COVID-19 May Lead to Permanent Changes in Oncology Services

According to commentary published in The Lancet Oncology, experts predict that the development of new ways of practicing cancer care as a result of the coronavirus disease 2019 (COVID-19) pandemic will permanently lead to a change in oncology services.

“The pandemic has meant a transformation of every aspect of cancer care, irrespective of treatment, inpatient or outpatient, and radical or palliative intent,” James Spicer of Guy’s and St Thomas’ Hospital NHS Foundation Trust in London, was quoted as saying in the commentary.

Oncology teams have had to begin adopting new ways of practicing to try and minimize the risk to patients and staff while simultaneously optimizing treatment and care. Specifically, treatment regimens have been changed to reduce hospital visits. 

“Regimens with less intensive treatment visits are now strongly favored, such as 400 mg pembrolizumab 6-weekly instead of 200 mg 3-weekly,” Spicer was quoted as saying in the commentary. 

Radiotherapy has also had to be altered, with patients being treated using fewer fractions of radiotherapy with higher dose per fraction where possible. This approach may lead to toxicity however, so appropriate schemes for which hypofractionation can be done safely have had to be developed.

Throughout the pandemic, high rates of infection among healthcare workers due to COVID-19 have dramatically reduced the numbers of available staff. In a survey done by the Royal College of Physicians in April 2020, it was found that 20% of the 2,513 respondents were taking time off work.

It is suspected that the main reason for this survey result was COVID-19, followed by self-isolation due to another family member exhibiting symptoms. However, this effect has been counteracted by the fact addition of academic staff working in the field and research fellows returning to work in clinics and wards following the closure of research laboratories.

Support organizations have also begun filling some of the gaps left by reduced staff. Groups such as Macmillan Cancer Support have moved their staff to working from home, ensuring that they are still able to provide necessary aid to patients. 

At the National Cancer Institute of Singapore, healthcare teams have been split into 2, with minimal contact between the groups. Other institutions have begun taking measures to try and relocate cancer teams and services away from general hospitals in order to expose patients with cancer as little as possible. 

“I am working to set up a community center for oncology treatments, similar to a community dialysis center. It would be a safer and less medicalized environment,” Eva Segelov, of Monash Health in Melbourne, was quoted as saying in the commentary.

Universally, outpatient visits and other discussions with healthcare providers have been switched to telemedicine. Oncology organizations, including the European Society for Medical Oncology, are strong proponents of this change; however, it represents a major shift in patient interaction.

“Doctors have traditionally been very fixed in one clinical environment but are generally finding the move to telehealth positive,” was quoted as saying in the commentary. “People with cancer understand competing risks of death. Having the conversations now, and documenting them, is important. Above all we need to reassure them that their cancer is being treated appropriately, but we also need to keep them safe.”

Overall, this balance in caring for patients with cancer and combating COVID-19 has led to a paradigm shift, which may become permanent depending on the evaluated impact.

“This pandemic has led to new ways of working together and we should try to keep the best changes after the pandemic is over,” Ben Slotman, of Amsterdam UMC in Amsterdam, was quoted as saying in the commentary.

Reference:

Mayor S. COVID-19: impact on cancer workforce and delivery of care. The Lancet Oncology. doi:10.1016/S1470-2045(20)30240-0.