COMMENTARY

How COVID-19 Is Already Changing Cancer Care

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

March 24, 2020

This transcript has been edited for clarity.

Hello. I'm David Kerr, professor of cancer medicine from University of Oxford in England. Today I'd like to talk about oncology in the time of this coronavirus pandemic.

I've just come back from clinic. We've had some top-down pressure, I think appropriately, for us to reduce the number of outpatient appointments in our hospital. Because of that sense of patients "herding" together, thinking about social distancing seems important. We decided that, for the patients who have to come for chemotherapy, obviously we will see them in clinic face-to-face. We also want face-to-face appointments with new patients, who I still like to physically examine regardless of CT scans and so on. But half to almost two thirds of our patients are on long-term follow-up, or they are on follow-up and due chemotherapy next week, that sort of thing—an in-between chemotherapy check.

So I sat in a quiet room and phoned about 20 of these patients. We had warned them that we would be doing this; we prepared them for it. Some of them were getting the results of CT scans, so we explained that we would be breaking news, with the remote possibility of bad news if the scan had shown tumor recurrence. All of the patients agreed and were very keen to accept our offer of that telephone conversation. It worked incredibly well. We had a timetable; patients were expecting me to call them at such and such a time. That all worked perfectly; everyone was available. And the conversations flowed quickly, effectively, and clearly. I didn't have to break any bad news.

This coronavirus outbreak will change forever the way people practice medicine.

I've been a doctor since 1980, but nevertheless, I do things in the way that my colleagues from 19th century medicine would do them in terms of follow-up and so on, and I haven't ever challenged it. I know we're embracing the digital age and modern technology—we just had a publication in The Lancet about our work using digital pathology and artificial intelligence to come up with a brilliant new prognostic marker for colorectal cancer—so I'm doing all of that, but this experience was rather revelatory. I learned that we could hugely reduce the amount of in-person follow-up through our department just with thoughtful, planned telephone conversations—not even a video link. So I believe that this coronavirus outbreak will change forever the way people, certainly oldsters like me, practice medicine. That's one good thing.

The second thing is more complicated. I often talk about all of us being part of our global community—that the cancer community is like a village in which we share data and information, in which we work together, with those from the North, South, East, West, and so on. The coronavirus outbreak is challenging that model of transnational cooperation. I know that many of my colleagues in Europe are beleaguered. I have many friends in Wuhan, so I know about the extraordinary steps the Chinese government has taken to control the epidemic. For example, they moved tens of thousands of doctors into Hubei province. I have friends who work in Huaxi Hospital in Sichuan who were moved into the city of Wuhan to help deal with the crisis. So there was an extraordinary public health effort from China on behalf of their own citizens first and foremost, and on behalf of the rest of the world.

In the United Kingdom, we are in the early stages of the epidemic and we're beginning to enter the foothills of the exponential phase. But it seems to me that governmentally, each of us is doing our own thing. We haven't shut down schools. (Editor's note: Schools were shut on March 23). We haven't as yet, but soon will, ban large public meetings, sporting events, and such occasions. (Editor’s Note: As of March 23, public meetings of more than two people are not allowed). To date these have been self-canceling. But it seems to me that the world is at its best when we come together, when governments—whether the G20 or the United Nations—share data, share a concerted approach. This feels more like every country for itself, closing barriers, looking inward, slowing down.

The scientific community hasn't done that. We are incredibly grateful to Chinese colleagues who sequenced and published the genetic sequence of coronavirus as soon as they had it. There was no secrecy, everything was put out there to aid the global effort to find vaccines and so on. The last time I remember us coming together was a fiscal disaster, the great recession of 2008, and governments genuinely did work together then.

There is no doubt that the coronavirus will have an enormous effect on the global economy, but even there I don't see any sense of governments coming together, asking how we might handle and push this together. Instead we have barriers being raised rather than lowered. I don't think we can say that it's necessarily the rise of populism, but if governments' first duty is to protect citizens, it may well be that when these pandemics occur, when panic sets in, the first thought is to put barriers up rather than to think how can we work together.

I'd be very interested in what you think, and post any comments online. For the time being Medscapers, thanks, as always. Over and out.

Dr David J. Kerr is a professor of cancer medicine at the University of Oxford in Oxford, England. He is recognized internationally for his work in the research and treatment of colorectal cancer, and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth.

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