Managing lung cancer, COVID-19: Balancing quality treatment with risk mitigation
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The COVID-19 pandemic presents many challenges to health care and, more specifically, cancer care. Patients with lung cancer have high rates of complications due to their underlying disease.
Healio spoke with Cardinale B. Smith, MD, PhD, director of quality for cancer services at Mount Sinai Health System and associate professor at Icahn School of Medicine, about the evolution of lung cancer care amid the COVID-19 pandemic, adaptations to health care needed moving forward and more.
Healio: Being a year into this pandemic, how has the care of patients with lung cancer adapted and evolved?
Smith: We continue to encourage patients with lung cancer to follow all the safety precautions including frequent hand washing, wearing a mask and physically distancing. We are encouraging all our lung cancer patients without a contraindication to the COVID-19 vaccine to get vaccinated with any vaccine as soon as it becomes available to them.
We have adopted treatments that may allow patients to decrease the number of visits to the cancer center for treatment (eg, 6 weeks vs. 3 weeks for pembrolizumab). We have also transitioned to telehealth (video visits) for follow-up in between infusions or for those on oral agents that are stable.
Healio: What habits, procedures, protocols or adaptations do you foresee continuing post pandemic?
Smith: Telehealth will become a permanent part of lung cancer care and mask wearing will be of a mainstay in cancer management.
Healio: What advice do you have for clinicians advising patients on the COVID vaccine?
Smith: Consistent with guidelines published from NCCN and ASCO, patients should get the vaccine, any vaccine, whenever it is available to them. While we do not know if those patients with lung cancer actively on systemic treatment will have the same results with the vaccine, we do think they will be provided with some protection. Given the high risk for poor outcomes and death for patients with lung cancer that are infected with COVID, this is especially important to encourage receipt of vaccine.
Healio: What challenges have lung cancer specialists been facing?
Smith: The uncertainty of what will happen in terms of COVID rates and trying to balance quality of cancer treatment while attempting to mitigate the risk for COVID infection.
Healio: What research is available on lung cancer and COVID and what more is needed?
Smith: We know the impact on lung cancer patients in terms of risk for death. We don’t know what long-term complications exist and how infection interferes with lung cancer treatment. Additionally, we need a better understanding of the efficacy of the vaccine for patients with lung cancer in general and those on specific cancer treatments like radiation, chemotherapy and immunotherapy.
Healio: How has the pandemic impacted equity of and access to care?
Smith: We have seen incredible disparities in cancer care during this pandemic. Access to care, specifically, testing and timely treatment for COVID; access to telehealth has disproportionally impacted communities of color.
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