Community oncology providers have risen to the challenge of cancer care in COVID-19, said experts during an Association for Value-Based Cancer Care webcast, held on July 30, 2020. “We are in uncharted territory with a path ahead that is uncertain,” said Debra Patt, MD, PhD, MBA, Executive Vice President, Policy and Strategic Initiatives, Texas Oncology, whose 221-site practice serves approximately 50% of all patients with cancer in Texas. “But with hospitals overrun, and many patients who don’t want to travel and are more reluctant to go to hospital systems, we have been champions in guiding a lot of vulnerable citizens through difficult waters. Our practices have adopted more than 30 different new protocols, such as decreasing visitors in clinics, screening, navigation, enhanced cleaning practices, and work from home, trying to make our cancer centers the safest places possible in the United States because we serve the most vulnerable citizens.”
New Mexico Hematology Oncology Consultants, with offices in Albuquerque and Gallup, has implemented some telemedicine services but overall has not seen patient visits decline. “Telemedicine is not the end-all and be-all of medicine, especially not in cancer care,” said Barbara McAneny, MD, MACP, FASCO, who is CEO of the organization. “Our patients need radiation, chemotherapy, surgery, laboratory visits, and physical examinations. Our clinics are probably the safest places these patients can be—we’ve staffed up our cleaning crews and the facilities are being cleaned all day long. Despite the fact that people may be exposed at home or in the grocery store, we have yet to have a staff member test positive for COVID.”
Community oncology practices have taken extraordinary steps to support their staff through the crisis. “We have not and do not plan to furlough or lay off anyone,” said Dr McAneny. In fact, her practice gave a COVID family medical raise to all employees earning under a specified income, to offset some of the income losses their partners and other family members may be facing.”
Carolina Blood and Cancer Care Associates has made a similar commitment, said Kashyap Patel, MD, the organization’s CEO. “Even before we knew what our volume would be during the pandemic, we decided that before we would lay off a single staff member, all of the partners would stop drawing a salary. We didn’t need to do that because our practice continued to have volume, but we have also given employees 2 extra salaries as a bonus to help with childcare and other additional expenses.”
Additional support for patients has been a critical part of community cancer centers’ work for the past several months, said Dr Patt. “Every patient that we see requires an additional 10-minute conversation about things like whether or not they can see their grandchildren, how to manage exercise during a time of sedentary isolation, and how they manage depression. These are not new problems, but they are of escalating importance because now every patient must have dedicated time. I’d say about one-third of our office visit time is now dedicated to management of the COVID crisis.”
Texas Oncology has launched a series of virtual support groups, employing 11 social workers across the state to help manage them. “They are filled to the max every time, and continuing to grow,” Dr Patt said.
“One of the first questions I ask every patient is, ‘How are you adapting and existing in this COVID world?’” said Michael Diaz, MD, Assistant Managing Physician and Vice President of Florida Cancer Specialists, which has some 90 locations serving approximately one-third of patients with cancer in the state of Florida. “COVID-19 can spill over into our patients’ ability to get treatment, maintain their nutrition and hydration requirements, activity levels, and mental health. I find that I’m discussing, both with patients and staff, basic things about their home life that I normally wouldn’t have time to do.
The New Mexico Cancer Center Foundation has been providing grants and other support to patients so that they can continue to pay for food and housing during the crisis, Dr McAneny said. “There was a time when they closed down the entire city of Gallup and did not let anyone in or out, which meant that the surrounding small communities like Zuni had no place to buy food. We created food bags and gave away hundreds of bags of food. At first people were very proud and didn’t want to say they needed help. But when we asked, ‘Are you afraid to go to the grocery store because of COVID?’ then everyone gratefully accepted a food bag.”
Dr Patt predicted that the new protocols and services adopted by community cancer centers will continue to be part of operations for at least the next year. “But now we need to start thinking about the fact that a lot of people who have cancer don’t know it,” she said. “In my community, we’ve seen about a 90% reduction in cancer screenings such as colonoscopy and mammography. We need to make sure that these people come to the attention of oncologists and have their care navigated appropriately.”