Oncology Pharmacists Discuss Pandemic Management, Ongoing Impact for Patients with Cancer

Although they said there is only anecdotal evidence so far, a group of panelists at the Community Oncology Alliance (COA) virtual 2021 conference anticipate more late-stage cancer diagnoses as a result of delayed screenings and physician visits during the COVID-19 pandemic.

The panelists, moderated by Barry Russo, MBA, chief executive officer of the Center for Cancer & Blood Disorders & OneOncology, said the impacts of the pandemic on their day-to-day operations, staff management, and patient interactions were challenging, although they all said they were proud of their various organizations and how their staff handled the rapid changes in spring 2020.

Some of the most immediate changes involved physical changes to their offices and spaces where patients would normally be, according to speaker Lucio Gordan, MD, managing physician and president of the Florida Cancer Specialists & Research Institute. Gordan said his institute created a large COVID-19 team with nurses, physicians, pharmacists, and others, who helped disseminate necessary information and make decisions. They also leapt into action to separate chemotherapy chairs and create dividers to go between them, to ensure patient safety.

“I think all of us were able to maintain a focus on patient care and delivering the best care at all times,” Gordan said.

James Perry, MD, chief medical officer of Alliance Cancer Specialists, said staff management became a challenge as many employees had COVID-19 scares or diagnoses forcing them to stay home. Staff members often covered for each other when needed, and Perry said one of the major challenges was getting testing performed in a timely matter, especially over the summer. However, he said employees were largely ready and willing to jump in wherever needed.

Panelist Jennifer Pichoske, MS, AOCNP, FNP, chief clinical officer of the Hematology-Oncology Associates of Central New York, echoed Perry’s sentiments that staff members banded together to help each other. She added that their facility implemented an A and B formation, in which one group managed patients in the office while the others worked from home on case management and triaging patient calls. This system allowed them to safely assume that if a few employees in the office had to quarantine at home, others who had been working at home would be able to come into the office.

When discussing patient impacts of the pandemic, the panelists agreed that one of the major ongoing consequences will be more late-stage diagnoses and stage migration. Gordan said that he has only seen anecdotal situations so far but added that it is only a matter of time before clinicians begin seeing an uptick.

Perry agreed, adding, “We clearly saw less screening, and there’s consequences to that.”

He added that some patients who presented with later-stage cancers had noted their symptoms earlier, but attributed them to COVID-19, although these cases are also anecdotal. Perry emphasized that more data and information will be necessary to determine the true impacts of the pandemic on cancer diagnoses.

Pichoske said several physicians at her facility have commented on seeing larger tumors and later stage diagnoses, especially among their large population of patients with breast cancer. She also said they have seen a few oncologic emergencies, and although Pichoske said it is not an overwhelming issue yet, she expects these problems will continue.

Despite these concerning trends, all of the panelists said that their facilities have begun the process of reopening, although they are at different stages. Perry said his facility has now resumed relatively normal activities and Pichoske said they now have all staff members back in the office, although both added that they will continue using telemedicine as needed.

Gordan said they have paused their reopening progress until May, given a current spike in cases in Florida. Still, he expressed optimism about the ability of oncology care providers to handle ongoing challenges presented by the pandemic.

“I trust in the resilience of community oncology…that we’ll be able to get these patients in as quickly as possible to try to mitigate the migration and worse outcomes,” Gordan concluded.

REFERENCE

Russo B, Gordan L, Perry J, Pichoske J. Learnings from COVID-19; April 8, 2021. Presented at: Community Oncology Association virtual 2021 conference. Accessed April 8, 2021.