Managing the delivery of quality cancer care during the COVID-19 pandemic in a small community cancer clinic.

Authors

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Kashyap B. Patel

Tri Cty Onc, Charlotte, NC

Kashyap B. Patel, Natasha Clinton

Organizations

Tri Cty Onc, Charlotte, NC, AmerisourceBergen, Plano, TX

Research Funding

No funding received
None.

Background: The global pandemic resulting from COVID-19 has resulted in over 400,000 deaths and nearly 7 million active cases at the time of writing this abstract (World Health Organization, 2020). This Public Health Emergency (PHE) represents an unprecedented challenge for oncologists and cancer patients alike. They are met with the challenge of providing uninterrupted care to cancer patients, a predicament that includes a balance between the use of immunosuppressive chemotherapy, it’s potential impact on contracting COVID-19 and the risk of cancer progression. Liang et al reported that cancer patients were not only at very high risk of contracting COVID -19, but also at a much higher risk of complications and death. Our medium sized oncology practice rapidly adapted to meet the challenge to continue to provide care. Methods: Employee and patient safety: Implement CDC recommendations in waiting room, infusion suites and supply of PPE. Categorize patients into priorities based on severity and need of treatment. Implement telehealth. Implement care in accordance to Cancer Patients Assessment and Treatment Priority Determination (top, intermediate and low priority)–Table. As a part of our initial strategy, we discussed the risk and balance of postponing chemotherapy or elective surgery for stable cancer patients during the first phase of closures. We also focused on more intensive surveillance in the older patient population or those with multiple high-risk comorbidities. For patients in complete remission on maintenance therapy, we balanced risk and benefit of stopping chemotherapy. In other patients, we considered the option of switching their chemotherapy regimen from IV to oral therapies, where clinically appropriate, to decrease the frequency of clinic visits and potential exposure. In cases where the option of non-immunosuppressive oral therapy is existed, we implemented the same. Results: Our clinic continues to provide uninterrupted care since the declaration of PHE. We saw a drop of 25% patient volume in March and 35% in April. However, with instant adaptation and implementation of CDC recommendations patient volume reached back to pre COVID 19 related emergency. None of our employees, their dependents nor any of our patients have contracted COVID-19 to date (according to DHEC feedback) at the time of writing. We had a total of 5082 patients visits (1261 chemo visits). Conclusions: By implementing the right steps and precautions, it is possible to provide continued care for and protect staff, physicians and patients.

Treatment priority categoryDescriptionExamples of treatment with precision medicine guided targeted agents
Top Priority(A)Patients with newly diagnosed aggressive tumors such as DLBCL, ALL, AML, Small cell lung cancer, brain mets with swelling; pancytopenia, stage IV non-small cell lung cancer (just to name a few)Immunotherapy, targeted agents as well as oral agents, such as BTK inhibitors, Venetoclax, TKIs, PARP inhibitors just to name a few
Intermediate Priority(B)Most patients requiring ongoing outpatient chemotherapy will be priority B. For patients starting therapy, recognizing that there are little to no data supporting long delays, this will be a clinical judgement call for each individual patient.
Patients already receiving therapy will need to be assessed as to whether they require ongoing treatment and should be considered Priority A. Those patients that can possibly wait weeks before continuing treatment should be considered Priority B. Also, consideration should be made for those patients that can be switched over to oral agents (consider less immunosuppressive agents),
Maintenance regimen for lymphoma
Convert patients on oral therapies if possible (BTK, targeted therapies, TKIs), patients on on-going PARP inhibitors, CDK4/6
Convert Multiple myeloma patients on all oral regimen
Low priority(C)Patients receiving oral hormonal therapy, especially in the adjuvant setting, such as HMA for low grade and low risk MDS, growth factors for low grade MDS; adjuvant hormone blockers for prostate cancer; patients receiving bisphosphonates only. Patients on maintenance treatment with deep remission

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Abstract Details

Meeting

2020 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

On-Demand Poster Session: Cost, Value, and Policy

Track

Cost, Value, and Policy

Sub Track

Organizational and Operational Issues

Citation

J Clin Oncol 38, 2020 (suppl 29; abstr 45)

DOI

10.1200/JCO.2020.38.29_suppl.45

Abstract #

45

Poster Bd #

Online Only

Abstract Disclosures

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