Dr. Laura Esserman on How to think about your cancer care in the time of COVID-19

April 28, 2020

BY DR. LAURA ESSERMAN
APRIL 28, 2020 6:30 AM EDT
Esserman is Professor of Surgery and Radiology at the University of California, San Francisco (UCSF) and director of the UCSF Breast Care Clinic. Her work in breast cancer spans the spectrum from basic science to public policy issues, and the impact of both on the delivery of clinical care.

Getting the news that you have cancer is overwhelming and frightening. The COVID-19 crisis adds another layer of anxiety. But know this: you can protect yourself from COVID-19 without compromising your cancer treatment. Don’t panic. In the vast majority of cases, a diagnosis of cancer is not an emergency even though it feels like one. There is time to learn about your options and sort out what is right for you.

For now, there will be changes to how we do things. Some of the changes will feel disruptive, but many will lead to better, more patient-centered care. Minimizing your chances of exposure to the virus doesn’t require sacrificing good care.

How you interact with your cancer care team will change during this period.
In keeping with directives to shelter in place, whenever possible, your visits will be by phone or video. In-hospital appointments will be kept to a minimum to reduce your potential for exposure.

Your treatment/screening schedule may change. Your care team will reschedule or delay treatment when it is safe to do so, without compromising the effectiveness of your treatment.

Many oncology societies have issued guidance for care *. Your care team will know best about your particular situation. Your cancer care teams are still at work.

If you are newly diagnosed with invasive cancer

There are safe ways to postpone surgery. Systemic therapies (chemotherapy, hormone therapy, biologics and immuno-oncology treatments) are already a part of cancer care. Starting with that therapy before surgery (neoadjuvant therapy) is a great approach and is not only equally safe but allows us to learn how your tumor responds, if additional treatment will help, and whether aggressive surgical procedures or radiation can be avoided. We use this for breast cancer routinely. Switching the order of therapy helps tailor your treatments to response.

If you are in the middle of chemotherapy treatments, you should continue. Your doctors may take more precautions to support your blood counts. Stay home. Have others grocery shop for you. Your physicians may have you come in less often and have your caregivers/support accompany you by phone/video.

A new precancerous/high risk lesion (Ductal Carcinoma in situ (DCIS), atypical lesions, cervical neoplasia) is not an emergency. Waiting a few months is safe and active surveillance and prevention medications are possible alternatives.

If you are waiting to start radiation, your radiation oncologist will prioritize when to start. For some, waiting up to 12 weeks is safe. Shorter courses of treatment may be appropriate and just as safe.

If you are due for routine cancer screening, don’t go in now for mammograms, lung CT, or repeat imaging for low risk findings. Waiting 3 months will not change your outcome.

If you have recently learned that you are at VERY high risk, because you have inherited a mutation that increases your risk for developing cancer, you can get a video consult, learn about options for risk-reduction and screening, and schedule appropriate screening 3 months out.

If you are a cancer survivor, follow-ups and screening can be safely put off 3 months.

If you have a new mass or a new symptom that worries you, that may be reason to go in for imaging or an exam. Cancer clinics are open to care for you. You can always start with a video-visit.

Why it is important to triage surgical cases – We still need to put the infrastructure in place and scale up the tools we need to take care of everyone safely. This includes COVID testing, personal protective equipment, beds, blood supply, and ventilators in place for safe care of cancer patients in the operating rooms and hospitals. Postponing surgical procedures using multidisciplinary approaches can also allow combined reconstructive cases to proceed safely. If everyone stays home now, we prevent our health care system from being overwhelmed, so emergent and urgent cases can proceed. As COVID testing becomes widely available, we can safely resume surgical procedures, and allow loved ones to be present. When possible, facilities will be separated for COVID and non-COVID related care.

The silver lining is that a crisis drives innovation and patient centered care. We have a strong foundation of science and clinical studies upon which to build, more effective treatments, more options and a better understanding of how to personalize care. We can safely do less for those with very low risk tumors, and more for those that need it. Even without COVID, we should be tailoring treatment to risk, biology, and evolving clinical data. When it is safe to do less, that is actually a benefit. This is a time when acting on such data is particularly important.

Many cancer research studies have been put on hold, but not all, and COVID 19 studies are starting in earnest**. Once the worst of the crisis passes, and COVID testing is in place, we need to safely re-open research studies because finding new and better ways to treat cancer is essential.

If everyone helps to do their part, we will all get through this better as a community, making sure we do what is best for you and everyone going through this incredibly challenging health pandemic.

Stay home, help flatten the curve, and know that we are here for you.

Resources

*Clinical guidance

https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19

https://www.nccn.org/covid-19/

https://www.breastsurgeons.org/management/practice/covid19

https://www.facs.org/covid-19/clinical-guidance/elective-case/colorectal-cancer

https://www.facs.org/covid-19

https://www.ucsfhealth.org/education/breast-care-in-the-time-of-covid-19

**Research guidance

https://www.nih.gov/health-information/coronavirus

https://www.thewisdomstudy.org/

Original Post: https://time.com/5828180/cancer-care-covid19/

For more information, email k.zeitzer@quantumleaphealth.org