A Guest Post: A Gyn Onc's Thoughts on Cancer Care in the Time of COVID-19

Over that past few weeks I have read many articles and heard patients describe their feelings of having to deal with a cancer diagnosis and treatment in the time of COVID-19. A few days ago I read an article in Reuters about how medical testing and cancer screenings have dropped since the outbreak.  
I am pleased to share this guest post by Mira Hellmann MD, Gynecologic Oncologist, Regional Cancer Care Associates, Hackensack University Medical Center on Cancer Care in the Time of COVID-19. 

The WHO (World Health Organization) declared the Coronavirus  outbreak a pandemic on 3/11/2020. This led to immediate action around the world aimed at decreasing the spread of infection.Many different recommendations have emerged regarding safety and precautions that are necessary in order to slow the spread of the pandemic and to save as many lives as possible. Furthermore, fears of collapsing the healthcare systems resulted in recommendations that reserved much of the system’s resources for management of patients diagnosed with COVID-19. Various cancer societies around the world put together suggested guidelines regarding the care and management of cancer patients during this pandemic. These recommendations were derived from data from China that indicated a significantly higher risk of coronavirus in patients with active cancer, and potentially in patients with a history of cancer. In some reports cancer was noted to be present in up to 20% of coronavirus infected patients. Mortality also appeared to be higher in active cancer patients, with a mortality rate of 2.3% in the overall population versus 5.6% in the active cancer patient population. These recommendations resulted in a precipitous drop in patient visits to the doctor. For patients who do present for treatment, modifications to standard treatments were recommended, such as withholding surgical or chemotherapy interventions in slower growing cancers, and modifying management in more aggressive cancers including increasing use of outpatient therapies and non cytotoxic therapies in lieu of surgery or cytotoxic chemotherapy.

This started six weeks ago. We have now learned more about the disease, its pattern of spread, and most importantly its anticipated trajectory. As more data emerges the likelihood of this pandemic ending abruptly; and thereby resulting in a rapid reopening of all services and resumption of normal standard of care,  is rapidly decreasing. As time progresses, the concern for rising rates of adverse non COVID outcomes, such as cancer, become more acute. Some have dubbed this the distraction effect. The extent of this effect is currently unmeasured, but with further delay in care the magnitude of this effect will continue to grow. According to the American Cancer Society 5,000 new cancer cases are diagnosed daily in the US. Given the current restrictions with access to health care, many of these cancers are going undiagnosed. Many cancers, including ovarian cancer and high grade endometrial cancer, as well as other solid and liquid tumors,  are time sensitive in terms of  treatment urgency and its effects on cancer outcomes. According to a report published in Reuters 4/28/2020 rates of screening tests for various cancers, including cervical cancer,  have plummeted in the United States since mid March, with a notable drop of 68% nationally, and even higher in coronavirus hotspots. Since we have gained more insight into the disease, we have managed to institute measures that increase safety of delivery of care, at the same time avoiding compromising the quality of the care. Universal masking measures, both for patients as well as providers, symptoms screening, including screening of contacts, and more readily available swab testing, amongst many other measures, have dramatically improved the safety of delivery of care. Telehealth, although useful in some situations, lacks physical exam, which is integral  to evaluating gynecologic malignancies.  I am urging all patients to be proactive about their cancer care, and ensure that they are not having their cancer care compromised.  Please go to your doctor, or find a doctor who will see you. Please do not allow fear to interfere with your health care. 

Stay healthy, stay safe.

Mira Hellmann MD

Gynecologic Oncologist, Regional Cancer Care Associates, Hackensack University Medical Center

Thank you Dr Hellmann. 

Dee Sparacio
Every Day is a Blessing!

After a Month ...

A month ago I wrote about how we can get through this. I firmly believe we will but I must admit things sure have changed in one months time.

Unless you are an essential business in NJ you are closed. If you are a restaurant you are closed unless you can do take-out or delivery. Schools and universities are closed, some till the end of the school year. New Jersey has a stay at home order in place where you are only able to go outside under certain conditions. We are all now required to wear a face mask when we are out in public.

I have not ventured out much except to take my dog to the vet and pick up dog food. I order food from Tractor Supply shop, they bring your order out to your car and put it in the trunk. My dog had surgery in late March and needs to have her calcium checked weekly until it levels off. Even how those short tech visits are handled has changed. We are all adjusting to how things are done.

My county, Mercer County,  as of 4/25/2020 has 3,245 cases and 183 deaths. My borough now has a total of 92 cases. At the same time there are more testing centers for those exhibiting symptoms. In most cases a doctors referral / script is needed to have the test done. 

It is difficult reading the stories of the people whose lives are taken because of the coronoavirus. Some are older with chronic conditions but others are young and up to that point healthy. A Brother I taught with passed away and many friends have family sick at home or in the hospital trying to overcome this virus. It is tragic to not be able to say goodbye to your loved one except through Facetime , nor gather with family to have funeral services or celebrate your loved one.

But there are also times of joy. My church, St Anthony of Padua provided food to over 1000 families this afternoon during a drive up event. Neighbors are shopping for neighbors.

There is also the work being conducted by researchers to give us hope . Researchers at Rutgers Cancer Institute of NJ are conducting a randomized clinical trial to once and for all answer the question if  the combination of hydroxycloroquine and the antibiotic azithromicin is effective against Covid-19.

Other researchers at Rutgers RUCDR Infinite Biologics received an emergency use authorization for a saliva collection method to determine Covid-19 without using swabs in the nose. All that is good news.

I am happy to be able to take part in Zoom meetings with my support group at Cancer Support Community of Central NJ and the Rutgers Cancer Institute of NJ. My neighbor is providing yoga classes on Facebook Messenger. This month's #gyncsm chat was an Open Mic on Covid-19 with guests from the SGO Covid-19 Task Force sharing information and answering patient questions. 

We may have a long way to go but we are making it work.

Take care & Stay Safe

Dee
Every Day is a Blessing!

We Can Get Through This

It has been almost two weeks since I last posted. At that point in time there were no cases of COVID19 in my county or borough in NJ. Things have changed. Today there are 22 cases in my county and we have one case in my small borough of ~5300 residents. Restaurants are open for take out only while bars, casinos, gyms, schools  and other businesses are closed. I am writing this as we await an update from Governor Murphy later today.

I get daily updates on the research into treatments and vaccines and risk factors from JAMA , ASCO, NCI and SGO.  It is amazing the research going on and being shared in the medical community around the world. I feel for the men, women and children who are in treatment for cancer or on trials and have to deal with this entirely new level of stress. I pray for those doctors , nurses and staff caring for coronavirus patients.

My husband and I are hunkered down with our dogs.We are washing our hands and keeping our social distance from our neighbors in our 55+ community where we are all at higher risk for the coronavirus.

But two days ago it hit me. I wasn't going to write about it but I have found over the years that it is helpful for me to write how I feel at different times.

After an e-mail exchange about something related to my community,  I felt overwhelmed and anxious. I couldn't understand the need to be discussing this topic when we were in the midst of this outbreak. That is when I flashed back to when I was in treatment. That is exactly how I felt when I was in treatment and people spoke to me about being annoyed at some insignificant incident. Who cares about that. I remembered when everyone was going out to a wedding and I was home because my counts were low. It wasn't events getting cancelled then but me having to cancel going to events which was really disappointing. Or how sad I felt when I asked if I could transfer the reservation for our  anniversary trip because I was having surgery for a recurrence the week before. I remember being so tired I couldn't get out of bed yet I could hear everyone else going about their business - mowing lawns and kids playing ball outside. I sat there and cried remembering these things. But I remembered to that it was just few months and I got through it with the help of family and friends.

This is not the first time many cancer patients have had to deal with "social distancing" and staying home due to something out of our control. We know how hard it is but we all did it because it was what what we had to do.

Now for all those people who can't see their grandchildren for two weeks (or maybe it will be a month). It was an entire year before I saw my daughter, her husband and my grandchildren because of an overseas military deployment. And right now they can not come back to the states so Skype , Facetime , phone calls and texting will have to do. So military families deal with being separated from their loved ones all the time. And with the support of other military families they get through that separation. It is not easy but it is done for a greater good.

So you see world there are many people who have had their movement restricted due to health reasons many times and there are those who are not able to live close to their grandchildren or other family member. We made it through and so can you.

Stay home, wash your hands and call, write Facetime or Skype with others so you don't loose that connection. 

Dee
Every Day is a Blessing!

Online #coronavirus Information for Cancer Survivors

There is a lot of information available on the internet about the COVID -19 virus ( #coronavirus ) and what we know changes daily. Those with underlying conditions such as heart, lung  or kidney disease and compromised immune systems are at greatest risks. .

The best place to get your information is directly from the CDC. The page is updated regularly.
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
The CDC has a special page for People at Risk for Serious Illness from COVID-19
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

The WHO  ( World Health Organization) provides information at https://www.who.int/emergencies/diseases/novel-coronavirus-2019 .

Cancer.net has a page with advice for cancer patients ( https://www.cancer.net/blog/2020-03/coronavirus-2019-what-people-with-cancer-need-know) as do a number of cancer centers. Here are a few website,

Fred Hutch  - Corona Virus : What Patients Need to Know
https://www.fredhutch.org/en/news/center-news/2020/03/coronavirus-what-cancer-patients-need-to-know.html

Memorial Sloan Kettering Cancer Center - Novel Coronavirus(COVID-19) What You Should Know
https://www.mskcc.org/experience/become-patient/novel-coronavirus-covid-19

MD Anderson Cancer Center  - 2019 Novel Coronavirus Precautions
https://www.mdanderson.org/patients-family/becoming-our-patient/planning-for-care/coronavirus-protections.html?intcmp=HPFaces1_coronavirus_03052020

If you are like me and are interested in a visual way to see data regarding COVID-19 cases you may view Coronavirus Global Cases by Johns Hopkins CSSE at https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

You may also want to check to see if your county has specific information about COVIS-19 for their residents like my county in NJ.(http://www.mercercounty.org/departments/division-of-public-health/coronavirus-disease-2019-covid-19-outbreak ) 

Remember to follow this advice:

 If you have symptoms ( Fever, Cough, Shortness of Breath) or questions regarding your specific situation, please contact your Health Care Provider .

Dee
Every Day is a Blessing!