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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 discussed COVID-19 testing and precautions, the impact of continuing or delaying treatment and coping with stress and anxiety during these prolonged uncertain times. They also answered patient questions.

Follow Safety Guidelines

Clearly, cancer patients need to continue following CDC hygiene guidelines, the panel agreed. With no COVID-19 vaccine yet, it’s important to avoid exposure. Stay home as much as possible ― even when the world begins to re-open ― wash your hands, avoid touching your face, maintain safe social distancing, and wear a mask and gloves when you must go out. You should also disinfect surfaces frequently.

Those with weak 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. “Patients with a history of cancer who developed COVID-19 were at more than twice the risk of going to the ICU than COVID-19 patients without cancer,” Dr. Venkatappa said. In addition, studies show that cancer patients with COVID-19 also have a higher mortality rate, along with others with pre-existing health conditions.

Discuss Treatment Options

Patients understandably concerned about possible COVID-19 exposure in the healthcare setting were urged to speak to their physicians about treatment options that may enable them to continue their care without coming to the facility as frequently as they might have pre-COVID-19. For example, some visits may be accomplished 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 not limiting consultations,” Dr. Chuong said. “However, in many cases we can do these via telemedicine.” He added that the care of patients receiving radiation is reviewed to determine whether other treatment options are available. If not, they consider whether radiation could be delayed or the number of visits lessened. It’s all about reducing the chance of exposure to someone who is infected.

“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-19 Medications

While researchers perform studies to determine if existing medications might be effective against COVID-19, some patients wondered whether they could take drugs they’d heard helped treat the virus. “We really shouldn’t take medications without oversight from a physician,” said Dr. Gauthier, adding that medications like hydroxychloroquine, originally touted as helpful, have the potential to harm some COVID-19 patients. Ask your doctor before taking anything that hasn’t been prescribed to you.

Lowering Stress

With the overwhelming amount of information ― and misinformation ― available on the internet, social media and on news channels, many patients are feeling increasingly stressed, sad or depressed. Dr. Currier suggested the use of the free online platforms for support groups and education classes offered by Miami Cancer Institute. From exercise to cooking, classes allow patients to take an active role in their care and limit the information overload that comes from channel surfing or too much time on social media. Subscribe to virtual programming by clicking here [1]. Or go to www.miamicancerinstitute.com [2], scroll to the bottom of the page and click on “Subscribe Now” under the Join the 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.

Other techniques to lower chronic stress, prevent insomnia and fatigue and recapture that feeling of control over your life include daily exercise, mindfulness meditation, eating a healthy diet and staying socially connected through technology.

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

Because every individual’s circumstance is different, please connect with your oncologist or medical provider for answers to specific questions related to your cancer care. For the latest updates on Baptist Health South Florida and Miami Cancer Institute COVID-19 news, click here [3].