The COVID-19 pandemic has had a profound impact on cancer care delivery in the United States—for the worse, but also for the better. Although access to high-quality care has certainly been compromised, the pandemic has also driven innovation, according to information presented at the 2020 ASCO Quality Care Symposium by experts who discussed recent healthcare transformations from the perspectives of community oncology and a larger healthcare system.
Community Oncology Perspective: Transforming Fear
Vast differences exist among individual community oncology practices, including hospital systems and health resources, said Ray D. Page, DO, PhD, FACOI, FASCO, President and Director of Research, the Center for Cancer and Blood Disorders, Fort Worth, TX.
“Each location is culturally different, and the social determinants of health are unique,” he emphasized. “Therefore, optimizing protection of the vulnerable from COVID-19 for each population in the practice environment is extremely challenging.”
Despite these challenges and the great concerns about the novel coronavirus that gripped his organization in the early days of the pandemic, Dr Page and colleagues have used data to “transform fear through prudence,” relying on policies and laws that advocate for social distancing, face masks for all, handwashing, and use of far-ultraviolet C light to guide infection prevention for patients and staff.
“I can’t stress enough the importance of continual patient and staff education through any method possible,” Dr Page said. He expects cancer centers to be among the last of all healthcare facilities to return to “normal,” even when other medical specialties may relax their policies sooner.
Although access to care has improved since the start of the pandemic, said Dr Page, delays in surgical procedures; cancer treatments, including radiation therapy; and diagnostic testing have been very real and had a “detrimental impact on our cancer patients.”
“Patients with symptoms, in the community, were not seeing their doctors, and most community oncology practices had greater than a 25% reduction in new patient volume between March and July,” he said.
Telemedicine, however, which emerged “virtually overnight,” he said, has helped to increase access for all patient populations, especially for patients living in rural areas. Establishing oncology-related standards and policies for this technology, which could continue to be implemented after the crisis, will be important for these populations.
Providing avenues for morale and support at the practice level is also crucial, as physicians and staff have in recent months reported increasing apathy and disengagement, exhaustion, cynicism, and even moral distress.
“We can protect our most vulnerable, while still providing quality cancer care,” Dr Page concluded. “Remember to focus on the mental health and well-being of our patients and staff and colleagues.”
Health System Perspective: Oncology Leading the Way
Inga T. Lennes, MD, MPH, MBA, Senior Vice President, Ambulatory Operations and Patient Experience, Massachusetts General Hospital, Boston, explained that successful response to the COVID-19 pandemic has required agility and creativity, along with enormous effort from thousands of healthcare staff.
“COVID-19 has operationally transformed healthcare,” said Dr Lennes. “The amount of transformation within the hospital system is almost too much to discuss in this short amount of time.”
Nevertheless, Dr Lennes highlighted the rise of virtual care, which increased from representing only 1% of all ambulatory care at her institution before the pandemic to more than 40% after the COVID-19 surge.
“At its peak, we were delivering more than 80% of ambulatory care virtually,” she said.
For patients with cancer, Dr Lennes and colleagues also developed a clinic called the Routine Ambulatory Care of COVID-Positive Patients.
“It became clear very early on that we had to be able to see and care for patients with cancer who had suspected COVID-19 or even COVID-positive status,” said Dr Lennes. She noted that the clinic and infusion space is hosted by the cancer center, but it is available to all patients within the health system.
The clinic is staffed by 5 cancer advanced practice providers and 2 registered nurses who primarily see patients with cancer, but also support patients from across the organization. More than 600 patients with cancer have tested positive for COVID-19 so far within the health system, said Dr Lennes, and up to 12 COVID-positive patients are infused each day in their infusion center.