Perelman School of Medicine at the University of Pennsylvania

Cancer Care in the Time of COVID

Newswise — Don’t delay your medical care. It sounds like common sense, but in the era of COVID-19, people who normally wouldn’t hesitate to call a doctor when something doesn’t feel right, might avoid doing so out of concern about any kind of post-lockdown activity. But the medical community is urgently trying to advise the public that seeking health care is still essential.

Whether or not people are actually avoiding going to the doctor when they’re sick — or to the hospital if they’re having a true emergency — is still a matter of some debate. But while no study has shown it definitively, there are two trends that are cause for concern. First, an analysis of deaths in the U.S. so far in 2020 compared to the same point in 2019 show 2020 deaths are higher by a larger margin than can be attributed to COVID-19 alone. Second, as patients do make appointments for what ails them, some are showing up with signs of previous, untreated issues.

“For example, we’re seeing patients with cardiovascular symptoms whose imaging shows signs of an untreated cardiac event from several months earlier, meaning there may be patients not seeking the treatment they need, even in an emergency,” said Mitchell D. Schnall, MD, PhD, chair of Radiology at the Perelman School of Medicine of the University of Pennsylvania.

Importance for Cancer Patients

While this is a concern across all fields of medicine, it’s particularly complicated in cancer care, where early detection is key. The prognosis for cancer patients almost always depends on how advanced the disease is at diagnosis. The more the cancer has grown or spread, the more difficult it is to treat, and the worse patients generally fare.

Another factor is that any significant delay in cancer diagnosis would hide from the immediate numbers researchers use to analyze the impact of the phenomenon, since cancer mortality is measured in years, compared to traumatic events like a heart attack.

“It may be that rather than dying in several years, you die in one year instead. The effects of delaying cancer diagnoses are something we’ll be dealing with for a long time, and it’s something we’re actively studying to better understand it and focus on how to minimize it,” said Lawrence Shulman, MD, the deputy director for Clinical Services and director of the Center for Global Cancer Medicine in the Abramson Cancer Center (ACC) of the University of Pennsylvania.

Is it Safe to Seek Care?

Hospitals and medical practices have put safety measures in place that go beyond other public places. It’s more than temperature and symptom checks. It’s also infection control procedures and other best practices, and as the pandemic wears on, these practices are continued and only get better.

“We have a lot of experience with infection control and COVID right now, and we have plenty of personal protective equipment for Penn workers and patients,” Schnall said. “There is very little risk of seeking care right now, whereas the risk of putting off care is very real.”

“It’s safer to come to the hospital than it is to go to the grocery store, and that’s true because we continue to have a high concern for caution and safety. We haven’t let down our guard at all,” Shulman added.

These precautions also apply to crucial cancer screening tests, like mammograms or colonoscopies. And for patients who have positive screening tests, or symptoms suggestive of cancer, telemedicine consultations with an oncology expert can then direct patients to the appropriate next steps before setting foot out their door.

“Lean on our expertise for whether or not your issue is serious and you need to be seen,” Schnall said. “It’s better if we know about it and we can tell you you’re ok, rather than avoiding potentially life-saving care out of fear or uncertainty.”

During the height of the crisis, clinicians guided some cancer patients to safely take advantage of “bridge” therapies to delay needed surgeries, but some other cancer treatments are so time-sensitive and essential that they were safely treated immediately as needed.

Since March, the ACC has kept almost every appointment for patients receiving radiation therapy, including cutting edge proton treatments at the Roberts Proton Therapy Center. Chemotherapy infusions have continued, and in some practices, patient volumes are higher than ever before. And in the month of April, the first full month of the Philadelphia region’s shutdown, Penn treated more patients with CAR T therapy — a gene-based cancer treatment pioneered and developed at the ACC — than in any month on record.

Safety at Every Step

Just as the initial appointment is often only the beginning of care, safety measures and virtual visits extend to each step of a patient’s potential journey. The Center for Cancer Care Innovation was already working on moving more cancer care into patients’ homes, and COVID-19 has spurred the team to scale up that effort to meet the demands of the moment. The Patient and Family Services group — which offers a variety of programs from support groups to yoga classes specifically geared toward patients with specific cancer types — has shifted its resources online to maintain connections with patients. The feedback has been overwhelmingly positive, and many of these services are now making plans to continue long after the current crisis is over.

All of these lessons also apply to clinical trials. The ACC never shut down its trial infrastructure entirely, leaving studies open to serve both patients already on trials and patients for whom there were no reasonable treatment alternatives. Now, with safety measures in place, the majority of cancer clinical trials open before COVID are open again, potentially with better reach than in the past.

“A lot of the patient monitoring that would have been in person had to switch to telehealth over the last few months, and knowing we can do that may enable us to reach more patients who may have had a difficult time getting to our hospitals for inclusion in these trials,” Shulman said.

The pandemic isn’t over, and safety and protection should still be top of mind for everyone. But even as COVID remains a threat, the people responsible for keeping patients safe continue to learn and improve. And even if cases spike, those lessons will continue to pay dividends as they allow non-COVID patients to get the care they need.

“We have all our tools available,” Schnall said.

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