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March 18, 2020

The coronavirus brings new challenges to cancer care

Staff and equipment shortages among hurdles that must be overcome

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How hospitals are managing cancer care during COVID-19 Source/Image licensed from Ingram Image

Hospitals are facing unprecedented challenges treating cancer patients during the coronavirus pandemic. Doctors at the epicenter of the United States crisis share some of the early lessons they have learned.

Social distancing and other coronavirus mitigation efforts being implemented by government officials are designed to reduce the infection risk of all United States residents. But they're particularly important for people with weakened immune systems, including cancer patients. 

Providing cancer care amid the pandemic has brought its own set of challenges. 

"The COVID-19 pandemic is impacting every facet of our global and domestic societies and health care systems in unprecedented fashion," said Robert W. Carlson, chief executive officer of the National Comprehensive Cancer Network, which is headquartered in Montgomery County.

"People with cancer appear to be at increased risk of COVID-19, and their outcomes are worse than individuals without cancer. The NCCN Member Institutions are rapidly gaining experience in preventing and managing COVID-19."

Experts from Seattle Cancer Care Alliance, an NCCN member, published the early lessons they have learned on managing cancer care during the coronavirus pandemic in the Journal of the National Comprehensive Cancer Network.

The SCAA includes the Fred Hutchinson Cancer Research Center and the University of Washington, both at the epicenter of the COVID-19 outbreak in the United States. 

King County, which includes Seattle, had 562 coronavirus cases, including 56 deaths, through Wednesday evening. Washington had 1,187 cases, including 66 deaths.

"Responding quickly and confidently to the COVID-19 crisis is the health care challenge of our generation," SCAA Medical Director F. Marc Stewart said. "Our overachieving goal is to keep our cancer patients and staff safe while continuing to provide compassionate, high-quality care under circumstances we've never had to face before."

The most important step is triaging patients with respiratory symptoms to reduce exposure to other patients and staff, and providing COVID-19 testing when indicated, the experts wrote.

They also recommended creating an Incident Command Structure to facilitate better communication between administrators and staff, patients, caregivers and the general public, as new challenges constantly emerge.

"Virtual town halls with leadership are essential for clear and consistent messaging," they wrote. "Leveraging media resources for real-time patient communication is vital."

Effective media resources include handouts, signs, web-based communication and dedicated phone lines for questions and triage.

Staff shortages due to potential COVID-19 exposure and school closings should be expected, they wrote. So should limitations to important resources, including hospital beds, mechanical ventilators and other equipment. Cancer treatment also may be delayed because of travel bans.

They suggested rescheduling well visits and elective surgeries, and increasing the hours of operation. Limiting the number of team members who enter a patient's room and instituting a no visitor policy – except in end-of-life scenarios – also proved helpful.

In some cases, changes in treatment plans also may become necessary, they wrote. One example: delaying surgery and instead providing several months of endocrine therapy for some breast cancer patients.

To protect staff, the SCAA experts recommended compensation polices, a back-up labor pool and reassigning staffers with weakened immune systems to administrative roles.

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