Transcription:
Evolving Cancer Care During COVID-19

Melanie Cole (Host):  This is the Northwestern Medicine Podcast on Covid-19. The podcast is dated March 23, 2020.

Welcome. This is Better Edge, a Northwestern Medicine podcast for physicians. I’m Melanie Cole. And joining me today is Dr. Leon Platanias. He’s Director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Today, we’re talking about how the Lurie Cancer Center is evolving to treat cancer patients during the Coronavirus Disease 2019 Pandemic also known as COVID-19. Doctor, I’m so glad to have you join us today. These are unprecedented times for medical care across the board. But for cancer patients, this can be an especially difficult time to navigate. Can you tell us how the Lurie Cancer Center has evolved to provide care for your patients while keeping them safe? Tell us how you are handling both routine office visits, Telemedicine, Personal Protective Equipment, screening; that sort of thing and how is this virus affecting cancer patients? What do we know thus far?

Leonidas Platanias, MD, PhD (Guest):  These are very stressful times for everyone, and you can only imagine how it is for cancer patients who have to deal with cancer at the same time. So, it is very challenging, and we have adapted to the situation. We have developed new approaches to make sure we minimize the risk for our patients, for our cancer patients and we have developed ways so they can feel safe to come and get their treatments.

So, one thing that is very important and we try to do is not to bring people unnecessarily to the hospital because, as you know, COVID-19 patients also come to the hospital and there is always a risk for transmission by going to any hospital and this is especially important for some of our cancer patients who are very immunocompromised, who are getting chemotherapy or other treatments, bone marrow transplants, who their immune system is very weak and makes them very vulnerable to COVID. So, we have developed proactively, we are being proactive and have in place new procedures to specifically address COVID-19 issues.

As an example, when we have patients calling for an appointment, we screen them for fever, cough, and or recent international travel. Depending on the answers to the screening questions; we triage them to a COVID-19 nurse hotline that we have, or we schedule them for a visit with instructions to wear a mask and take other precautions if necessary.

We have also established the COVID-19 response team that activated if any patient arrives after failing the screening questions, in this case, we try to – the patient and their companions are given masks and brought to a negative air flow room for assessment and we work very closely with the Northwestern Medicine Infection Prevention team on these measures.

Now, one important thing we do, I mentioned we try to minimize exposure of patients. We have maximized the Telemedicine capabilities. We have changed many appointments which involve the patient coming to the Lurie Cancer Center to be either a phone call or a face to face Telemedicine call and we can handle a lot of things like that. We also have a website dedicated to COVID-19 info that is available for our patients and many other things in place.

Host:  Well that is certainly comprehensive and Doctor, for critical cancer treatments that can’t be delayed; can and should they be continuing with their regimen treatments, chemo, radiation, infusions? Tell us a little bit about what you are telling them to keep themselves safe so they can continue those critical treatments.

Dr. Platanias:  Again, cancer is a bad disease. And we need to deal with this. So, although the risk from COVID-19 is high for everyone; we should not let the fear for COVID-19 prevent life saving cancer treatments. So, we – what we try to do is essentially have a very sterile environment as much as we can in the cancer center for patients who need to get treated, meaning, minimizing exposure, cleaning surfaces, personal protective equipment for our doctors, screening patients and most importantly, is what I mentioned. Minimizing all unnecessary traffic in the cancer center. Bringing people only who need the treatment. By doing so, we decrease their exposure because other people who don’t need to be there, we handle them by Telemedicine.

So, for patients who need to get their treatments; we continue to do so. For other ones, that are regular follow ups, or things can be done remotely; we do it remotely.

Host:  Doctor, one thing that I think is so important is aside from the physical health of cancer patients and survivors; there’s a concern across the board of our mental health during isolation, during the stress. For cancer patients, the stress of it recurring, all of these things plus now isolation. How are you advising your patients and what would you like other providers to know about advising their cancer patients with the stress that we are all under?

Dr. Platanias:  Yes. So, we obviously need to maintain mental health and we have various support mechanisms for that. Now we have to keep something in mind. We have this concept of social distancing, right, to protect patients and everyone pretty much but we need people to avoid having contact, especially cancer patients with as much as possible and when they do so to keep a distance of six feet. But in the era we live right now and the electronics and all that stuff; we can also distance socially. So, the idea is that although patients may be isolated, without the direct physical contacts, they can use various media to reestablish contacts with friends, talk with friends via telephone, or video and we try to encourage that. There is a social support team that we have. There is also – we have other organizations. There is a cancer support community which includes Gilda’s Club and we work with them and they have staff answering the hotline for people who have stress of they want to talk to someone; Monday through Friday 9 a.m. to 9 p.m. and over the weekend from 9 to 5 p.m. for patients in need.

There is also another partner which is Northwestern Medicine Living Well in the west region that they also provide – they have online and telephone presence – I’m sorry that the don’t have as much online and telephone presence but they have Facebook page and a website where they provide support. And we have – finally, we have our own supportive oncology program in the cancer center that is fully staffed and up and running in the event that people need help in the interim before the normal appointments are restored. So, we have staff on site and all of the staff who are working from home are available every weekday to answer phone calls, MyChart messages, emails for patients in need.

Our psychologists and psychiatrist staff are seeing all patients via telephone or video link these days and they are also available. So, we have many mechanisms in place to do exactly that.

Host:  Such an important aspect of everything that we’re seeing. Now along the lines of healthcare providers, they are at a high risk for exposure, especially with a worldwide shortage in personal protective equipment Doctor; tell us about how your team is working to mitigate that risk for exposure and what protocols you have in place in the event that someone on your team is exposed or tests positive.

Dr. Platanias:  Yes so, we work very closely with the Northwestern Medicine’s supply team to make sure that all our healthcare workers have all the personal protective equipment that they need, and they are well-protected. So, now if there is a potential exposure of a healthcare worker to COVID-19, there are several steps that we take. If a patient is considered of having a COVID-19 infection, all potentially exposed staff are assessed for risk of exposure and then there is a work determination based on that risk whether they should isolate or so on. So, all staff with possible exposure are enrolled in the temperature and symptoms monitoring twice a day for 14 days after the last day of exposure.

The risk of exposure and the way we define if they should go in isolation or just go on the monitoring process depends on the amount of contact with the patient and the type of the personal protective equipment worn at that time. Now the CDC offers specific guidelines or next steps for self-care personnel who may have been exposed and there is a whole process. Some of them will need testing for COVID-19. So, there is a whole algorithm that we have and a whole protocol in place of how to deal with that. That is too detailed now to go through this.

Host:  So, as we wrap up, Doctor, what would you like other providers to know about treating cancer patients during the COVID-19 pandemic, what you want them to know about the protections you’ve put in place and the plan that you have at Northwestern Medicine?

Dr. Platanias:  First of all, I have some advice for our cancer patients. And these are to strictly avoid contact with anyone who displays symptoms that could be Coronavirus like high temperature, or cough or symptoms like that. Do not leave your house. That’s the most important thing. Do not go out of your house unless you absolutely have to. Do not attend any gatherings. No friends, families. Minimize any social contact as much as possible. Avoid going out to shop or travel. It is better to have deliveries for food and medications when possible instead of going out. And keep using technology, phone, internet and social media to stay in touch.

For our doctors, and the healthcare personnel; we are very grateful for their commitment and their efforts and they have to stay safe. Them staying safe means our patients stay safe. So, they are very well trained and prepared to deal with that and we’re going to keep updating our recommendations every day that goes by as needed.

Host:  Thank you so much Doctor, for joining us today and sharing your expertise. It’s such an important topic for cancer patients, survivors and providers to hear what Northwestern Medicine is doing to keep them safe. Thank you again for joining us.

And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on how Northwestern Medicine is evolving to treat patients during COVID-19 pandemic, please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I’m Melanie Cole.