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Cancer Care in the Time of COVID

July 6, 2020

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Community Conversation: Dr. Eric Whitman

With the spring of 2020 ending, the restrictions and lockdowns caused by COVID-19 are being lifted. For many of us, however, life still does not feel normal.

Eric Whitman, MD, medical director for Atlantic Health System Cancer Care, stressed during a “Community Conversation” on Facebook Live held on Wednesday, June 3, that he understands the comparison of risks to benefits that people make regarding their health care during the COVID-19 pandemic. He knows that decisions to seek treatment are personal. Especially for people with compromised immune systems, as many oncology patients have, COVID-19 poses real risks.

But, he explained, “it's important to know that our facilities at Atlantic Health are taking every possible precaution to be safe. Not just in the usual way, and not just wiping down, but testing everyone. Making sure that people are COVID-19 negative, that they’re not infected when they come in. Making sure that all the machinery and everything is clean. Making sure that the people around them in the room are okay.”

For routine screenings, Dr. Whitman said he hopes that patients aren’t avoiding care but are having conversations with their physicians to determine a timeline. COVID-19 must still be reckoned with, but preventative measures, such as physical distancing and increased sanitation, have proven effective. However, he says, while we’ve taken time to adjust our lives to this new normal, cancer has not taken a holiday.

For both ongoing treatment as well as new masses or other symptoms of possible cancer, Dr. Whitman believes that the risk-benefit analysis of care has shifted away from avoidance. We must still be aware of the threat of COVID-19, he said, but not to the point that cancer care is neglected. 

“Coronavirus … seems to be fading right now. We’re still taking precautions obviously, but cancer’s not going to play by that rule. Cancer is going to be there. And unless it’s treated, it will continue to progress to the point where it can hurt you.” 

Every Case, Every Cancer, and Every Situation Is Different

While all cancers are concerning, some types are more urgent than others. Some patients can wait a few weeks or a month for treatment and their prognosis won’t change.

For others, however, weeks can be life changing.

For those still hesitant to come to the hospital for treatment, having a discussion with their physician is the most important thing. “Reach out to your doctor,” Dr. Whitman advised. “Talk to them, in a very concrete way, about the risks and benefits of continuing treatment … about how safe it is to come in and have a procedure, versus how important the procedure is to have.” Discuss recommended treatments and how the timing fits within the pandemic.

“Patients develop quite a powerful relationship with their caregivers or with the team that is assigned to help them on this journey, this fight against cancer. Those relationships are powerful, and patients and providers can have those open conversations and that can be an effective way to get people over that trepidation,” Dr. Whitman said.

In the past months, Dr. Whitman saw that most patients “wanted treatment, but they also wanted to feel safe.” But, because of the threat posed by COVID-19 to cancer patients, new standards in prevention were needed. “Most of our cancer patients wanted to come in. They wanted to be safe, so we have to provide a safe environment.”

The New Normal: A Raised Standard of Prevention

“I can’t say enough about the team – the staff, the nurses, the people at the desk answering phones.” With obvious pride, Dr. Whitman said that everyone at Atlantic Health System is involved in preventing the spread of COVID-19.

New standards “start at the front door. We screen people who are coming in to make sure no one is obviously sick, with fever, or recently exposed.” This applies to both patients and staff.

Atlantic Health System has also limited the number of people in its waiting rooms, and the number of visitors that patients can bring. And that’s been hard. Oncology waiting rooms tend to be larger than in other hospital wards because patients tend to bring entire support networks. “People come in with whole entourages,” Dr. Whitman mused. “They want more ears to hear, and more questions answered.”

Because the number of visitors has been limited to help combat the spread of COVID-19, Atlantic Health System has embraced new technologies to help patients feel that they are heard, and that their doctor is available. Conference calls, three-way calls, live video chats, and other remote technologies have all become standard care, and every effort is made to include a patient’s support network while still keeping the hospital and its staff and patients safe.

“It’s a new thing,” said Dr. Whitman. “but it’s actually really good. I think there are some ways that as doctors, not just cancer doctors, I think there are some opportunities in this whole coronavirus pandemic that we can be better.” In Dr. Whitman’s mind, the pandemic has shown him and others how new technologies can help with the basics of health care – communicating with patients “what you’re doing and why.”

To help combat COVID-19, on top of increased physical distancing, Atlantic Health System has upped its sanitation regimen. “We always cleaned the rooms … but now it’s more thorough. We’re cleaning every surface. We’re wearing masks and washing our hands like crazy. Of course, we’ve always done that, but we’ve taken it up a notch.”

COVID’s Effect on Cancer Patients

Drugs, radiation, and surgery can all negatively affect the immune system, and so all increase the chances of contracting disease. But with the right measures, COVID-19 can be largely prevented, he said.

An area of concern, however, is with lung cancer patients. Because of the effect the novel coronavirus has on the lungs, lung cancer patients are at an increased risk of complications. “Because we know that coronavirus can really attack the lungs and that’s what people get very sick from initially, the pneumonia.”

Looking on the bright side, Dr. Whitman said, “One good thing is that cancer patients on chemotherapy knew they were immunocompromised.” They, and their family and friends, were wearing masks and washing their hands “before wearing masks or handwashing was popular. They were used to it.” 

COVID’s Effect on Research

Research has always been an important facet of cancer care. As with so many other things, however, COVID-19 has had its effects there as well.

Dr. Whitman reported that, at the height of the pandemic, some cancer research programs stopped enrolling new patients. There were concerns about the potential interaction of unknown treatments and the new virus, as well as for the well-being of caregivers.

Atlantic Health System, however, has continued as much of its research as possible; a current trial or a new discovery could become the difference between life and death.

To Dr. Whitman, the most exciting studies are those that combine different methods of treatment in very specific, mutually beneficial ways. One therapy may, for example, boost the immune system so that it’s better able to fight cancer cells. At the same time, another therapy will target the cancer cells with a treatment that allows the immune system to more easily see it as a threat. Essentially, the body is given a stronger weapon against an easier target.

When the Game Changes, It’s Back to Fundamentals 

The novel coronavirus has been game changing, Dr. Whitman said. It’s changed the way medicine is done, the standards of disease prevention, and the expectations patients have when they come to a medical facility. In the face of that, Dr. Whitman is reminded that the most important thing in health care is good communication with his patients. And the silver lining he looks at is how this virus has taught the industry to use modern technologies to facilitate better communication. 

In part, because of the preventative measures taken by the health care industry, and in part due to the social distancing applied across entire communities, the threat of the pandemic has lessened. People now should start thinking again about preventive care – their screening mammograms, colonoscopies, PSA and other blood tests.

While precautions against COVID-19 should still be taken, getting back to normal measures of care is important. “These are things,” Dr. Whitman stressed, “that could affect your longevity for a long time, not just over the next few months.”