Expert Advice: Cancer Care During COVID-19

As the COVID-19 pandemic grinds on with the debate of re-opening businesses and relaxing quarantines, cancer patients understandably continue to have questions about their safety and care.

To address key concerns, experts at Miami Cancer Institute recently held a free, live webinar for patients, Managing Your Care During This COVID-19 Crisis. The panel included: Horacio Asbun, M.D., surgical oncologist and professor of surgery, chief of Hepatobiliary and Pancreas Surgery; M. Beatriz Currier, M.D., medical director, Cancer Patient Support Center and chief of Psychiatric Oncology; Michael Chuong, M.D., radiation oncologist and medical director of Proton Therapy and MR-guided Therapy; Timothy Gauthier, Pharm.D., manager of Antimicrobial Stewardship Clinical Program at Baptist Health; Milton Gaviria, M.D., infectious disease specialist and director of Antibiotic Stewardship Clinical Program; and Siddharta Venkatappa, M.D., medical oncologist.

You can view the program in its entirety below:

The group discussedCOVID-19 testing and precautions, the impact of continuing or delayingtreatment and coping with stress and anxiety during these prolonged uncertaintimes. They also answered patient questions.

FollowSafety Guidelines

Clearly,cancer patients need to continue following CDC hygiene guidelines, the panelagreed. With no COVID-19 vaccine yet, it’s important to avoid exposure. Stayhome as much as possible ― even when the world begins to re-open ― wash yourhands, avoid touching your face, maintain safe social distancing, and wear amask and gloves when you must go out. You should also disinfect surfacesfrequently.

Those withweak immune systems, such as cancer patients, are at higher risk for COVID-19,and, if they do get the virus, they are more likely to become severely ill. “Patientswith a history of cancer who developed COVID-19 were at more than twice therisk of going to the ICU than COVID-19 patients without cancer,” Dr. Venkatappasaid. In addition, studies show that cancer patients with COVID-19 also have ahigher mortality rate, along with others with pre-existing health conditions.

DiscussTreatment Options

Patientsunderstandably concerned about possible COVID-19 exposure in the healthcaresetting were urged to speak to their physicians about treatment options thatmay enable them to continue their care without coming to the facility asfrequently as they might have pre-COVID-19. For example, some visits may beaccomplished virtually.

“Miami Cancer Institute has taken significant steps to prevent transmission of this disease to healthcare workers and patients,” Dr. Gaviria said. Some of the safety initiatives taken at Institute facilities include reconfiguring the buildings to allow for plenty of space between people, eliminating visitors, allowing non-clinical staff to work from home, screening all patients and staff and enforcing the mask and glove policy for all. Recently, Baptist Hospital of Miami’s Molecular Diagnostic Laboratory at Miami Cancer Institute was granted Emergency Use Authorization by the FDA to perform COVID-19 tests in-house. It became one of 12 in-hospital labs to receive the approval.

“We are notlimiting consultations,” Dr. Chuong said. “However, in many cases we can dothese via telemedicine.” He added that the care of patients receiving radiationis reviewed to determine whether other treatment options are available. If not,they consider whether radiation could be delayed or the number of visitslessened. It’s all about reducing the chance of exposure to someone who isinfected.

“Patient safety is on our minds at all times,” Dr. Asbun said. “As a surgeon, I take pride in the fact that we move quickly from diagnosis to surgery, but these are not the times to do that.” Patients who need life-saving surgery are still being taken to the O.R. Equally, when there is not a suitable treatment alternative and if postponing the surgery would be of detriment, we still proceed with surgery but take necessary precautions, he said.

Physicians are careful to balance safety with providing high-quality cancer care and cases are discussed in a multidisciplinary board. Patients are tested for COVID-19 before procedures, not only because of the danger a positive patient presents to others, but because a patient with cancer who contracts a virus may need time to recuperate from the virus before the body is put under more stress from surgery.

Miami Cancer Institute’s Tumor Boards help with the delicate balancing act, Dr. Asbun said. Multidisciplinary groups of physicians meet regularly to review patient cases, exploring all of the options to ensure that the best and safest care is being offered.

COVID-19Medications

Whileresearchers perform studies to determine if existing medications might beeffective against COVID-19, some patients wondered whether they could takedrugs they’d heard helped treat the virus. “We really shouldn’t takemedications without oversight from a physician,” said Dr. Gauthier, adding thatmedications like hydroxychloroquine, originally touted as helpful, have thepotential to harm some COVID-19 patients. Ask your doctor before takinganything that hasn’t been prescribed to you.

LoweringStress

With theoverwhelming amount of information ― and misinformation ― available on theinternet, social media and on news channels, many patients are feelingincreasingly stressed, sad or depressed. Dr. Currier suggested the use of thefree online platforms for support groups and education classes offered by MiamiCancer Institute. From exercise to cooking, classes allow patients to take anactive role in their care and limit the information overload that comes fromchannel surfing or too much time on social media. Subscribe to virtualprogramming by clicking here. Or goto www.miamicancerinstitute.com,scroll to the bottom of the page and click on “Subscribe Now” under the Jointhe Community heading.

In addition, Dr. Currier stressed good sleep hygiene. “Sleep is ground zero for mental health,” she said. “Most of the population requires seven hours a night.” She recommends avoiding alcohol and reading or watching TV in bed, minimizing blue light exposure after 7 p.m., and trying to go to bed and wake up at approximately the same time each day.

Othertechniques to lower chronic stress, prevent insomnia and fatigue and recapturethat feeling of control over your life include daily exercise, mindfulnessmeditation, eating a healthy diet and staying socially connected throughtechnology.

Dr. Asbunconcluded the session by reminding patients of their resilience. “You havecourage, you have curiosity,” he said. “The fact that we have some fear doesn’tmean we don’t have courage. Human spirit will prevail and one day this will beover.”

Because every individual’s circumstance is different,please connect with your oncologist or medical provider for answers to specificquestions related to your cancer care. For the latest updates on Baptist HealthSouth Florida and Miami Cancer Institute COVID-19 news, click here.