Bekaii-Saab Highlights How COVID-19 Could Impact Future Practice

Partner | Cancer Centers | <b>Mayo Clinic Cancer Center</b>

Tanios S. Bekaii-Saab, MD, FACP, discusses the shift toward telemedicine, the impact of protective strategies on the trajectory of COVID-19, and the potential aftereffects of the virus.

Tanios S. Bekaii-Saab, MD, FACP

As the number of confirmed cases of the novel coronavirus 2019 (COVID-19) continues to rise in the United States and around the world, hospitals, clinics, and academic institutions have implemented protective measures to keep vulnerable patients safe during the pandemic, said Tanios S. Bekaii-Saab, MD, FACP.

Such measures include the use of telemedicine, cancelling elective surgeries, rotating providers, maintaining social distancing, and surge planning.

"COVID-19 has moved us into a new world. While the history of humanity has seen a lot of pandemics, we haven't seen anything like this in our lifetimes,” said Bekaii-Saab. “However, I am an internal optimist. This will be over at some point—hopefully sooner rather than later—and then we will get back to caring for our patients in the way we always did."

In an interview with OncLive, Bekaii-Saab, medical oncologist, head of the Gastrointestinal Cancer Program, Mayo Clinic Cancer Center, medical director, Cancer Clinical Research Office, and vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discussed the shift toward telemedicine, the impact of protective strategies on the trajectory of COVID-19, and the potential aftereffects of the virus.

OncLive: What safety measures have been put in place at Mayo Clinic to reduce the spread of COVID-19?

Bekaii-Saab: Since we first started seeing the data coming out of China, we've been most concerned for our vulnerable patients who are the most susceptible to getting sick and dying from the virus. Up to 20% of older patients who have comorbidities can die from COVID-19.

We took measures early on. We knew that we would have to move to telemedicine at some point, so at Mayo Clinic, we started implementing telemedicine and digital platform strategies even before COVID-19 [spread to the United States].

How have your patients responded to these protective strategies?

My patients have been incredibly understanding. We want to protect them; that is the primary goal. We want those patients who do not need to be physically present to [remain at home].

Healthier patients are at risk of infecting others. If those patients come into the clinic, they put those who are on treatment or those who are in the hospital at higher risk. We want to protect the most vulnerable patients who require treatment regardless of this pandemic.

Additionally, we want to protect our providers. Of course, as providers we understand that we take risks all the time when treating our patients. However, this is certainly a different level than we have seen. We want to protect ourselves because we are the ones who take care of the patients. If we lose our providers to illness—or potentially death—we can no longer take care of our patients.

What other measures have been taken to reduce the spread of the virus?

We want to preserve resources. Elective surgeries and other elective [procedures] have been cancelled to preserve masks, protective gear, ventilators, and other materials for patients who will need them. That is what we call surge planning. I pray it will not get to that point, but if it does, we are going to be ready so that we minimize mortality.

We have been working aggressively to rotate our providers. Those who are not actively seeing patients on a particular day are asked to work from home. It is strange for physicians to think about home as [a place to work] because we are used to being in the clinic and hospital all the time for our patients, but it is understandable. This principle keeps the standard of social distancing. The fewer of us who are in the hospital, the less we will be in contact with each other.

Those measures have certainly affected our day-to-day operations in many ways, but we are focusing on safety measures [regarding] COVID-19.

Do you anticipate there being disruptions or delays in care?

My biggest concern is that once this is over—and it will be over—a lot of patients who will delay their care over the next 3 months, will present with more advanced disease. Some patients will not come to see a doctor even if they are symptomatic because they are scared.

Also, we may have to sacrifice the intensity of treatment for some patients for their own protection or because that is their desire. That may affect long-term outcomes.

We are trying to balance things out as much as possible, and our patients are incredibly understanding.

How could this affect clinical practice in the long-term?

At Mayo Clinic, we have been quite focused on telemedicine. We understand the capacities [of telehealth] are large, and [it may aid] a lot of our patients who travel quite far to see our experts.

This pandemic has accelerated the desire to implement telemedicine, and it is happening faster than planned. That is good in the long-term for our patients because many of them do not need to be physically present in the clinic.

As we move toward more oral drugs, less patients will need to be present in infusion centers. However, we are still bringing patients in on a routine basis. Frankly, at some point these patients will need to be seen every 3 months. For my patients with colon cancer, if I am scheduled to see them for a routine follow-up and their test, scans, and cancer markers look great, I'll call or video conference with them in 6 months. Then I'll go through their symptoms and [assuming everything looks good], I tell them I will physically see them in 1 year.

Of course, if I see something concerning, I am going to bring them in. As I said, we are seeing so many improvements in how we care for our patients. The likelihood of getting patients to remission and curing them is going to go up and, in turn, the need for patients to be physically present in the clinic is going to go down.

Based on COVID-19, we are going to change a lot of what we do, but that was needed. This crisis led us to the understanding that we need to move toward [telemedicine]. We don't need to bring patients into the clinic, make them wait in the waiting room, do the scan, do the blood test, and have them spend 1 or 2 days doing everything we require of them. Now, they can do the test, go home, and we can talk to them [virtually].

What areas of practice will be impacted the most?

Globally, we've seen severe acute respiratory syndrome and Middle East respiratory syndrome. However, those were on a smaller scale, and while they did not go away completely, they [are largely gone].

We've learned from COVID-19 that we can never become complacent; we have to be ready. We shouldn't be paranoid and constantly think that the world is going to come to an end, but when this happens again—not if, when—we need to be more prepared.

During this pandemic, we have established a lot of things that will become part of our routine. Hopefully, [these measures] will make [the virus] less burdensome to the overall healthcare system.

I hope we learn from this. Everyone needs to continue social distancing. As providers, we always appreciate the thoughts and prayers from everyone as we can continue to [care for our patients].