visits on March 18. We have completed more than 9,300 virtual visits to date. This option created an avenue for patients to connect/communicate with their providers during these unprecedented times.”
About The Author
Dr. Lijo Simpson is a board-certified Hematologist and Medical Oncologist with Atlanta Cancer Care and practices at DeKalb Medical Center and Southern Regional Medical Center. He has published numerous articles outlining his research in colorectal, genitourinary, hematologic cancers and melanoma and presented extensively at the American Society of Clinical Oncology, American Society of Hematology and American Society of Bone Marrow Transplantation. He completed his fellowship in Hematology and Medical Oncology at The Mayo Clinic, Rochester, Minn., and residency at Advocate Illinois Masonic Medical Center, Chicago. He is chief medical officer and co-founder of OncoLens.