As oncologists, we are here to help patients and their families as much as we can. That is why we went into cancer medicine. It is what we do every day. Until the coronavirus disease 2019 pandemic knocked on our doors.
Mitchell C. Posner, MD
It happens to oncologists all the time. A friend or acquaintance pulls you aside, seeking a little advice following a diagnosis of cancer. They hope for news of a great new treatment, but, fundamentally, they are seeking assurance that a care team is ready to guide a patient expertly, efficiently, and with empathy through the maze of therapeutic options.
As oncologists, we are here to help patients and their families as much as we can. That is why we went into cancer medicine. It is what we do every day.
Until the coronavirus disease 2019 (COVID-19) pandemic knocked on our doors. In March 2020, as we struggled to flatten the curve, care for seriously ill patients with COVID-19, and ensure the safety of everyone on our medical campus, the University of Chicago (UChicago) Medicine and other institutions were forced to cut back on surgeries and shutter clinics. Cancer screenings stopped. With the city under a stay-at-home order, patients were reluctant to see a doctor in person or come to the hospital.
But we did not sit still. Given the growing constriction on personal protective equipment, staff, and resources because of burgeoning COVID-19 hospitalizations, UChicago Medicine surgeons from all disciplines collaborated to develop a system to manage resources ethically and efficiently during the pandemic. Details of this prioritization scoring system, called Medically Necessary, Time-Sensitive (MeNTS) procedures, were published in August.
However, there was more to do within the cancer realm. We already had one example of the role telemedicine could play at our institution. UChicago Medicine’s Remote Second Opinion program debuted in April 2019. Although the program is multidisciplinary, approximately 50% of requests to use it have been for cancer consultations, and 60% have been to interact with international patients.
Additionally, our team developed a number of new approaches to pandemic cancer care that included scheduling virtual visits for our patients. Our focus soon centered on the need not only to provide continued medical access to current patients, but also to provide those who had received new diagnoses with perspective, information, and reassurance.
We wanted to address the concerns of these patients who now faced closed clinics and no clear path forward, such as a woman referred for a mammogram because she felt a lump, and who thinks, “It’s breast cancer for sure. What do I do now?”
The first thing many patients with a new diagnosis do is to call their family and close friends, creating a nest of anxiety. Those loved ones try to help with opinions and stories about what other people they know have gone through. Everyone goes online, reading things that have no context to the individual in question. Many say not to worry, but of course the patient does; their diagnosis is a life-changing event.
The idea was simple enough; the UChicago Medicine team encouraged these quarantined patients with cancer to call us. Within a short time, the idea evolved into a formal pilot program called the Express Expert Cancer Opinion (EECO). The program is for patients to connect with a UChicago Medicine cancer expert for 15 minutes via video or over the phone. Sessions are scheduled with a cancer expert in the field related to the diagnosis within 24 to 48 hours of the patient’s first call. Families can participate and the program is available at no cost to the patient.
During the sessions, clinicians try to provide a sense of calm to patients and convey the empathy we feel and hopefully relieve some of their anxiety.
Given that all we know is their diagnosis— no medical records or scans are required to participate—we aim to provide hope as well as a realistic, if generic, blueprint of what care could entail.
Although we can only speak in general terms, we can offer a lot of information during that time, providing a landscape of what lies ahead. Discussions can include information about workups that may be needed, possible treatments that may be offered, and clinical trials that are available. Answers to common queries about risk of death or life expectancy are not provided as we do not have all the relevant data, and that is never a casual conversation. But we do emphasize that it matters where they first receive care, and that it is best if they seek a treatment plan from a multidisciplinary team of cancer physicians who have experience with the latest advances and who have access to clinical trials. Typically, this includes many cancer centers.
Our experience suggests that this program is popular, sustainable, and humane. The EECO was launched on June 22, 2020, and 35 patients had an EECO session in the first 3 months, half of whom live outside the cancer center’s traditional service areas. Nevertheless, 80% of those who called the EECO line scheduled a visit to the University of Chicago Medicine Comprehensive Cancer Center as a new patient.
We do not think of EECO as marketing our services, but rather as an educational, public service approach to assisting patients with cancer during the COVID-19 pandemic. More than 40 of our cancer specialists are now participating, each of whom is volunteering their time. There has been so much support. We are reaching out to anyone who wants guidance, helping patients to navigate their cancer voyage.
EECO is something we can all do with a video link, a little time, and a good dose of compassion. The beauty lies in its simplicity.
Prachand VN, Milner R, Angelos P, et al. Medically necessary, time-sensitive procedures: scoring system to ethically and efficiently manage resource scarcity and provider risk during the COVID-19 pandemic. J Am Coll Surg. 2020;231(2):281-288. doi:10.1016/j.jamcollsurg.2020.04.011