Caring for Cancer Patients in This New Normal

Mark G. Kris, MD


June 23, 2020

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This transcript has been edited for clarity.

Hello. This is Mark Kris from Memorial Sloan Kettering Cancer Center.

Now that COVID-19 is becoming more of a new normal, it is time to start shifting our emphasis back to what we actually do, which is to provide oncology care. The need for oncology care never went away, even with the spikes in the number of patients with COVID-19.

As we start to reintegrate patients who have recovered from COVID-19, it is important to ensure that their medical record shows previous COVID-19 infection and recovery, and that the infection precautions are removed so that they can continue their care. I also encourage you to pay strict attention to your institutional and state guidelines to ensure that they're carefully followed.

In thoracic oncology, a lack of operating room space has led to a backlog of patients who could have curative surgeries but have been unable to. Our surgeons have worked hard to see patients virtually and to prioritize them, but everybody's been stymied by simply not having the operating room space that was available in January. As medical oncologists, we have to work with our surgical colleagues to support our patients. This includes patients for whom we need to determine when neoadjuvant therapy might be appropriate for them. And for patients who have completed neoadjuvant therapy, we must determine how to get them to their planned surgery as quickly as possible. As the restrictions ease, I hope that we'll be able to open up more operating room time.

I know we're not seeing patients, but we need to maintain contact. That's really the message here: Maintaining care is essential. The truth is, even though we have fewer visits, the additional stress and complications brought on by COVID-19 require us to spend even more time with our patients, and we need to find creative ways to do it. There are a couple of simple things to keep in mind.

I don't cancel any appointments now. That is the wrong thing to do and sends a bad message. It increases the distance between patients and their care team. While I do not see patients face to face as we did before, I do see them virtually via telemedicine visits. Whenever possible, we should substitute video for that face-to-face interaction.

We try, whenever possible, to continue treatments on schedule. There is a pact between patients and their care teams about what treatments are appropriate, and I urge you to stick to what you have mutually agreed upon as much as possible. You can minimize contact during on-schedule treatment in a way that both limits the patient's exposure to the staff and limits the staff’s exposure to the patient. You can also conduct a televisit while the patient is in the treatment area.

Patients need our attention and more explanation now. In addition to their cancer, there is this deadly infection that they and their families are facing.

Last, we can't forget the significant others and families of our patients. We've always relied on them being there with the patient so that when we explained something to, or had a discussion with, a patient, they were there to listen and share their thoughts. We don't have that now because, more often than not, a family member cannot accompany a patient for their treatment visits or into the hospital. We need to ensure that families are included in these very tough discussions.

With COVID-19, we need to find ways to maintain contact with patients and the intensity of the relationships we have with them, all without direct contact. But it's going to take some work.

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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