Cancer Care During COVID: It's Been a Mixed Experience

David J. Kerr, CBE, MD, DSc


November 18, 2020

This transcript has been edited for clarity.

I'm David Kerr, a medical oncologist and professor of cancer medicine at the University of Oxford.

We're about to enter another national lockdown in the United Kingdom, and I'd like to talk a little about how we're delivering cancer services at our institution during this time of COVID-19.

Throughout all of this, we've managed to maintain delivery of our chemotherapy services. We did so because we have a fantastic, wonderful, dedicated, frontline, nurse-led chemotherapy unit. Those wonderful health professionals have continued throughout to deliver the same high-quality service that we do in times of thick and in times of thin.

We have fantastic pharmacy back-up, and the laboratories are working. Of course, our patients have been careful and dutiful and have done that which we've asked them to do in terms of self-isolating, protecting themselves, and so on.

We modified the chemotherapy regimens somewhat. We've reduced intensity and we've switched, where we can, from intravenous to oral. For older patients, we have further modified the intensity of chemotherapy. In some cases with adjuvant chemotherapy, I believe there's a 3-month window from the time of surgery in which we can deliver it. We have perhaps been a bit more flexible in terms of when we will initiate adjuvant treatments. All that technical stuff has been part of it.

Psychologically, I sit here at my kitchen table. This is where I've been delivering our clinics. We speak to 30 or 40 patients every Friday. We have our multidisciplinary team conferences done over Zoom. I'm running my laboratory group via Zoom. We've just been allowed back into the laboratories at the University.

I'm lecturing. I've given about a dozen virtual lectures, all recorded in Zoom, in places as widespread as Shanghai, Chengdu, Riyadh in Saudi Arabia, South Africa, France, and on and on. In some ways, our virtual life has continued, in a way, unabated.

Psychologically, patients quite like this. It saves them the hassle of coming up to our chemotherapy unit and queuing for an hour to get access to our hopelessly restricted car park. It saves them taking a day out of their lives. It keeps them out of hospital at a time when citizens see hospitals as being a focus of COVID-19 infection. We thought that breaking bad news would be extraordinarily difficult, but we're managing, as are our patients and their families.

The request for face-to-face meetings accounts for perhaps 5% of our clinical workload. The vast majority of our patients are very happy for us to speak to them by telephone or using Zoom and video recordings.

It's been funny for us, though, in terms of how we go about things. It's been quite difficult for us to adapt, I think, because we're spending prolonged periods of time missing our colleagues, in a way. Although we've kept Zoom and other meetings, it's fairly compartmentalized. I think we miss the day-to-day interaction.

I don't think I have been as thoughtful or as innovative as I normally would be. I like the process of bouncing ideas off others. I think that's limited by Zoom. Our Zoom calls tend to be businesslike, functional, and target-oriented. They're not places that one could brainstorm or bounce new ideas around. I miss that quite a lot.

It will surprise you — all of you, I would have thought — that I'm in my sixties. I know I look a decade younger. Even though I've got two wee tiny children, who are a constant source of germs, colds, infections, and so on, I'm one of that group of elderly clinicians, senior clinicians, and wise clinicians that the hospital considers should be protected and work from home as much as possible. Now, that hasn't stopped me going into university and doing the various bits of work that we need.

I do miss that sense of contact with colleagues and with patients, and I'm looking forward to returning to a new normal. It will never be as it was before. Up until now, I have delivered outpatient cancer care as if I were still working in the 1950s. That's gone. This is a new normal, but I need to find a blend of how to have face-to-face interactions along with these remote interactions.

I'd be very interested in anybody who's listening or reading, either who's been a patient or a fellow health professional, as to how they feel and how they've coped during this interesting time, and for you to personalize it, to illustrate it, with your own stories and case histories.

As always, thanks for listening. For the time being, Medscapers, over and out. Thank you.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. 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 II.

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