Treating cancer during COVID-19
“Cancer doesn’t go away during COVID-19,” said Shelley West, nurse manager of cancer services at Cape Cod Hospital in Hyannis.
Local healthcare professionals have adapted to the new environment, taking extra precautions to prevent the coronavirus from spreading between them and patients, and determining which procedures can be postponed, which visits can be done over the phone or computer, and prioritizing those patients who require prompt attention.
“We’re still here, we’re still treating,” said Jeffrey M. Martin, MD, chief of radiology oncology for Cape Cod Healthcare. “We’re doing our best to try to keep everybody safe – patients safe and staff safe.”
Cape Cod Healthcare moved quickly to institute strict infection control measures once the coronavirus threat became clear, West said. By the second or third week of March, staff involved with cancer treatment were all wearing masks at all times, gowns and gloves masks, when warranted. Since then, every patient is now screened for COVID-19 symptoms or recent possible exposure: first by phone, and then at the hospital, where, their temperature is taken at the front door prior to being allowed into the department, and they’re handed a mask.
Routine screenings, such as mammograms, are postponed, as are non-emergency surgeries. Other vital procedures continue, but with heightened emphasis on infection control. For example, every Tuesday, about 20-30 patients receive injections of Procrit (erythropoietin), a drug that boosts blood cell production to counter anemia caused by some chemotherapy. These patients no longer enter the hospital, but are given injections in their cars in the parking lot, West said. This reduces their exposure to other people.
Coming Into the Hospital
Other cancer patients must come into the hospital, including those who receive infusions of chemotherapy, a process that can last several hours. Workload varies, with the number of patients in the main treatment room ranging from 30 to 60 throughout the day, she said. Prior to the pandemic, nurses administering these medicines wore masks to limit the chance of germs entering a patient’s port, an implanted catheter that feeds directly into the bloodstream. Now the nurses wear masks at all times and (are fully garbed in protective gear for chemotherapy administration, which has always been the case) and the patients also wear masks, West said.
No patient diagnosed with a known active COVID-19 infection has received chemotherapy, though the issue of how to handle an infected cancer patient has been discussed by hospital officials.
“If it’s chemo, we likely won’t do it,” she said. “We don’t give chemo to someone with the flu (either) – they’re too sick.” This is a case-by-case decision made by the physician, she added.
Chemotherapy and radiation therapy can knock down the immune system, making it difficult for cancer patients to fight off infection.
Radiation treatment is ongoing, as is diagnostic imaging, such as PET scans, as well as biopsies and related procedures, West said. Everything is done on a case-by-case basis, weighing the patient’s cancer risk against their risk of infection. Decisions follow guidelines from Dana-Farber Cancer Institute, with which the hospital collaborates.
“We have transitioned to telemedicine for most initial consultation and follow-ups,” Dr. Martin said.
Some procedures, such as implantation of radioactive “seeds” for treatment of prostate cancer, have been postponed temporarily. But external beam radiation treatments have continued, he said. To reduce risk of coronavirus exposure, patients stay in their cars until being called, rather than sitting in a waiting room, and they go directly into the radiation treatment room. Extra care is being taken to clean equipment and surfaces between patients.
One very difficult change has been no longer allowing cancer patients to be accompanied by a family member or friend during hospital visits. West said such support is important and barring entrance to friends and family is particularly hard when end-of-life decisions must be discussed. In those times, the discussion can be broadcast by phone to the patient’s loved one, who must stay outside in a car.
There have been exceptions made for end-of-treatment/hospice discussions, but the family member must also be screened, said West.
“It’s painful for staff; it’s painful for the patient,” she said.
Doctors, nurses and social workers recognize the fear and loneliness of cancer patients, and are spending more time on phone calls, asking not only about their health, but if patients have food or need other help, West said.
“We’re another lifeline,” she said.
Many patients are glad to hear they don’t have to go into the hospital for a visit, if it can be done by phone or computer. They are staying home to avoid possible infection.
“They don’t want to be here anymore than anyone else wants to be out,” she said. “Most are happy to say, ‘Yeah, just call me – that would be so much better.’”
But some patients are reluctant to come in, even if they are having symptoms that may need treatment, Dr. Martin said.
“If they’re already known to us, they can call and we can decide on urgency,” he said. “Patients with new symptoms without a prior cancer diagnosis should be having a discussion with their primary (care physician).”
Changes caused by the pandemic have cut patient visits 25-30 percent, West estimated.
Staffing has also shifted, with some nurses working from home to contact patients by phone or computer.
Cape Cod Healthcare patients who have a surgery, test or procedure that has been delayed, should contact their clinical care provider office for guidance.