Stay the Course With Cancer Care Even During COVID-19

Mark G. Kris, MD


June 02, 2020

This transcript has been edited for clarity.

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Hello. This is Mark Kris from Memorial Sloan Kettering.

I'm speaking today about the extraordinary times that we find ourselves in, trying to cope with the COVID-19 crisis and yet maintain care for people with cancer.

I'm a thoracic oncologist. My practice is almost entirely composed of patients with advanced stages of lung cancer and who are getting chemotherapy, immunotherapies, or targeted therapies. Even though things are different now than they were a few weeks ago, one thing that hasn't changed is what our challenge is—to look at the COVID-19 pandemic as just one more complication for our patients who are battling lethal cancer. Like any other complication, we cannot let this complication derail the plans that we have put in place with our patients. Whatever goals that we have set to achieve, they are still the same; we cannot change them.

How can we achieve those goals? How can we put into place the strategies that we have proposed to our patients and that we have mutually agreed to pursue? How can we do that with this new complication? We can and must change the logistics. Operationally, it's kind of like another febrile neutropenia, a potentially deadly complication that could put a stop to treatment. We learned to deal with that, and we will have to learn to deal with this. We have to find a way to get through it without abandoning our patient care goals.

First and foremost, and even more than we have in the past, we must keep those goals in mind and listen to our patients. I would be very careful about making blanket decisions right now (eg, we should postpone everyone's chemotherapy by 2 weeks, we should postpone every follow-up visit by a certain amount of time). I urge you to let these decisions be made on a patient-by-patient basis. Some are comfortable with a postponement; for others, it's an absolutely devastating situation to deal with. You have to understand where the patient is, and you have to try to deal with that.

We also have had to think more about limiting our face-to-face time with patients. Patients need to limit their contact with staff. Unfortunately, we are potential carriers of this virus. I would state that we are at a higher risk for carrying it because of the number of people, including sick people, we see. Clearly, COVID-19 is in our institutions, and we are exposed to it. Of course, our patients could also have COVID-19, so we have to try to carefully cut down on the risk to our staff. We're no good to our patients if we're home sick with COVID-19, even if it's just an exposure that's going to lead to recovery. It still knocks us out of the healthcare system for 1-2 weeks at a minimum. We can't afford not to be there for our patients. We also can't afford to make our patients sick.

As you try to limit the visits, think about what is the most critical thing. The most important thing for my population of patients is the treatment. Patients are very concerned whenever their treatments are postponed or delayed.

Now, I think we have much more latitude in limiting testing. Many of our conventions about when testing is done, such as after one cycle, after two cycles, or after 3 months, are not evidence-based. It is usually the interval that is based on the cycle length of the treatment. It's also the interval that was used for the scanning and clinical trials. And although it's a good rule of thumb for choosing the interval for scanning, it's not necessarily the answer as to exactly what is the proper one.

If you have a patient who is tolerating treatment well by whatever criteria you like, where the patient is not telling you that there is something amiss, that there is some change in their condition, or that there is some concerning symptom that needs to be evaluated, I will say that would be a patient not to bring in for a scan. Everybody wins by doing that. Patients are not brought to a healthcare facility for extra testing. Healthcare workers are not exposed. The test slots are left for those patients who are having a symptom or have a critical situation where testing needs to be done.

The key message here is that it's not business as usual. In the same way that you would use the utmost precision in choosing a therapy for one of your patients with advanced cancer, you need to use that same precision in deciding on whether or not to have a visit and how to conduct that visit.

Mark G. Kris, MD, is chief of the thoracic oncology service and the William and Joy Ruane Chair in Thoracic Oncology at Memorial Sloan Kettering Cancer Center in New York City. His research interests include targeted therapies for lung cancer, multimodality therapy, the development of new anticancer drugs, and symptom management with a focus on preventing emesis.

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