The following essay by EIPM Member Allyson Ocean, M.D. first appeared in Medium.
Oncologists Are Struggling to Treat Cancer Patients Amid the Pandemic
A diagnosis of cancer is one of the most frightening things a patient could ever receive . Despite great advances made in treatment, early detection, and prevention, patients will often feel vulnerable and lost in a maze of the unknown. And now, in the face of the ongoing coronavirus pandemic, every one of us — the healthy and those with health ailments — also feels vulnerable.
Oncologists rely on data and clinical experience when treating patients… but now, I’m treating my patients in a time of great uncertainty and no frame of reference. I’ve been practicing for nearly 20 years, and I can honestly say this is one of the most challenging times in my career. There is very limited data to help providers in the management of cancer patients confronting Covid-19. We don’t have evidence on appropriate adjustments of treatment regimens and practice patterns — both for the safety of our patients, but also our colleagues and staff.
In just a few short weeks, this pandemic has completely changed my practice. I am still seeing patients two to three days a week in my outpatient oncology clinic. I have not been deployed to the Emergency Room, but I think the call may come in any day now.
Before people started staying home, our office was much busier. People were coming in with many family members, but we soon realized that we had to limit patient traffic in order to contain this virus. Many of my patients had cold symptoms that could have been confused with the symptoms of the virus. It was frightening — mostly because I didn’t know how to proceed. Should I wear a mask? Should I find an N95? But from where? Should I wear a gown? I already was washing my hands excessively, but it just didn’t feel like enough.
When I saw a patient with a fever or a cough, they were quickly taken into an “isolation room” — but it really was just one of our exam rooms. Luckily, none of the patients I encountered early on had Covid-19 so I wasn’t exposed. Or was I?
Soon we were told that some patients and staff developed symptoms and had tested positive. At the end of February, I met with my patient who had just finished chemotherapy for stage 3 colon cancer. About to turn 65, he was thinking about retiring after working in a hospital stock room for nearly 40 years. We talked about what the future looked like for him — how often would he need to see me, when’s the next CT scan, and what else could he do to keep this cancer from returning. He expressed gratitude for everything I had done for him. I loved being able to tell him to start living, and how to live well again. We hugged.
In the middle of March, his wife called to tell me that he went to an outside hospital with Covid-19 symptoms two days earlier, on his 65th birthday. He died the next day.
I was crushed. I didn’t know what to say to his wife. I told her how much I loved taking care of him, and how he would always try to play a joke on me during our appointments. Covid-19 took away this wonderful soul who was about to start living again after cancer.
This virus doesn’t care if you have cancer, heart disease, or diabetes — or whether you are young or old. It’s just a packet of RNA protein, looking for a cell it can infect so it can multiply. We all know the best way currently to fight Covid-19 is through social distancing and rigorous hygiene. But cancer patients who are undergoing treatment, especially chemotherapy, have weakened immune systems. The very medications that may help them live longer also can make them a perfect target for a virus looking for a host. That means that doctors in oncology must devise ways not only to continue to help our patients fight cancer — but also to mitigate their risk of becoming infected.
My patients’ biggest fear is that their cancer will grow and take over. My biggest fear in these next few weeks is that a patient will contract the virus and die very fast, just like my other patient. I tell my patients that they most likely will be okay. Normally my words are pretty reassuring, but not in this time of Covid.
When our patients with cancer leave their homes for chemotherapy or for radiology appointments, they potentially increase their exposure risk. My colleagues and I often ask ourselves, “Should patients risk exposure to coronavirus in order to receive chemotherapy?” We are approaching this on a case by case basis. However, we know that the symptoms of Covid-19 are probably more severe in patients with cancer than those without. We also know that being older (over 60) and having more medical problems (other than cancer) are associated with more severe symptoms and worse outcomes.
But we are not abandoning anyone. Patients are still receiving treatment. Regimens are being modified, more appointments are being done virtually, and, in many instances, we go back to the drawing board and come up with new treatment plans.
For some of my patients who were previously on intravenous chemotherapy, I switch them over to chemo pills if that’s an option. I have changed the length of chemotherapy cycles for other patients — instead of coming in every two weeks for therapy, I extend it to every three weeks. Every treatment decision during this pandemic is made with thorough caution and deliberation.
Another thing to consider: clinical trials. With cancer, these trials not only advance science — but also offer some patients the chance at a longer life… or even a cure. These are being affected as well. Some trials are proceeding, but some have needed modifications. Others have been placed on hold. This may be the most frustrating part. Patients and doctors alike realize that when research halts, progress halts, but cancer can continue to progress.
When my patients ask me what they can during this trying time, I encourage them to participate in a research survey that helps track coronavirus symptoms. Researchers at Weill Cornell Medicine Englander Institute for Precision Medicine have developed a COVID-19 digital survey (right), which is now available in ten languages. I ask them to fill out a new questionnaire every day to help anticipate the progression of coronavirus through the country, and to share it with their family and friends. So far, I’ve heard from my patients that it feels good to help with this, while cancer research is on hold.
In the midst of all of this, I also decided to create a campaign with my friend Jared Zwerling and his basketball media company CloseUp360. We created the “Hoopers Meets Heroes” campaign, in which NBA players remotely interview health care workers and scientists on the front lines. We are aiming to raise awareness about the importance of social distancing and handwashing; support the fight for more personal protective equipment (PPE); and to discuss the latest clinical trials and treatment of this virus. All of this directly benefits the grassroots movement #GetUsPPE, started by E.R. physicians to coordinate these life-saving efforts.
I am so impressed by the heroic efforts of all health care providers during this unprecedented and challenging time.
If you have cancer and are feeling overwhelmed, please reach out to your medical team, social worker, counselor, or advocacy groups dedicated to your disease type. We must support our patients’ emotional well-being during this crisis. An extra call or video visit is a dose of really good medicine. Remember, every day, pandemic or not, we are “In This Together.” Be well and do your best to stay safe.
Dr. Allyson Ocean is a medical oncologist, and the co-founder and chair of the Scientific Advisory Board of Let’s Win! Pancreatic Cancer, an online platform that connects doctors, researchers, and patients with the latest science.
# # #