Cancer clinics must take extensive coronavirus precautions because their patients are at high risk of serious illness.
Cancer clinics are making operational changes and launching other initiatives in response to the coronavirus disease 2019 (COVID-19) pandemic.
Patients with cancer are a high-risk group during the COVID-19 pandemic, according to a World Health Organization report published in February. The report, which is based on data collected in China, found that COVID-19 patients with cancer are more than five times more likely to die from the disease compared to COVID-19 patients who have no comorbid conditions.
There are three primary reasons why patients with cancer are at high risk during the pandemic, says Catherine Liu, MD, associate director of infection control at Seattle Cancer Care Alliance (SCCA) in Seattle, and associate professor of medicine at University of Washington School of Medicine in Seattle.
- Patients with cancer receive treatments such as bone marrow transplants that can suppress the immune system
- Certain types of cancer place patients at high risk, including hematologic malignancies such as leukemia and lymphoma
- Cancer patients often have other underlying conditions that have been associated with increased risk of severe illness with COVID-19, including diabetes and high blood pressure
Delaying nonessential procedures and surgery
Like other healthcare providers across the country, SCCA has delayed nonessential procedures and surgery during the COVID-19 pandemic.
Cancer clinics have to carefully weigh which procedures and surgery can be delayed, Liu says. "Many cancer surgeries are not considered elective. We know that some of the more aggressive cancers such as pancreatic and colorectal cancer have a more immediate need for surgery. We have to be thoughtful about prioritizing some of these procedures. For example, there are some slower-growing cancers for which nonsurgical interventions may be appropriate."
SCCA has taken a team-based approach to these decisions, she says. "It has been a collaborative decision between oncologists, the care team, and patients to make a decision about moving forward with surgery. Everyone is involved in this process to determine whether surgery can be postponed, using other interventions in the meantime."
There are three primary considerations, Liu says. "It depends on the type of cancer, the type of procedure, and the clinical situation of the patient in determining whether a procedure can be delayed or needs to be performed right away."
SCCA has implemented seven operational initiatives to reduce exposure to the virus and increase the safety of patients and staff, she says.
1. All patients and staff are screened for respiratory symptoms when they enter the clinic. Symptomatic patients are masked and moved to a designated area of the clinic where they can be tested. Symptomatic employees are also given a mask, tested, and told to go home until their symptoms resolve.
2. Patients have been asked to call a nurse coronavirus triage hotline if they are experiencing any respiratory symptoms such as cough or shortness of breath. The nurses provide guidance to patients about whether they should come in for a scheduled appointment, postpone a visit until their symptoms resolve, or schedule a telehealth visit.
3. Symptomatic patients and employees can be tested at an off-site, drive-thru location. The service was established to limit exposure in the clinic.
4. Pre-visit screening phone calls are conducted about two days before a patient's clinic visit to see whether they have respiratory symptoms. Symptomatic patients are tested at the drive-thru location. If the test results are not available before the patient's clinic visit, a telehealth visit is set up or the clinic visit is rescheduled.
5. The use of a surgical mask is recommended for use by all staff in the clinic, primarily to limit the risk of infection from healthcare workers who have asymptomatic or pre-symptomatic infections.
6. Visitor restrictions to limit exposures include patients only bringing one additional person over age 12 to a clinic visit and no guests accompanying patients in the chemotherapy infusion rooms.
7. Nonessential staff have been restricted in clinic areas to reduce the density of people.
Treating coronavirus-positive patients
SCCA has developed guidelines for managing patients who test positive for coronavirus, Liu says.
"From a clinical perspective, the oncologist will discuss individual treatment plans with their patients and determine what aspects of their care need to be continued and what aspects should be delayed. In some cases, patients may need to continue their therapy or require some other types of essential care such as infusion."
Precautions are taken if a coronavirus-positive patient needs to have an essential care visit, she says.
"We developed infection prevention guidance to ensure that when these patients enter the clinic their care is carefully organized. We ensure that there is coordination between environmental services, the infection prevention team, and the treating team to allow for a controlled and safe environment for our other patients. We developed a process in which the patient is escorted into the clinic to a designated area, where they are seen and have their care managed."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Reasons why cancer patients are at high risk during the coronavirus pandemic include immunosuppressive therapy such as bone marrow transplants.
Cancer clinics need a thoughtful process in determining which procedures and surgery are essential or can be delayed.
If a patient needs an essential care visit, cancer clinics should have a process for managing care such as escorting the patient to a designated treatment area.