COVID-19 response may lead to lasting changes in cancer care
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Throughout history, crisis situations often have forced provisional changes that, upon further reflection, have been deemed worthy of permanent institution.
“Many upheavals have required changes that have turned into best practices,” David E. Cohn, MD, MBA chief medical officer at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, Ohio, told Healio. “The changes [to airport screening practices] we made after 9/11 improved passenger safety long term. So, it’s not unexpected that something like COVID-19 would cause us to reflect and identify good opportunities to make improvements for our patients, our providers and our health care systems.”
Cohn spoke with Healio about ways the COVID-19 pandemic is likely to change the practice of oncology, both in the short term and the long term.
Question: What do you expect to be the short-term and long-term implications of the COVID-19 pandemic on cancer care?
Answer: The short-term implications for cancer care would include the process of ramping up to accommodate the number of patients that were expected in a variety of regions. I think the appropriate next step is to get those patients for whom we’ve made intentional, deliberate decisions to either delay or modify care to return to a normal schedule again.
The long-term piece is looking at the COVID-19 pandemic and trying to figure out what we can take from this — what it has exposed in our health care systems and oncology that would make us want to modify the things we’ve been doing for years. There are opportunities in both directions.
Q: What long-term changes might occur in the way cancer care is delivered?
A: We have learned a lot from this experience, and it has caused us to reflect upon opportunities to provide more efficient, safe and convenient care for our patients. We may use examples that were forced upon us by the pandemic — such as online patient registration, or a reduction in the frequency of laboratory testing and examinations — as best practices in the future.
There are a lot of operational processes that we can all reflect upon and say, “This really does look like best practice.” We would have never been here had it not been for COVID-19, but we can reflect upon it and recognize some value.
Q: What do think will be the lasting impact of increased use of telehealth during the pandemic?
A: Since COVID-19, we have become aware of the value of telehealth. In our institution, we had been thinking and talking about a virtual oncology platform for years. Then, in a couple of days, we developed something consistent with what has been done across the country. This has been an incredible opportunity for our patients and our providers. It’s not just physicians, nurse practitioners or physician assistants. It’s social workers and dietitians. I think this is going to have the long-term effect of delivering some level of care back into the community that doesn’t require patients to take a car or public transportation to a health care facility, unless it is necessary.
Q: Most routine cancer screenings have been postponed amid the pandemic. What short-and long-term impact could this have? Could there be a spike in patients diagnosed with later-stage cancers once the pandemic is over and screenings resume?
A: With the process of canceling routine cancer screening tests, it seems that many patients perceived this as a signal that our hospitals and clinics were not a safe location for care during the pandemic. This likely led additional patients to cancer or delay other medical care outside of screening tests. These factors together lead to the fear that patients could be diagnosed with more advanced cancer in the future. However, it’s unlikely that a couple months’ delay is going to significantly impact an asymptomatic patient whose disease is picked up by screening.
We’ve done a great job of being ready for COVID-19, but now we need to assure our patients that it is safe for them to get back to clinics and to schedule or reschedule their cancer screenings. A 6- or 8-week delay in screening shouldn’t make a difference in cancer outcome, but if patients extend the time until they get back to medical care, that could definitely change this metric.
Q: Will this pandemic impact the way clinical trials are designed/structured?
A: Clinical trial design probably will look the same. However, I think the rigidity of clinical trials will change. There won’t be as much of a need to be face-to-face, or to get labs done on specific schedules. I expect that we may reflect upon this and realize it doesn’t negatively impact the quality of the data generated by a trial or significantly impact the outcome of our patients. We may end up walking back some of these very restrictive policies around clinical trials, but I think the trials will be very similar structurally. In terms of how we deliver the trials, we may find ways that will be more efficient for our patients and our staff.
Q: Are there any other lessons learned during the pandemic that will shape and influence how cancer care is delivered?
A: One of the things we’ve realized is the importance of wellness and resilience. The lives of oncologists have been increasingly challenged by electronic medical records, administrative structure, patient volumes and reimbursement. Considering the pressure of COVID-19 on top of these other factors, we’ve recognized that focusing on the wellness of our workforce and on developing the techniques for resilience is the key in getting us through this. That’s one huge thing we’re going to take with us post-COVID: recognizing that we’ve got to take care of ourselves. We also have to take care of each other, and not just by providing book clubs or outlets for exercise. Structurally, hospitals and health care systems must be responsible for supporting providers in their wellness and resiliency. Only through this process can we ensure that when the next pandemic comes along, we are ready.
For more information:
David E. Cohn, MD, MBA can be reached at 460 W. 10th Ave., Suite D920A, Columbus, OH 43210; email: david.cohn@osumc.edu.
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