COMMENTARY

Don't Let COVID-19 'Distract' You From Your Cancer Care Efforts

Mark G. Kris, MD

Disclosures

June 09, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

This is Mark Kris from Memorial Sloan Kettering Cancer Center, with some practical suggestions for taking care of patients with advanced cancer during the COVID-19 pandemic.

First and foremost, do not let this pandemic distract you from your efforts to care for patients. While COVID-19 cannot be ignored, it can be managed like anything else. In oncology, we are used to managing complications; we find a way around them to continue care.

For our patients, treating cancer is their greatest concern. COVID-19 is, of course, a grave concern, but it's probably number two to cancer for these patients. It's also a concern to them from their family's point of view and from their interactions with other people.

Who and When to Test

In regard to testing, I'm not an infectious disease expert, but I urge everybody to follow the COVID-19 testing standards for their institution and their state, and from the CDC. I think that's the best advice we have, and it keeps changing.

For a patient who has symptoms but is not ill enough to require a medical evaluation or hospitalization, the recommendation is that they stay home and stay in contact with their healthcare team. They do not necessarily need to be tested.

But who should be tested? I'll tell you about some of my experiences where I think the tests have been helpful.

One was a patient who had a family member who was a healthcare worker. Although that patient had mild symptoms capable of being cared for at home, the concern was whether it was COVID-19 and possible exposure to that patient's partner, also a healthcare provider. It made sense to test that patient. We tested, and the result was negative.

Another one was a patient in need of home care services. The home care agency asked that COVID-19 testing be done because patients with advanced lung cancer may have a cough, be feeling poorly, or have malaise or fatigue, which are symptoms that could be consistent with COVID-19.

Additionally, there are people who develop COVID-19 by exposure to asymptomatic or minimally symptomatic carriers. That is always a possibility. If you're going to be reaching out to bring other healthcare providers into somebody’s home, you're probably going to need COVID-19 testing for your patients with advanced cancers.

The other thing is that COVID-19 testing is being requested for those patients who are being scheduled for procedures within institutions. Because all of our patients have coughs and are feeling poorly, they need to be tested. Be ready for that, and advise patients that they're going to need to be tested and get that done. Don't let that testing get in the way of the procedures that have been mutually agreed upon by you and the patient to move forward.

The Art of Practicing Medicine

I'm amazed how our patients are so grateful for what we, as healthcare providers, are doing. I cannot tell you how many times, at the end of a conversation, a patient turns to me and says, "How are you? I don't want you to be sick, Dr Kris. I need you. How is your family doing?" Despite all their concerns, it's unbelievably heartwarming to hear them being concerned about me.

The Hippocratic Oath is one of the things that we agreed to when we graduated from medical school. I recently heard a statement from the modern Hippocratic Oath that I thought was really applicable to COVID-19: "I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug."

I think these words can be no truer than they are today. There is no knife. There is no drug, although there will hopefully be one for COVID-19. For now, we have to use the other things that we pledged to do at that medical school graduation.

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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