Oncologists Respond to Care Challenges Presented by COVID-19

April 24, 2020
In ASCO survey, 60 percent of cancer clinical research programs reported halting screening and/or enrollment for certain clinical trials

Only a few weeks into the pandemic, 60 percent of cancer clinical research programs reported halting screening and/or enrollment for certain clinical trials, according to a new survey by the American Society of Clinical Oncology (ASCO).

More than two-thirds of survey respondents reported using remote visits to replace clinical trial visits, although research sites were facing challenges in organizing, implementing and conducting telehealth. Respondents also reported a decline in patients’ ability or willingness to come to the site, and limited availability of radiology, surgery, cardiology, and other ancillary services that are essential for some clinical trials.

 “COVID-19 is placing an incredible strain on the cancer care system, causing tragic results for some patients with cancer and their families, but there has also been an unprecedented response by the oncology community, which is coming together and adapting in new ways,” said ASCO President Howard A. “Skip” Burris, III, M.D., during a press briefing on April 24.

 During the press briefing, Melissa Dillmon, M.D., a hematologist/oncologist at Harbin Clinic Cancer Center in Rome, Ga., described the impact of the pandemic on her practice, which is in an area with one of the earliest community outbreaks in the Southeast.

 She said her patient population has high rates of comorbidities and is being significantly impacted by the outbreak. Her cancer center has taken proactive measures, including screening all patients and caregivers at the door with questions and temperature checks. They are allowing only one person to accompany a patient. “We are not going to local hospitals unless it is an emergency,” she said. “We are using electronic charts and hospitalists to do virtual consults.”  The tumor boards, which include weekly meetings with 25 members, have switched to virtual format.

Harbin Clinic and colleagues have had to prioritize the most urgent surgeries. Some patients have interrupted their treatment, she noted, and there has been a  dramatic decline in screening tests, including mammograms and colonoscopies. “We have a high incidence of lung cancer in our region, and I have great concern about missing lung scans,” Dillmon added.

 Screening centers will be challenged to catch up with the backlog once things open up again. Although they have been able to use telehealth, but there are obstacles in cases where patients have limited access to smartphones, laptops and Internet access. They have had success using home health agency workers taking  iPads to connect with elderly patients. “The human toll is considerable,” she said, “and we will feel this for a long time. It weighs heavily on me and my team. We are concerned as to how clinic can provide care if the financial toll causes practices or hospitals to close. We are concerned about the ability of healthcare in America to face future crises.”

 During the briefing, Burris noted that there is limited data on how to treat cancer patients with COVID-19, and even when they are not exposed to the virus, patients face daunting challenges around delays in care. In some cases, there are evidence-based workarounds, but that is not always true, he said.

 “While we’re in very tough times, this crisis presents an opportunity to improve the quality and resiliency of cancer care. To maximize that potential, we’ll be drawing on the expertise of the full cancer community, action by policymakers, and data to proactively transition to post-crisis cancer care and achieve the best outcomes for patients in the months and years ahead.”

 Noting that bold policy actions at the federal level will be essential, Burris also described ASCO’s advocacy agenda for Congress and the Trump Administration. ASCO’s recommendations include:

• Continued Support for Telehealth. ASCO urges the Centers for Medicare & Medicaid Services (CMS) and private payers to fully reimburse for audio-only visits.

• Additional and Immediate Financial Support for Practices. Many oncology practices received funds through the CARES Act. However, additional financial support is needed, and Medicaid providers should be paid rates equivalent to Medicare providers.

• Passage of Federal Oral Parity Legislation. Congress should require that oral cancer treatments be reimbursed at levels comparable to intravenous (IV) chemotherapy, since oral medicines can be taken at home without risk of COVID-19 exposure. In its next COVID-19 relief package, Congress should include The Cancer Drug Parity Act, which would prohibit the currently unequal cost sharing between oral and IV drugs.

• Prevention of Additional Drug Shortages. ASCO recommends aggressive action to mitigate drug shortages—a comprehensive solution that would involve a “whole-of-government” approach across federal agencies, including constant awareness of potential supply chain disruptions and contingency plans to mitigate acute shortages.

 ASCO also recently launched a registry designed to help the cancer community learn more about the patterns of symptoms and severity of COVID-19 among patients with cancer, and how COVID-19 is impacting the delivery of cancer care and patient outcomes. The registry is designed to collect both baseline and longitudinal data on how the virus impacts cancer care and outcomes of patients with cancer during the COVID-19 pandemic and into 2021.

 Two new ASCO workgroups will be charged with evaluating how changes in care delivery and research prompted by the pandemic could inform new approaches to delivery of high-quality, high-value care and cancer research moving forward.

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