Physicians Perspective

Cancer Treatment in the Time of COVID

Without question, 2020 was one of the most memorable years of my career. When the COVID-19 pandemic began to unfold in the spring, as caregivers we had many questions and few answers regarding how best to protect our patients and each other. We received new information about the virus almost daily, and as we learned more about what we needed to do to keep everyone safe, Sentara RMH continually updated its policies and protocols.

The hospital’s infectious disease physician, Parag Patel, MD, visited the Hahn Cancer Center to analyze our unique issues and provide us with tailored recommendations to help keep our patients safe. Following Dr. Patel’s guidance, we spaced chairs further apart, removed magazines in waiting areas, and sanitized chairs and rooms after each patient visit. We also offered to postpone routine post-treatment follow-ups or convert them to phone or video conference (we did not, however, alter new patient appointments and follow-ups with concerns).

Under the new protocols, patients had to come in unaccompanied unless they had memory issues, and this change proved to be the most difficult challenge for patients and physicians alike. Although patients naturally experience anxiety with a cancer diagnosis, coming to the Cancer Center with no support person in the midst of a pandemic was a very difficult experience for some. Having a support person present can be valuable for both patients and caregivers, since family members provide an extra set of ears to help the patient recall details, and often think of good questions to ask during appointments. With that in mind, I would do my best to provide extra support during these visits, often having family on speakerphone or talking with them separately at a later time. 

For patients who were already receiving daily radiation treatment, we spaced appointments out to avoid crowding in the small waiting area near the machines, as well as to allow enough time to sterilize the treatment table and all other surfaces between appointments. We did not interrupt any ongoing radiation treatment, but we were able to postpone a few patients who had slow-growing cancers or could control their cancers with hormonal therapy in the interim. However, we could not safely postpone the vast majority of our patients without increasing the risk of their cancer worsening. For this reason, we had to prepare for the inevitable circumstance of having to treat a patient who had contracted COVID-19. Our plan was to treat the patient at the end of the day if they were in the midst of treatment, provided they were in stable condition.

One such Cancer Center patient I recall was hospitalized with COVID-19 in the midst of treatment, which we were able to resume after a short break, while he recovered from the virus. Thankfully, he then completed his course and was discharged to a rehab facility—although he had missed one important ceremonial moment of his treatment. In our center, patients who have completed treatment have the option of ringing a bell three times to commemorate their milestone. The patient had missed that opportunity, but when he returned for his two-month follow-up, he was able to ring the bell to celebrate his victory over both COVID-19 and cancer. 

I am proud of the fact that, even in the midst of a pandemic, our Cancer Center persevered to provide the best possible care and outcomes for patients.

On another note, a worrisome pattern began to emerge. By the fall, although we had learned to adapt to life in the pandemic, I began to notice an increasing number of new patients with advanced cancer, with a common theme: diagnosis had been delayed due to COVID. Often such delays were due to patients’fear of going to the doctor to report symptoms during the height of the pandemic. Unfortunately, a similar pattern has been reported nationwide, and it has been heartbreaking to see patients come in with cancers that, due to a delay in diagnosis, now require more aggressive treatment or can no longer be cured.

In light of this trend, if I could get one message out to our community members, I would urge them not to postpone cancer screening or ignore worrisome symptoms—due to COVID-related concerns or any other reason. Physician offices and hospitals are now well prepared to keep patients safe during their evaluations, and earlier detection of a cancer generally results in a better chance of cure with less aggressive treatment. If you are due for a screening or have concerns about your health, be sure to see your physician as soon as possible.

Getting Through COVID, Getting Back to Normal

By Mary Helen Witt, MD

Medical Oncologist/Hematologist

Sentara RMH Hahn Cancer Center

Prior to early 2020, the most feared two-syllable word starting with C was cancer—and then the term COVID entered both our world and our vocabulary. At the Hahn Cancer Center, we’re used to dealing with the former, but dealing with both diseases simultaneously required a new strategy.

Delivery of traditional oncology care is normally loaded with personal interactions: clinic visits, treatments that can last for hours, visits for lab work, surgery, imaging, support and educational classes—all of which are opportunities for virus transmission. Cancer patients in general are especially vulnerable to infection, and COVID added yet another threat. Those with lung cancer and hematologic malignancies have proven to be at the highest risk for complications from COVID infection.

Although telemedicine became an option for many practices, the majority of our Cancer Center patients require in-person care. We had some tough decisions to make during the pandemic, but the goal remained essentially the same: maximizing care for our cancer patients by minimizing interruptions in lifesaving and life-prolonging treatments—now, however, while keeping patients and staff safe from COVID. 

In response to the crisis, we were put in the uncomfortable position of having to decide which cancer patients needed immediate treatment, and which ones could delay treatment without compromising outcomes. For example, utilization of oral hormone pills allowed some women with lower-risk breast cancer to postpone surgery safely. Patients with chronic malignancies that had multiple, equally effective treatment options often chose an oral agent or a regimen that minimized visits to the Cancer Center. 

As an added complication, more recently we have had to consider the timing of treatments that could lower a patient’s immune response and impact the efficacy of COVID vaccinations.

Although isolation and separation are already part of a typical cancer diagnosis and journey, during the pandemic we had to limit the number of people passing through the Cancer Center on a daily basis. This led to the requirement that patients come to appointments and treatments alone. Early on in the pandemic, as I entered an exam room, I often found myself worried about the absence of the typically ever-present caregiver. Then I would remember why the patient was alone and be relieved that the support person was probably just waiting in the car and not sick at home or in the hospital.

Several provisions were made to facilitate communication with patients, including allowing a visitor to accompany patients being seen for the first time with a new diagnosis of cancer. An extra set of ears is crucial during that visit, and many family members participated in such consultations via speakerphone. Still, communication has been more challenging during COVID, since we humans rely on many forms of nonverbal cues, including body language and facial expressions, for information. In that respect, masks and goggles haven’t helped, either—but we have managed to muddle through as best we could. With the pandemic now appearing to be easing, I look forward to handshakes, hugs and seeing each other’s faces again.

While COVID has disrupted lives in countless ways, one area of collateral damage that may lead to long-term harm is the disruption of cancer screenings like mammograms and colonoscopies. Thankfully, screening exams were only halted for a few months, and extra precautions have been implemented in the meantime to ensure safety during these visits. So, while many of us plan long-overdue vacations, I encourage everyone to get any necessary screening exams back on their calendars as well.

For those with cancer, despite all the necessary changes, we at the Cancer Center remain dedicated to continuing to provide the best and safest treatment possible.


Supporting Cancer Patients and their Families

The Sentara RMH Hahn Cancer Center offers a variety of support services in both face-to-face and virtual settings for patients and their families. These include: 

  • Cancer Treatment Class: To inform new patients about what to expect during treatment, and support services offered 
  • Womens Stage IV (breast cancer) support group: twice monthly via Zoom
  • One-hour Zoom chair yoga class: every Wednesday for cancer patients, survivors, and caregivers 
  • Facing Forward: Life After Cancer Treatment: for cancer patients who have completed treatment; quarterly via Zoom 
  • Clinical dietitian Robin Atwood, MS, RDN, CSO: available for nutrition counseling 
  • Social worker Maxine Jean-Louis, MSW, LCSW: available to provide counseling services and assist patients in coordinating supportive care

To learn more, contact Maxine Jean-Louis at 540-689-7065 or mgjeanlo@sentara.com. 

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