Ensuring High-quality Cancer Care During the COVID-19 Pandemic

Technology Networks recently had the pleasure of speaking to Dr Sandeep “Bobby” Reddy, Chief Medical Officer of NantHealth to gain a better understanding of the impact COVID-19 is having on the treatment of cancer. Reddy discusses what is currently known, in terms of risk and severity of SARS-CoV-2 infection in individuals with cancer, and elaborates on the innovative approaches that have been adopted by oncologists to enable continuation of high-quality care during the pandemic.

Laura Lansdowne (LL): What impact is the COVID-19 pandemic having on the treatment of cancer?

Sandeep Reddy (SR): The impact is significant because treatment regimens have been adapted for two main reasons: (i) to minimize the number of hospital visits and hospitalizations, and (ii) to prevent anticancer treatment-induced complications of COVID-19. Specific examples include:

• Increased use of growth factors to avoid blood transfusions
• Increased use of oral drugs to replace IV alternatives
• Postponing or delaying treatment, such as surgery or radiation, or switching to lower risk surgery (outpatient vs. inpatient procedures) and hypofractionated radiation schedules
• Reduced use of steroids (commonly used to treat side effects of chemotherapy)

LL: When it comes to risk and severity of SARS-CoV-2 infection in cancer patients, what do we currently know?

SR: Data from China and Italy suggests that cancer patients have higher risk of mortality when they become infected with SARS-CoV-2. In the initial data from Wuhan, the case fatality rate for patients with cancer as a comorbid condition and laboratory confirmed infection was 7.6%. This is as compared to: overall 3.8%, no comorbid condition 1.4%, cardiovascular disease 13.2%, diabetes 9.2%, hypertension 8.4%, chronic respiratory disease 8.0%.¹

LL: How will social distancing impact patient interactions with their treating physician – how does this impact cancer care approaches?

SR: Most institutions have adopted measures to minimize risk to patients and staff which changes how we treat these patients. For example, triage of second opinions, follow-up appointments by phone (except when physical examination is necessary). When possible, reduce or delay the number of radiological-response evaluations. Perform blood tests outside the hospital (e.g. home nurse), when possible. Deliver oral medications to the patient’s home, rather than being picked up at the pharmacy. All of these measures can continue in a post-SARS-CoV-2 world and may lead to reduced costs and improved quality of life for cancer patients.

LL: What questions are oncologists facing when recreating treatment plans?

SR: The main questions asked by oncologists are whether they should reduce the intensity of treatments in the non-curative setting and how best to manage toxicities in the potentially curative setting. For example, a patient has early-stage disease and requires adjuvant chemotherapy to prevent relapse but is currently well, with no evidence of disease. Chemotherapy will cause immune suppression, and this certainly increases the risk of mortality with SARS-CoV-2, but insufficient chemotherapy may increase the risk of cancer mortality. These scenarios must be considered carefully and each treatment plan must be individualized for the specific patient based on their unique risk factors and goals of treatment.

LL: What tools and technologies can be used to help in the care of patients with cancer during the pandemic?

SR: Telemedicine has been the greatest asset in widespread use. Virtual tumor boards were rare prior to the pandemic and now are routine and likely may continue post pandemic as a means for broad, easy communication for multi-disciplinary teams. Remote monitoring devices are also proving valuable to evaluate patients without bringing them out of isolation.

Additionally, our Eviti platform at NantHealth can help by arming oncologists with comprehensive information so they can recommend evidence-based treatment plans that maximize outcomes and minimize waste, enabling high-quality, high-value care for patients during this time.

References

1. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available at: https://www.who.int/publications-detail/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)

Dr Sandeep “Bobby” Reddy, was speaking with Laura Elizabeth Lansdowne, Senior Science Writer for Technology Networks.