Cancer patients’ care during COVID-19 crisis

May 01, 2020

By A/Prof Ali Tafreshi
At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in an epidemic throughout China, followed by an increasing number of cases in other countries throughout the world.

On January 30, 2020, the WHO declared the COVID-19 outbreak a public health emergency of international concern and, in March 2020, began to characterise it as a pandemic.

The primary intervention to slow disease spread has been social distancing, hand and respiratory hygiene, and staying home as much as possible. There are currently multiple clinical trials investigating potential vaccines and antiviral treatments.

Delivering cancer care during this crisis is challenging given the competing risks of death from cancer versus death from infection, and the higher lethality of COVID-19 infection in immunocompromised hosts.

Although COVID-19 is typically more severe and lethal among older people, people of any age with underlying medical conditions are at increased risk if they contract the virus. These conditions include active or past history of cancer, particularly if they recently received or are continuing to receive treatment. In a report from Italy, 20 percent of the deaths from COVID-19 in the entire country were in patients with active cancer.

Wollongong Private Hospital and I have implemented specific strategies and measures to minimise the risks for cancer patients and support them during this crisis:

• I offer remote consultations to cancer patients via telehealth.

• Cancer patients are contacted the day before their treatment to be checked for infective symptoms or suspicious contacts.

• Patients are informed regarding the symptoms of COVID-19, and trained in proper handwashing, hygiene, and minimizing exposure to sick contacts and large crowds.

• Cancer patients who attend the day oncology for treatment have access to dedicated entrance and complimentary onsite parking. On arrival to the hospital, they are checked for fever and other infective symptoms.

• We reduce the time in waiting rooms and have rearranged patient contact areas to maximise social distancing. Patients are recommended to avoid visitor/company unless absolutely necessary.

• We minimise patients’ exposure to medical facilities by one-stop shop approach and providing onsite consultation, investigations (pathology, CT, MRI, biopsy and nuclear medicine) and treatments.

• I do consider chemo at home for appropriate treatment regimens and patients from remote areas. The cancer treatments (chemotherapy and immunotherapy) have evolved over the years and these days significant number of treatments can be delivered safely and comfortably at home.

• I do modify treatment regimens where appropriate and consider adding supportive measures like addition of GCSF (granulocyte colony stimulating factor). There is no "one size fits all" approach to delivering cancer care during the COVID-19 pandemic. Specific patient comorbidities as well as values and preferences must also be considered in each case. It is important to discuss goals of care and advanced care directives with patients.

• We try to minimise the need for ED presentations and potential exposure to COVID-19 patients by direct admissions to Wollongong Private Hospital when necessary.

• Globally, the COVID-19 pandemic is leading to mental health problems such as stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear. Cancer patients may have additional feelings of anxiety, fear, and vulnerability for disease recurrence or progression. My patients at Wollongong Private Hospital have access to an experienced dedicated social worker for cancer patients and cancer nurse care coordinator to support them during this difficult time.

• We understand that waiting for a specialist appointment for new patients does increase their anxiety and stress and therefore will offer appointments within 48 hours from referral. Please note you do not need tissue diagnosis confirmation before making a referral.

• I do routinely provide my patients with support letters to their work, insurance or other facilities to maximise their social distancing, for example letters to supermarkets to organise groceries delivery.

I am sure through our multidisciplinary approach and collaboration we are going to continue to provide the best quality care to our cancer patients safely during this unprecedented crisis.

Please feel free to contact me to discuss or refer your cancer patients:

Phone: 02 4225 1133
Fax: 02 4226 5769
Email: reception@wollongongoncology.com.au