The COVID-19 pandemic brought nearly every facet of American life to a grinding halt. But for oncologists and staff at local cancer care centers, the work hasn’t stopped. If anything, the virus has only further complicated a world that already deals with matters of life and death each day.
As stay-at-home orders are relaxed, cancer care teams field questions from patients who worry about what a public health crisis may mean for their treatment. Am I at an increased risk for infection? Should I cancel my medical appointments and stay home? What do I do if I get sick?
“It’s an extremely complicated environment for cancer patients,” says Syed Ahmad, M.D., co-director of the UC Cancer Institute. “They’re having to deal with a double burden—not only the diagnosis, but also the fear of possibly getting an infection and having complications.”
Uncertainty has forced quick innovation and difficult decisions. After all, a cancer diagnosis doesn’t wait for a pandemic to end. But Cincinnati’s hospitals are finding new ways to step up to the challenge and adapt to the rapidly shifting landscape of cancer care in the era of COVID-19.
Unprecedented Challenges
A cancer patient’s experience often involves a complex web of medical professionals—a team that’s working with the patient from the moment of diagnosis. One patient alone may see a general physician, an infusion nurse, a radiation therapist, a genetic counselor, a behavioral health specialist, and a nutritionist. The list goes on.
“That’s part of cancer care,” says Mark Witte, executive director of the TriHealth Cancer Institute. “And that interaction is a component that we think is so vitally important in terms of how patients experience their care, who they come to know, and all of those elements. So how do we compensate for that experience that you have and the way that you’re treated during a very intense time?”
There’s no simple answer to that question. Many patients, Ahmad says, are concerned about weighing the risk of their cancer returning or progressing versus the possibility of getting sick. They may worry that the very same drugs helping them stay alive are also suppressing their immune systems, heightening the risk for infection.
The sheer novelty of the virus makes it difficult to gauge just how dangerous it might be for cancer patients.
The World Health Organization estimates that about 1.4 percent of infected patients with no underlying conditions will die from COVID-19. For cancer patients, that rate jumps to about 7.6 percent. And early data suggest that patients with respiratory malignancies may be at even greater risk.
At local cancer care centers, it’s far from business as usual. Clinical trials have been suspended, and patients, typically accompanied by family members, are often attending appointments alone.
There’s no telling how long it might take for a return to some semblance of normalcy. Ahmad knows that, at least for the foreseeable future, the new reality will mean later nights and longer days than doctors may be used to.
“You can imagine that we’ve delayed a lot of cases. And we have a lot of patients in the queue…and we only have so many operating rooms and so many people working,” Ahmad says. “So now, the next challenge is going to be trying to get all these cases done, and then handle the new cases that are coming in. So it’s going to be quite interesting. And it’s going to require working outside the box.”
The Changing Face of Cancer Care
Local cancer care centers are already working outside the box, exploring new ways to create a safe, supportive environment for patients.
At UC Cancer Center, precautions start at the front door. Temperature checks are mandatory for both doctors and patients. As of May, cancer patients were allowed to bring just one person with them to appointments. Social distancing guidelines are enforced the moment a patient sets foot in the waiting room.
In an effort to minimize the risk of infection, more providers have been turning to telehealth visits, saving in-person interactions only for patients who require lab testing or urgent physical exams that can’t be performed over a webcam.
“If you look at our clinics, half of those clinic visits are now telehealth visits and half are in-person,” Ahmad says. “And the only ones that are in-person are people who ask or require the doctor to interact with the patient to examine the patient.”
The same rings true for James Maher, a medical oncologist at TriHealth Cancer Institute who says telehealth visits count for at least a third of his recent appointments.
But telehealth isn’t always an option. Sometimes, radiation, chemotherapy, and surgery simply can’t wait, meaning oncologists have to make decisions caseby-case, looking at each patient’s cancer individually to determine who can safely wait for a procedure.
“Often, they can be delayed,” says Brian Mannion, M.D., executive medical director of the oncology service line at The Christ Hospital. “And many of them have been delayed. But some of them cannot, and so we’re treating them on a case-by-case basis.”
“The City Has United”
Oncologists and other cancer care center staffers may not be as visible as other frontline workers whose bravery and sacrifice inspire so many in the face of a pandemic. But in a time of unprecedented uncertainty in the medical field, Witte likens his own cancer treatment staff to battlefield nurses and doctors who put their own lives on the line to ensure the standard of patient care never wavered.
“We’re thinking so much about the frontline workers who are working in the ICU and on COVID units,” he says. “But not thinking so much of the routine care that still has to happen.”
Doctors have found themselves drawing inspiration from their patients, and patients from their doctors. TriHealth Cancer Institute even saw its patient satisfaction scores rise in April—a testament, Witte says, to the way cancer centers have adapted to the new reality.
The road ahead is uncertain. Cancer care will undoubtedly look different in the coming days, months, and maybe even years. But when it comes to the standard of care at Cincinnati’s cancer centers, much remains the same.
“Inspiration is all around,” Ahmad says. “This city has united. Every hospital in the city has gone above and beyond to work together, talk to one another, and determine the best way forward. It’s about being unified and working for a common purpose—a common goal.”
From wearing a mask in public to scheduling telehealth appointments, local cancer care specialists offer four easy ways you can lessen your risk of infection while staying on top of your health.
Don’t cancel your checkups:
“We don’t want people to go untreated or ignoring symptoms during this time that need to be addressed,” says Jenny Scott, executive director of The Christ Hospital’s oncology line. If you’re worried about how COVID-19 may impact your treatment plan, follow up with your doctor to determine the best course of action.
Schedule telehealth appointments, if possible:
Unless your upcoming appointment requires testing or a physical exam, ask your doctor about meeting over the phone or online. Many local cancer centers are encouraging telehealth appointments in place of in-person visits and Medicare has temporarily expanded its coverage of telehealth services. Check with your health insurance provider to see if they’re doing the same.
Wear a mask but know it’s no substitute for social distancing:
Going out? Whether it’s for a trip to the grocery store or a walk around town, The American Society of Clinical Oncology suggests both patients and clinicians follow the CDC’s general guidelines on mask usage, which recommends everyone wear a cloth face covering in public.
Limit your visitors:
Many cancer care centers are setting strict limits on who’s allowed to accompany patients to appointments. Consider doing the same. Follow your local health department’s social distancing guidelines and limit the number of people you come into contact with— it’s one of the most surefire ways to limit the spread of infection.
Music Hall was packed the night Berner was sentenced. Cincinnati’s leading citizens speechified in favor of a measured yet forceful protest and for reforms to the criminal justice system. But the audience howled for blood. As the standing-room throng of 10,000 angry men poured onto Elm Street, one cried out, “To the jail! Come on! Follow me and hang Berner!” The riot was on.
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