Lessons Learned: Cancer Care during COVID
Last March, as the COVID-19 pandemic started its relentless progression across the United States, hospitals and clinics nationwide closed their doors to all but the most gravely ill patients. While certain elective procedures and well visits were paused temporarily, patients with cancer didn’t have the luxury of waiting for things to return to normal. They needed unfettered access to regular scans, testing, and treatment resources at a time when a visit to a provider’s office was fraught with uncertainty.
Randall Oyer, MD, Penn Medicine Lancaster General Health
“Patients were understandably concerned,” said Randall A. Oyer, MD, Medical Director, Oncology Program, Penn Medicine Lancaster General Health and immediate past president of the Association of Community Cancer Centers (ACCC). “Would they be allowed into the cancer clinic? Would the clinic be fully functional? Would their doctor be there or out sick? Patients expect that the logistics of their care will run smoothly and consistently – from where to park to who greets them when they walk in the door. Early on, many of those support functions we take for granted were upended.”
According to Dr. Oyer, patients weren’t the only ones with concerns. Doctors, nurses and other provider staff also faced a great deal of uncertainty as processes and procedures changed – sometimes several times a week as new information became available. While COVID-related directives around social distancing, masking, and hygiene and sanitation may seem like second nature now, in the first few weeks of the pandemic, he said many staff were unsure what they needed to do.
For example, staff members were surprised to show up for work on a Monday morning in mid-March to find a tent had been erected outside the cancer center to screen patients for COVID.
“We had to quickly adopt new protocols, and then adapt those protocols to constantly changing conditions, including the weather,” he said. “We prioritized teamwork and shared a mindset that focused intently on patient and staff safety. Thanks to a good dose of humanity and humility, we remained agile and learned from both our successes and failures.”
Some Cancer Patients at Greater Risk for COVID Complications
People with cancer are three times more likely to get sick and die from COVID than the general population, according to Dr. Oyer, who added that some cancer patients – including those with hematologic malignancies and lung cancer – are even more likely to get COVID.
Upal Basu Roy, PhD, MPH, LUNGevity Research
“People with lung cancer need periodic imaging scans to check if the cancer is responding to treatment,” said Upal Basu Roy, PhD, MPH, Executive Director, LUNGevity Research. “They need laboratory tests to check general health, and access to infusions for chemotherapy or immunotherapy. These visits can increase risk for exposure and can be especially stressful for patients during a global pandemic, when health care facilities may feel unsafe.”
In addition, concerns about getting sick from infections are higher when a patient is on chemotherapy, said Dr. Basu Roy, who also pointed to issues around travel to other cities or states to receive treatments or participate in a clinical trial. These concerns were complicated by oft-changing travel and quarantine restrictions.
Equally worrisome, according to Dr. Basu Roy, was the effect on lung cancer screening. “Screening is considered elective, but it is vital for early detection,” he said. “Many individuals at high risk for lung cancer were delaying or postponing their lung cancer screenings.”
Emotional Impacts Take Their Toll
Drs. Oyer and Basu Roy said providers needed to be aware of the mental and emotional impacts of COVID among the cancer community.
“LUNGevity is well attuned to the educational and psychosocial needs of our community,” said Dr. Basu Roy. “We partnered with thought leaders in the community to bring the latest information to members who are dealing with stress, anxiety and isolation.”
To help address patients’ mental health and separate coronavirus fact from fiction, LUNGevity created a series of webinars and virtual meet-ups to connect patients with psychologists, art therapists, nutritionists and wellness experts. These efforts were designed to help patients relieve stress and find ways to be active and engaged from the safety of their homes.
As someone on the caregiving frontlines, Dr. Oyer has seen first-hand the emotional tolls of COVID on both patients and providers.
“One of the most difficult conversations our providers and staff have had with patients over the last year is why their loved ones are not allowed to visit them in the hospital or be with them during hours-long infusion sessions,” he said. “Patients benefit from the emotional and physical support of having a loved one nearby. And our staff is in a better position to care for patients when their loved ones provide input and share in decision making. It can be dispiriting to tell a patient that her husband of 50 years needs to wait in the car.”
In addition to the emotional toll of difficult conversations like that, he said cancer clinic staff have also been under tremendous stress managing the new workflow processes and procedures he referenced earlier.
“Cancer care is incredibly complex,” said Dr. Oyer. “On top of their traditional care duties, a good portion of our staff were forced to quickly pivot to COVID screening, standing all day in a tent outdoors, managing waiting lines, and directing patients and their loved ones where they could and couldn’t go. Everything required extra discussions and explanations – and all the while, messages are coming in, prescriptions are piling up, doctors need help, and patients need care.”
To help meet the mental health needs of frontline health care workers during the COVID-19 pandemic, Real World Health Care’s sponsor, the HealthWell Foundation, launched a fund to provide copayment assistance for behavioral health treatments. Through the COVID-19 Frontline Health Care Workers Behavioral Health Fund, HealthWell will provide up to $2,000 in financial assistance for a 12-month grant period to eligible health care workers who have annual household incomes up to 500 percent of the federal poverty level.
Supporting the Cancer Community
Over the past year-plus, the cancer community has come together to support each other and learn from others’ experiences. For example, the ACCC quickly scheduled teleconferences in which providers from Seattle and New York – two cities hit early and hard by the quickly escalating pandemic – shared their experiences to help other clinics know what to expect.
ACCC also created an ongoing webinar series with insightful discussions about topics such as new social distancing policies, office procedures, personal protective equipment requirements, and the pros and cons of caring for patients remotely through telehealth.
“In the early days of the pandemic, everyone was operating in a data-free zone,” said Dr. Oyer. “Our best course of action was collaborative information sharing and reading the latest literature together. I have never seen the oncology community come together so quickly before.”
LUNGevity also sprang into action in the early days of the pandemic, publishing “COVID-19 and Lung Cancer” on its website (in English and Spanish) to provide accurate, up-to-date information on the COVID-19 pandemic and how it affects people with lung cancer. As lockdowns became more common across the country, LUNGevity started focusing on self-care for patients and caregivers, with tips and videos on nutrition, exercise and mental health.
“We also worked with other patient advocacy groups to urge the CDC Advisory Committee on Immunization Practices to prioritize people with lung cancer during the vaccine roll-out,” said Dr. Basu Roy. “That effort led states to include people with cancer as high-risk groups to be vaccinated.”
Later this month (June 25-26), LUNGevity sponsors its annual COPE Summit, a virtual conference that addresses the special needs of family caregivers. The event is designed to give caregivers the tools they need to better manage and navigate their loved one’s care while learning about self-care and the caregiving community. The Summit is free to attend, but advance registration is required.
“We’ve reimagined all our in-person events as virtual over the past year,” Dr. Basu Roy concluded. “The entire lung cancer community as a whole has learned to be flexible and adaptative in everything, from how we reach the people we need to how care is provided.”
