Cancer Patients Are Concerned About Cancer, Then COVID-19

Mark G. Kris, MD


April 03, 2020

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This transcript has been edited for clarity.

Hello. It's Mark Kris from Memorial Sloan Kettering. I'm speaking today from my home because I'm isolated and working from home by the request of my workplace. I know many of you are probably in the same position.

I want to speak about the treatment of people with cancer in this era of COVID-19. It's an absolutely extraordinary time and it's fair to say that there is no precedent for exactly what's going on now. What's most unprecedented to me is that the rate of change every day is different, and frankly, every part of the day is different and will remain so.

It's given physicians a huge responsibility to stay current, and it's a whole new world with things changing so quickly. Obviously, it's a huge concern for all of our patients and their families. They already are facing a cancer concern. One thing that I want to focus on today is that for them, COVID-19 remains a possible concern; however, cancer is a definite concern.

The outcomes of cancer, particularly the advanced thoracic cancers like the ones I deal with, are very severe. The outcomes are sadly well known, and for our patients, they face these outcomes. In some ways, COVID-19 is an additional concern, but their main concern remains cancer.

Last weekend, the nurse I work with did the triaging for our institution and answered calls from patients and families. When she finished that weekend of triaging, I said to her, "Well, you must be sick of talking about COVID-19 with everybody on the phone."

She said, "The patients calling into our facility were not asking about COVID-19. They were asking about cancer and the complications of their cancer."

I found that very sobering and grounding because that told me what our patients are really interested in. Please remember that cancer remains their chief concern.

Our job just became much harder. With all the concerns we've been trying to deal with throughout our whole cancer careers, we suddenly have a post on the concerns, uncertainties brought on by COVID-19, for us personally, our friends, family, the staff we work with, and our patients. Our job really has gotten harder.

I urge you to think about how when somebody with cancer is speaking to us, their first concern is cancer and we need to stay focused on that. Now we have to consider how COVID-19 could impact their concerns on cancer. One piece of advice is to think about cancer first, and then think about how COVID-19 impacts that person's cancer. That's where their heads are at, and that's where our heads should be at too.

One thing we need to do now in this very complicated situation is to try to limit the distractions that we face. I know that there are constantly emails flying, text messages flying, and flashes from health alerts and health authorities. We need to put them aside for the patient.

If your institution is anything like mine, we have been asked to make our visits shorter and less frequent. It's incumbent on us to work as hard as we can to focus on the patient, eliminate the distractions, and make sure we address the needs of our patient. When all that's done, we have to layer on how COVID-19 affects their lives and how we are going to advise patients.

Please remember, at least for those of us who deal with thoracic cancers, that by the nature of our illness, everybody's at high risk for COVID-19. Our median age is over 70. A huge proportion of our patients have a prior history of smoking, COPD, and other smoking-related illnesses. So indeed they are high risk, but frankly, they're not at higher risk than they are from their cancer, which already puts them at a horrible high risk for threats to their health and their life.

Please remember that cancer and its consequences remain the chief concern of our patients, and it should be our chief concern as well. As we learn each new thing about this illness, we need to always put it into the context of cancer and make sure we answer our patients' concerns about cancer first, then how COVID-19 impacts upon their cancer and their cancer concerns.

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