Examining the Impact of COVID-19 on Cancer Treatment for World Cancer Day

The coronavirus disease 2019 (COVID-19) pandemic has drastically disrupted cancer care over the past year. Treatment regimens had to be rearranged due to safety concerns and many people who should be tested for cancer are forgoing their appointments in order to practice social distancing. Additionally, patients with cancer are a vulnerable population and protecting them from the virus has become of paramount importance.

As the COVID-19 vaccine rollout begins, oncology practices are on their way to getting back to normal in order to help their patients. However, there is a fear that due to the disruption in screening caused by the virus, more stage II and stage III cases will be seen in coming months.

Jeff Patton, MD, the CEO of OneOncology and executive board chair for Tennessee Oncology, discusses COVID-19’s impact on cancer treatment and testing in an interview with Targeted Oncology.

It’s been about a year since the first patient infected with COVID-19 entered the United States, what have we learned in that year in terms of cancer treatment and the pandemic?

PATTON: Well, we learned a lot because we didn't know much about the virus to start with. There was a lot of confusion. We certainly learned very well how to protect our most vulnerable patient population. So, we knew that [patients on] active treatment for cancer, regardless of whatever the characteristics of a bad virus, were the worst patients to get the infection. So, we've done a fantastic job and learned really well how to do something we've done for years, which is protect our most vulnerable patients. We've also learned how to deal with staffing shortages. Our staff got COVID. And our patient volumes didn't go down. Having staff out with COVID, we've very much learned how to deal with them clinic issue staffing, telemedicine, we've learned a ton; I could go on.

What practices have you implemented and continue to implement during COVID-19?

PATTON: I think we've gotten better at protecting our vulnerable population, which obviously is something we'll do going forward. We very much learned a lot about telemedicine, which will go forward. We've learned that some non-clinical staff can work from home; we've learned how to deal with staffing shortages. And so, in any crisis that you get through, you learn when you're in crisis mode. So, we've really learned a lot of lessons on patient management practice management that we'll use going forward.

Are there any practices from pre–COVID-19 that you've eliminated? And if so, why?

PATTON: We've eliminated some of the being casual about hand washing; we've eliminated being casual about, you know, close contact in our waiting rooms. We've eliminated some of the things that I won't say were careless—we just learned lessons and things that we won't do going forward.

What are some new efficiencies and practice management that you've implemented so far?

PATTON: So again, managing patients with low levels of staff and critical staff, we've really learned a lot about the demand management of low staffing levels. I would say we've learned a lot about telemedicine. We've learned how to do billing and really learn some efficiencies from that. Again, on the non-clinical practice management side, we've learned how to manage a remote workforce, which I think will go forward as well.

How will the use of telemedicine continue throughout this year? Do you think insurance companies will continue to come to cover these types of visits?

PATTON: I think they will. Because COVID hasn't gone away. Now, once a COVID is not critical, I think the commercial payers will continue to cover telemedicine, but as one unnamed medical director told me, “Yeah, we're going to cover it, but you're not going to like the reimbursement very much.” So, I think the reimbursement will go down. And whether that's enough to make it economically viable, I don't know at this point because we don't know what those rates will be. Yes, they'll cover it. Will it be enough for us to continue the practice? [That’s] to be determined.

What should community oncologists keep in mind for daily practice in terms of COVID-19?

PATTON: I think we've really learned a lot about how vulnerable our patient population is, but we knew it already. But there's, you know, shined a bright light on that we've learned better about PPE [personal protective equipment] and hand washing and all the things we've done for a long time. That needs to probably extend the patient-to-patient contact like front office and areas where you didn't really think of as clinical—check in, check out. So, I think we've learned a lot about how to protect our patient population.

The other thing is, society and the world has learned that COVID is going to be fine in a year or 2, but there's going to be another one, there's going to be another one. And I think all of us are learning that we were not fully prepared of how to deal with a pandemic, even though Bill Gates predicted this was going to happen 10 years ago, and it happened and it's going to happen again. And so, preparedness is something that we've all learned a lot about, or the need to be prepared.

How do you feel physician should counsel patients for screening visits and follow-up visits and adherence to COVID-19 protocols?

PATTON: So, we've encouraged—and I'm on the board of COA [Community Oncology Association]—we've had a campaign of how critical it is and how important it is to continue screening. It's safer. If you have PPE and you're in a safe environment, certainly [it’s safer] to get your screening then to avoid the possibility of the infection. So, we will see for several years stage migration of patients being delaying in their diagnosis and they're going to be diagnosed less; there will be more stage II, stage III because…potential patients delaying their screening. So screening is critical, even in this current environment of a pandemic.

Which disease types do you feel are most at risk for being missed due to lack of screenings or follow up?

PATTON: I would say breast cancer and colon cancer are where we have the most data for screening, prostate cancer as well. And lung cancer screening—lung cancer screening is less mature than breast cancer screening and colon cancer screening. But all 4 of those are disease types where we do have a proven screening capability.

How do you anticipate the vaccine rollout will affect office visits and delivery of care? Do you feel like visits will go back to pre-COVID norms?

PATTON: The timing of that, I don't know. I don't know whether that's going to be summer or the end of this year. There's a lot of debt. So, coronavirus is a rhinovirus. So, it's going to be like the cold—[it] is never going to leave us but it's not going to be like the flu; we have to be injected have follow up vaccines for forever. So, I don't know when we'll go back to normal, but we should go back to normal.

Is there anything else you would like to highlight in terms of COVID-19 and cancer?

PATTON: Well, there was a recently published article that not only patients who have active cancer, but patients who've had cancer previously are more susceptible to bad outcomes with COVID. So, it's not just who we would think are vulnerable. It's some patients who are likely cured of cancer; they also still seem to be more vulnerable to COVID. So that's a new finding that was published recently.