By Melba Newsome
In the four years since Doris Castevens was diagnosed with lung cancer, she has been a fixture at the Atrium Levine Cancer Center. For all her treatments including surgery, targeted therapy, radiation, chemotherapy and counseling, her husband Joe has been right by her side. That all changed with the arrival of the coronavirus. Castevens went alone to her last chemotherapy session because only those receiving care are allowed inside.
“It’s OK for now that he can’t go with me but if I have my next scan and I get all this shitty news, that will be hard,” says Castevens. “I think that’ll be the case because I’ve got way too much pain for this medication to be working.”
In addition to restricting building access to patients only, appointments that don’t require hands-on care are done virtually.
“We need to make sure that we are able to deliver the treatment they need and be very diligent about minimizing their exposures, especially to something that could complicate their treatments,” said Ed Kim, Levine Cancer Institute medical director. “That doesn’t change whether it is now, a year from now, or a year ago.”
Atrium is not alone in modifying the way it delivers care. Novant Health is also making substantial changes to minimize contact and the risk of infection transmission of COVID-19. This includes expanded visitor restrictions and making telemedicine and virtual visits the primary line of care. According to Novant Health, their providers went from conducting fewer than 1,000 video visits in the previous year to more than 11,000 between March 20 and March 26.
Lung cancer patients like Castevens are of particular concern because they check all the risk boxes: they tend to be older and have compromised immune systems and existing respiratory issues. According to the American Cancer Society, they are not only at greater risk of contracting the virus but any infection is likely to be more severe for them.
“The virus invades the respiratory tract in such a way that people with preexisting conditions such as COPD, asthma or other chronic lung conditions have less reserve and less ability to fight the infection,” explained Jaspal Singh, director of pulmonary oncology at Atrium Health.
The worry about contracting COVID-19 has forced the Castevens to be extra vigilant about social distancing and keeping things clean. Once the center for neighborhood social gatherings, visitors are no longer allowed inside the house.
“I gotta die of something and I know what it’s going to be. I’m working pretty damn hard to stay alive and I don’t wanna die of some other shit,” Castevens jokes. “I would be really pissed!”
Dr. Zosia Piotrowska, an oncologist at Massachusetts General Hospital, cautioned against being overly alarmed since not everyone who has a respiratory illness will succumb to COVID-19.
“Our patients have to be extra careful to keep themselves healthy. We expect symptoms will develop two to 14 days after exposure so that’s the timeframe we watch for,” said Piotrowska.
The treatment model
To lower the risk of infection, Atrium and Novant are delaying any treatment it considers elective or not beneficial but reassures that everyone who needs an appointment essential to their care will get one.
“We are just trying to be safe on our side to make sure we minimize exposure but the reality is that there will be interruptions,” says Kim. “We have implemented a restriction on visitors or family members to be safe as is done in the flu season when kids are not allowed to come to the hospital because of potential exposures.”
Atrium staff calls each cancer patient to see if they are experiencing fever, shortness of breath, chills or other COVID-19 symptoms. “We want to make sure that patients have access to care and that everything — whether it is transfusion, chemotherapy, radiation or testing– we want to do it in a safe manner,” said Kim.
Change in treatments
Medical professionals caution that the unprecedented nature of this pandemic makes it difficult to issue blanket statements of advice for all cancer patients because treatment decisions must be individualized.
“We know that everyone’s medical visits are urgent but if, for instance, you have completed treatment and are coming back for a three- or six-month follow-up, that’s something we can definitely push off because the risk of exposure to other potential people who may have the virus or contact with it outweighs the need to come in at that moment,” said Kim.
Oncologist and Lung Cancer Foundation of America spokesperson, Edward B. Garon, says he factors in the age of the patient and the anticipated benefit of that intervention when making treatment decisions.
“I’m more likely to pause treatment in a patient who is older,” he explained. “Patients who have an earlier stage disease may still be curable by surgery or other modalities. In the case of a new diagnosis, particularly of advanced disease when we know that without any treatment the disease course tends to be quite aggressive, it’s very important that the patient get the appropriate management for that [right away].”
The American Society of Clinical Oncology (ASCO) recommends that cancer patients contact their doctor if they meet any of the following criteria:
- have a fever and other symptoms of respiratory illness, such as a cough or shortness of breath;
- have been in close contact with a person known to have COVID-19; and
- live in or have recently traveled to an area known to have an outbreak of the disease.
“The infection prevention piece is extremely important,” says Singh. “Avoid large social gatherings, make sure there is good hand hygiene, and maintain social distance. Maintain your physical, emotional and spiritual health so that when infection comes you’re best prepared to fight it off.”