Managing cancer care during COVID-19: 5 oncologists, leaders weigh in

Five cancer care specialists and oncology service line leaders discuss how they are taking care of patients as their states see huge spikes in COVID-19 cases.

Editor's note: Responses were lightly edited for clarity and length and are presented alphabetically.

Question: How will you stay connected with your cancer patients and make sure they are receiving the care they need as COVID-19 cases surge?

Jorge Darcourt, MD, associate director for community cancer centers at Houston Methodist Hospital

At the onset of the COVID-19 pandemic in Houston in March, we implemented virtual video visits using the Houston Methodist MyChart video platform for our hematology and oncology patients from our seven cancer centers across the greater Houston area.

Most of our cancer patients (85 percent) agreed to participate on telehealth video visits, and all of our physicians became proficient in utilizing this platform. Currently, approximately 30 percent of our patient care is accomplished utilizing this technology.

Our follow-up surveys report a high level of satisfaction in participating patients and physicians. Most patients and most physicians would like to continue to have telemedicine video visits available for future patient care. Telemedicine has also given us an opportunity to stay closer to patients from distant and rural areas.

Vedner Guerrier, vice president of oncology services at Memorial Cancer Institute in Pembroke Pines, Fla.

We've utilized telehealth as the primary means of communication during the pandemic, with oncology-specific professionals responding to all calls to ensure patient needs are addressed immediately. Additionally, we have a dedicated triage team of an advanced practice RN and nurse that assist those requiring care, further reducing emergency department visits by patients.

For those COVID-19 patients that are also under active chemotherapy, Memorial Cancer Institute's team of nurses have set up a dedicated treatment area at Memorial Hospital West, one of five hospitals that are part of Memorial Healthcare System. Patients come directly from home to an isolated, negative-pressure room in our cancer center to receive daily treatment. Nurses utilize the appropriate personal protective equipment that enables them to safely deliver care. To date, we've treated three patients with the coronavirus.

We also have a plan in place to treat any radiation oncology patient that is COVID positive but have not needed to implement those strategies as of yet.

Rogerio Lilenbaum, MD, director of the Banner MD Anderson Cancer Center in Gilbert, Ariz.

We know that people who are immunocompromised, including those undergoing cancer treatment, are at higher risk for severe illness due to COVID-19. It is important for those with cancer to work with their care providers to determine if postponement of treatment is an option. In many cases it is not, and treatments should continue during this time to achieve the best possible outcomes.

Recommendations to prevent contraction of COVID-19 are no different for immunocompromised individuals than they are for the general public. These include regularly wash your hands (for at least 20 seconds) with soap and warm water and wearing a mask and exercising social distancing whenever possible, only leaving your home for essential activities such as doctor's appointments.

Strict adherence to these recommendations is of the utmost importance for those who are immunocompromised as well as the people they come into close contact with.

In addition, Banner MD Anderson Cancer Center is taking steps to enhance safety measures for its patients during this time, such as visitor restrictions, telehealth, postponing treatment if possible, etc.

We have been in the forefront of telehealth and are rapidly expanding the use of our virtual platform to reach out to patients in their own homes. This approach has been a game changer for patients and clinicians alike and has minimized the need to cancel ambulatory visits.

Mark Socinski, MD, executive medical director of the AdventHealth Cancer Institute in Orlando, Fla.

No cancer patient should go without medical care out of fear that they will contract COVID-19 in a hospital or physician practice, which is why AdventHealth has unveiled sweeping changes and innovative services that continue to safeguard our patients, teams and community.

Among the list of services available are telemedicine visits, as they have been throughout the pandemic, to lessen the burden on facilities and provide additional comfort and convenience for patients.

Telemedicine visits are virtual appointments with medical providers. By using this service, patients can receive care from an AdventHealth Cancer Institute physician via video — such as through the AdventHealth app or other video chat service — or by phone to best suit the patient's medical needs.

If a patient must go to a location to receive care, social distancing, universal masking and contactless services have become standard practice at all AdventHealth locations. Additionally, we have implemented tools such as curbside check-in and direct-to-exam/treatment room entry, a reduction of visitors and guests, and allowing patients to wait in their cars and be alerted when to come into the building for their appointments.

All patients coming to our infusion centers, as well as radiation therapy sites, are routinely tested for COVID to ensure safety when delivering care. Fortunately, we have found a very low rate of positive tests in our cancer population, which reassures us that delivery of cancer care to date has largely been uninterrupted. We have continued to stress to our patients the strategies mentioned in the previous paragraph must continue and can work to slow or prevent the spread of the virus.

Our cancer patients have also had access to free support programs such as Heal at Home, an innovative web series led by a team of AdventHealth providers and oncologists which teaches patients how to create and maintain a healthy lifestyle at any place in their cancer journey.

We are constantly reassessing our strategies and will react to new information in the best interest of our patients.

Aparna Surapaneni, MD, radiation oncologist with Memorial Hermann Cancer Center in Houston

Cancer care has always been challenging, but during the COVID-19 pandemic cancer patients have been especially tested. We have safely maintained our office visits and I am available by phone for those patients unable to come in who have questions or concerns. As a radiation oncologist, the majority of our patients come for their daily treatments for several weeks, so we are able to assess their needs daily as issues arise, while taking necessary precautions to minimize the risk to our patients and staff.

We have instituted daily screenings for all employees, daily mask-wearing and reconfigured offices for social distancing to minimize risk to our patients. It is important to communicate clearly to patients that they must continue to follow recommended guidelines to minimize their risk as COVID-19 cases surge.

I have had several patients who have expressed concerns about coming to the hospital given the current COVID-19 surge, but have explained that delays in cancer treatment can lead to more advanced disease and decreased chances for cure. I reassure our patients that we take all the necessary precautions so that we can continue to safely offer the highest level of cancer care.

In addition to our physicians, therapists and nurses, we have oncology nurse navigators who play an imperative role in the care for our patients. Their role has demonstrated many benefits for patients diagnosed with cancer, including reducing financial, logistical and psychological barriers to care. They have provided a very important role as well in maintaining excellent communication with patients during the pandemic to allow for timeliness of cancer care.

More articles on oncology: 
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How Memorial Sloan Kettering Cancer Center is managing patients with COVID-19
BCBS: Rise in chronic conditions increasing colorectal cancer risk, especially for millennials

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