Navigating medical care is challenging for many people during the 2019 coronavirus disease (COVID-19) pandemic. But it can be daunting for those who need cancer diagnosis and treatment.
The pandemic has intensified the uncertainty and anxiety surrounding cancer care. Patients may be wrestling with dueling concerns: how to proceed with diagnosis and treatment without putting themselves at greater risk of contracting the virus. For some, those fears may lead to delays or disruptions in care with lasting consequences.
Benjamin G. Neel, MD, PhD, director of NYU Langone’s Perlmutter Cancer Center, emphasizes that no one should put off essential cancer care during the pandemic. “We can continue treating you even if you are diagnosed with COVID-19. We would modify the treatment protocol, but we can provide treatment with the necessary safety precautions,” Dr. Neel says.
Doctors at Perlmutter Cancer Center, a National Cancer Institute–designated Comprehensive Cancer Center, continue to perform surgeries and are preparing to resume diagnostic tests, such as CT scans and mammograms. And to ensure the same high level of care while maintaining patient safety, they are swiftly transforming standard procedures and treatment protocols. Dr. Neel and other physicians discuss how they are providing cancer diagnosis and treatment during COVID-19.
Patient Safety and COVID-19 Screening
For the safety of patients and healthcare providers, staff at all Perlmutter Cancer Center and other NYU Langone locations are taking steps to make your doctor appointment or hospital stay as safe as possible.
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 surgery, chemotherapy, or radiation 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 not allowed to accompany patients to appointments at this time, unless our clinical staff determines it is medically necessary. Waiting areas in many clinics have been redesigned to facilitate social distancing, and the number of patients inside a clinic 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 happy to help 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 has started a Suspicion of Cancer Virtual Clinic, which 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
Perlmutter Cancer Center doctors consider the potential risks and benefits of each person’s treatment plan, including possible exposure to COVID-19 when patients travel 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 delaying cancer treatment, when possible. “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.