During the height of the 2019 coronavirus disease (COVID-19) pandemic in New York City, some people who needed cancer care delayed treatment while others avoided hospitals and doctors’ offices despite concerning signs and symptoms.
At NYU Langone’s Perlmutter Cancer Center, a National Cancer Institute–designated Comprehensive Cancer Center, our specialists continued to perform critical procedures and provide treatment. All Perlmutter Cancer Center and NYU Langone locations made changes designed to keep patients, providers, and staff safe, including testing patients for COVID-19 before procedures and minimizing in-office visits, as well as supercharging cleaning protocols.
Even as the number of COVID-19 cases have dramatically declined since the peak in April, people are waiting to seek time-sensitive care and foregoing routine screenings for cancer. Screenings such as mammograms and colonoscopies can identify those at high risk and detect cancer in its earliest stages, when there is a greater chance of successful treatment.
Benjamin G. Neel, MD, PhD, director of Perlmutter Cancer Center, emphasizes that no one should put off cancer care. “Delaying your screening or treatment can be a significant risk to your health. We are following strict protocols to continue to safely provide screenings, diagnosis, and treatment for cancer, and keep our facilities safe for all,” Dr. Neel says.
Patient Safety and COVID-19 Screening
Every patient is screened for possible COVID-19 symptoms as soon as they arrive for an appointment. Those who may have COVID-19 symptoms are evaluated further by a provider. Patients who are scheduled for screening or treatment are also tested for COVID-19 before their procedures to protect other patients and staff, and to ensure they get the care they need.
Visitors are now allowed to accompany patients to appointments, and they also have their temperature taken at the front door. Waiting areas in many locations have been redesigned to facilitate social distancing, and the number of patients inside is being limited at all times. “We are well prepared, and our patients should not be afraid to come in for treatment. Our physicians and staff are here to address your concerns and provide more information,” says Dr. Neel.
Video Visits and Suspicion of Cancer Virtual Clinic
To limit exposure to COVID-19, patients are being offered the option of a video visit for routine follow-up appointments. Doctors are also doing video check-ins with patients a day before infusion or chemotherapy treatments to confirm that they don’t have any COVID-19 symptoms. “While we like to be able to have patients come in and see us, for their own safety we want to minimize in-person visits and minimize their contact with others,” says Michael L. Grossbard, MD, section chief of hematology.
In addition, Perlmutter Cancer Center’s Suspicion of Cancer Virtual Clinic allows new and existing patients who are concerned they may have symptoms of cancer to schedule a video visit with a nurse practitioner. The provider can assess a person’s risk and help guide them on next steps, such as scheduling a follow-up video visit with a cancer specialist.
Modifying Cancer Treatment Protocols
Our doctors consider the potential risks and benefits of each person’s treatment plan, including possible exposure to COVID-19 when traveling for testing or procedures. A multidisciplinary team of surgeons, medical oncologists, and radiation oncologists works together to tailor treatment for each patient and ensure it is administered in the safest way possible. For example, chemotherapy can be prescribed as an oral medication instead of infusion when possible, or the dosage can be adjusted to reduce the frequency of visits for treatment.
“We are very thoughtful about our approach and how we advise patients about their treatment, especially during this pandemic,” says Eva Chalas, MD, physician director at Perlmutter Cancer Center at NYU Winthrop Hospital. “A patient who has ovarian cancer is likely to need chemotherapy as well as surgery. For such a patient, our approach would be to start chemotherapy first, prescribed in the form of an oral medication, and plan their surgery after chemotherapy.”
If a patient who is receiving treatment develops COVID-19, experts recommend temporarily pausing or waiting to start cancer treatment when that approach is unlikely to affect outcomes. “For patients who test positive, we don’t begin treatment or continue treatment for a minimum of 14 days from the resolution of symptoms,” says Abraham Chachoua, MD, chief of medical oncology.
If a family member of the patient in treatment tests positive for COVID-19, experts recommend waiting for at least 7 days to make sure no symptoms develop. “There is no one-size-fits-all approach. It depends on how critical it is for a patient to receive chemotherapy right away or if it can wait. We can test the patient for COVID-19 before we resume treatment,” Dr. Chachoua says.
For patients who are in treatment and do not have COVID-19, the team weighs the risks and benefits of each type of treatment and sometimes recommends modifications. Chemotherapy can weaken a person’s immune system and make them more vulnerable to the virus, so if doctors determine that chemotherapy is necessary, they may prescribe antibiotics and other medications to help boost the immune system.
Patients who are receiving immunotherapy may face a different set of considerations. Immunotherapy doesn’t weaken the immune system—it has the opposite effect. “COVID-19 tends to elicit an exuberant immune response, which is also what immunotherapy does. Both can lead to lung inflammation,” says Jeffrey G. Schneider, MD, division director of hematology–oncology at Perlmutter Cancer Center at NYU Winthrop Hospital. To avoid extensive lung damage, experts follow specific guidelines for administering immunotherapy, in case a patient develops COVID-19.
“All our physicians are monitoring the latest peer-reviewed guidelines relating to COVID-19 on a daily basis to ensure that we are making the best treatment decisions for our patients,” Dr. Neel says.