The need to establish preventive procedures that keep pace with the rapid evolution of coronavirus 2019 presents numerous challenges for the oncology field as institutions adapt standard treatment protocols to minimize the risk for virus spread among clinicians and patients alike.
Hope S. Rugo, MD, FASCO
The need to establish preventive procedures that keep pace with the rapid evolution of coronavirus 2019 (COVID-19) presents numerous challenges for the oncology field as institutions adapt standard treatment protocols to minimize the risk for virus spread among clinicians and patients alike.
“In oncology, we are now deluged from 2 sides: our patients who are scared to come for treatment and scared to miss treatment, asking [us] for guidance we ourselves are learning along the way, and our institutions, which are scrambling to create structures to protect staff and patients,” said Hope S. Rugo, MD, FASCO, director of Breast Oncology and Clinical Trials Education at the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center.
Like many other oncology centers across the nation, Helen Diller has implemented pandemic-specific protocols to prevent the community spread of COVID-19, a novel respiratory illness that originated in Wuhan, China in December 2019 and is thought to spread from person to person.1
Currently, Helen Diller clinicians are screening all patients for signs of infection the day before their appointments at the clinic. Those who present with any symptoms that are characteristic of COVID-19 such as fever are asked to refrain from visiting the clinic and seek testing.
The center has also transitioned many of its patient-physician interactions from an in-person to a digital format. “The pandemic has already led to much broader use of telemedicine, as we ‘see’ our patients [via] videoconferences to avoid exposing everyone to greater risk,” Rugo said.
This conversion encompasses the support services that the UCSF site offers its patients, such as its Meditation & Guided Imagery class, which is newly being conducted via Zoom. Other Helen Diller-hosted events that would normally necessitate physical attendance have either been postponed or cancelled.2 These preemptive actions are in accordance with the city of San Francisco’s recently issued Public Health Order, which mandated that residents must stay home from March 17 to April 7 and should only leave their homes if they are purchasing food, caring for a relative or friend, seeking necessary healthcare, or traveling to an essential job.3
“It is clear that [COVID-19] will take a big toll on clinical research, as our coordinators are barred from patient areas, and in San Francisco, from coming to work at all,” Rugo said.
Of note, the FDA acknowledged the impact of COVID-19 on clinical research in a statement released on March 18, in which the agency addressed the complications that the respiratory illness could introduce in the conduct of clinical trials, specifically.4
The FDA noted that “there may be unavoidable protocol deviations due to COVID-19” and outlined a series of considerations to maintain compliance and continue clinical investigation in a manner that conforms with agency standards. Evaluating alternative methods for assessments, such as phone calls or virtual evaluations is among the FDA’s recommended measures.
Considering different, pandemic-conscious ways to carry out standard oncological procedures and temporarily suspending non-essential processes will be critical not only to the operation of clinical trials but also to oncology clinics.
“The bottom line [is that we need to] protect our patients by cancelling routine visits and imaging, allowing us to take the best care of those who need ongoing treatment,” Rugo said. “We all need to work a little harder, and as efficiently as possible…COVID-19 is the biggest medical issue we have faced in modern times and has impacted all aspects of society around the world.”