Expert Discusses the Concerns and Options During the COVID-19 Pandemic

Timothy D. Moore, MD

Timothy D. Moore, MD

The coronavirus disease 2019 (COVID-19) has been changing the way of life for people across the world, with many countries placing travel bans and ordering residents to ‘stay at home’ or ‘shelter in place.’ These precautions interrupt important daily or weekly routines, particularly for patients with cancer and their oncology providers.

As of Monday night, Ohio has announced a ‘shelter in place’ order, but prior to this, the oncology community throughout the state could feel the effects of the pandemic.

“I think we’re all kind of feeling our way through the darkness, and it’s especially affecting clinical research,” said Timothy D. Moore, MD. “It sounds like [procedures are on a] state by state [basis]; we’re paranoid in Ohio. We’re instituting the restrictions, whereas in other states, I don’t see the same level of paranoia.”

In an interview withTargeted Oncology, Moore, the principal investigator for the Columbus NCORP (National Cancer Institute Community Oncology Research Program) and attending physician at the Zangmeister Cancer Center, discussed how his institution is handling concerns regarding COVID-19 and what he is seeing with patients and cancer programs.

TARGETEDONCOLOGY:What has changed in your daily routine at your institution?

Moore:We’ve cut back [on seeing patients]. Only urgent or necessary patient interactions and visits are coming in; our otherwise routine visits have been put off until at least May. I think the whole system has slowed down, so people aren’t getting elective surgeries, and I get the feeling that the new cancer diagnoses haven’t really been getting established [as] much.

I did not see a new cancer diagnosis this week, which is very unusual. My partners that are covering the hospitals are seeing new cancer diagnoses, but in the office, I haven’t. I think this is a result of limiting “elective procedures” [such as] colonoscopies and mammograms, and patients’ fears of exposure. If this continues for months, it could have a negative impact on disease outcomes moving forward; there is no specific time limit here, but the sooner we can return to normal, the better.

TARGETED ONCOLOGY:How has social distancing impacted interactions with patients?

Moore:We’re limiting things so there can only be 1 family member that comes in the room, and we try to maintain a 6-foot distance. Otherwise we still examine the patients. We have a tent set up out in front of our cancer center where our patients are screened before they come through. They have their temperature taken, and they take a mini questionnaire to make sure that they haven’t gone on a recent trip to Italy or something like that. Now, starting [March 19], everybody has their temperature taken when they arrive so that if we have a temperature over 100.5, even if they are feeling fine, they’re told to go home. 

TARGETED ONCOLOGY:Have you been implementing any form of telemedicine recently given the outbreak?

Moore:We have the codes in our computer. As I understand it, we’re waiting further instructions from the state and/or the federal government as far as how we can physically do it. I don’t know how much of that is on us and how much of that is on federal government, but it’s ready to roll out.

We are rolling out telemedicine for our “routine follow ups” who are not receiving active treatment and payment models are coming online. This area is literally changing by the hour.

It’s ironic, but it might have taken the COVID-19 crisis for our healthcare system to incorporate this technology into wider usage. I think we will see its broader acceptance moving forward.

TARGETED ONCOLOGY:Has oncology treatment been interrupted for your patients?

Moore:We are trying everything possible to not interrupt their treatment. So far, we’ve been able to maintain the same group of physicians. Nobody has tested positive. Nobody has gone down, been in quarantine, or been hospitalized. For the people that are under active treatment, they’ve been able to get their active treatment and have not missed a beat.

TARGETED ONCOLOGY:Are there other measures being taken to provide care while also minimizing contact?

Moore:We’re trying to minimize contact, especially physical contact, as much as possible. For example, 1 of my colleagues is assigned to the hospital right now, and for the people who have already been identified as, not established, but possibly at risk for COVID-19, he has picked up a phone and talked to them in their room but has not physically gone in the room to make contact. Over the phone [he says] “I’m a blood doctor, I’m here to see you for such and such.”

TARGETED ONCOLOGY:How have you seen the pandemic affecting other oncology groups?

Moore:I think we’re all kind of feeling our way through the darkness, and it’s especially affecting clinical research. It sounds like [procedures are on a] state by state [basis]; we’re paranoid in Ohio. We’re instituting the restrictions, whereas in other states, I don’t see the same level of paranoia. In this case, I think paranoia is a good thing. I’d rather be paranoid then not be paranoid.

TARGETED ONCOLOGY:Are there resources that you can offer to patients or physicians to overcome challenges during the pandemic?

Moore:We are blessed that at my cancer center, we have a full-time social worker who also is a psychiatric social worker by training. She has been wonderful because this obviously results in a lot of anxieties amongst people. She’s been making routine calls to the people that we’ve identified to be most at risk for having a stressful situation. We’ve tried to proactively identify those people and give them a phone call to ask how things are going. People that are alone are having a tough time.

TARGETED ONCOLOGY:What would you suggest to oncologists who are unsure of how to proceed?

Moore:Something that we’re all doing is weighing the urgency of the cancer treatment or the urgency of diagnostic test. Does the patient need to come in and have that bone marrow [biopsy or transplant] today or can they wait to have it done in 4 or 6 weeks from now when maybe things are a little clearer? We have to weigh the risks of doing the intervention versus the risks of not doing the intervention. 

TARGETED ONCOLOGY:Have patients shown more hesitation to come into your institution than they have before?

Moore:Not anything over the baseline. I have hesitation now going to the supermarket, and do I need to go there. I have seen patients cancel, and I’ve talked to them over the phone; they say, “I would like to see you, but do I need to see you?” The answer most of the time is no, you don’t need to see me. They’re showing hesitancy coming in. 

I haven’t seen anybody who is receiving active therapy say I want to put my treatment on hold and not come in, and I think the reason for that is we don’t know how long this going to go on. It’s not just a 1-week thing, it might be multiple weeks, so I haven’t seen anybody on active treatment do that, but I have seen people on surveillance [decide not to come in]. They’re concerned about coming into a doctors’ office.

TARGETED ONCOLOGY:For the patients who already started receiving treatment on clinical trials, what is their status now?

Moore:If they are already enrolled on a clinical trial, we are continuing with their treatment, and there have been no delays. We’re try to minimize or have as few people in the clinic as absolutely possible, and that includes research nurses. Our research nurses are not screening for any new patients at this point. They’re not going to enroll any new patients, which was a decision we made [on March 18], but it’s coinciding with what other centers that we’ve heard of are doing. Everybody is trying to maintain treatment with the preexisting patients. 

I got a phone call from 1 of the physicians at the Cleveland clinic that I’ve been working with and getting a patient set up for a bone marrow transplant. This [patient’s] myeloma is under good control at the present time. She was scheduled to go to the clinic for a bone marrow transplant [soon]. We talked over the phone, and we decided that we would maintain her on the current maintenance treatment that seems to be working and do the transplant at a later date when the world is hopefully a little safer. There wasn’t urgency to doing her transplant.

Now, with people who don’t have that luxury, they’re of course going to proceed with the transplant; given the nature of this [outbreak], I think institutions want to conserve the intensive bed space and not put the patient at risk.

TARGETED ONCOLOGY:Are the clinical trials at your institution on hold right now?

Moore:They’re all on hold. We are not activating any new studies, and for the studies that have already been activated, we’re not going to screen any patients or put any new patients on study right now. The patients that are already enrolled and are receiving active therapy will continue to receive active therapy on the protocol, but everything else is on hold.

If patients have finished active therapy, just for surveillance purposes, we’re telling them to push things back a month or 2, but if they’re receiving active therapy, we are not holding them. They are continuing on schedule.

TARGETED ONCOLOGY:What do you think of the current ‘shelter in place’ status in Ohio?

Moore:With regards to ‘shelter in place,’ I don’t see it impacting things that much from what already was being done in Ohio. I think it gives the authorities more flexibility to react to the rare outliers who are not being compliant.

I think we’ve had very upfront state leadership, and that’s crucial because if our leaders don’t sound like they have it together and aren’t providing a clear message, then it’s difficult for the people in the front lines to provide a clear message. We’ve been getting a clear message so that has been helpful from our standpoint. The patients understand where we’re coming from, and there’s no unreasonable expectations. In retrospect, when the dust settles, hopefully we’ll be able to look back on this and say we really pulled together when we needed to, but we’re still early in the process.

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