Coronavirus: What Oncologists Are Telling Their Patients

Patient concern about coronavirus 2019 (COVID-2019) varies by oncology clinic according to the OncologyLive^® advisory board members, who discussed in a recent interview how COVID-19 has guided their patient interactions and what steps they are advising patients to take to protect themselves.

To date, patient inquiries about COVID-19 have been more common among West coast oncology clinics than any other region. “Out here closer to California, I’m getting a lot of calls [about COVID-19]. Several patients have requested letters of medical necessity to cancel flights and vacations,” said Nicholas J. Vogelzang, MD, FASCO, FACP, an expert in genitourinary malignancies at Comprehensive Cancer Centers of Nevada in Las Vegas.

The uptick in patient communication about COVID-19 extends beyond Vogelzang’s clinic to oncology clinics in California, such as the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, where Hope Rugo, MD, said her colleague received numerous emails from patients questioning the safety of domestic and international travel while on chemotherapy.

Across the state of California, “COVID-19 is a real issue,” said Heather A. Wakelee, MD, a hematologist/oncologist at Stanford University Medical Center in Palo Alto, California. “My patients are all asking about it,” added Wakelee. Jack West, MD, a cancer thoracic surgeon at City of Hope in Duarte, California, echoed Wakelee’s sentiment. “The level of concern among patients, physicians, and administrators alike has escalated by the day,” West said. As of March 9, California had 110 reported cases of COVID-19, according to CDC data.¹

Geographic Differences

Although clinicians on the West coast are fielding more questions from patients about COVID-19, at this time, this communicative pattern has not extended nationwide. Despite the regularity with which COVID-19 has been discussed in patient-physician interactions in California, Philip Philip, MD, PhD, FRCP, has not had 1 patient mention the virus.

On March 9, there had been no reported cases of COVID-19 in Michigan, Philip said. “As such, patients are not really talking about it with us. I had over 30 patient encounters and none of the patients brought up the virus,” explained Philip, who is the leader of the Gastrointestinal and Neuroendocrine Multidisciplinary Team at the Karmanos Cancer Center in Detroit, Michigan.

Philip is not alone. “None of my patients are bringing it up,” said Jared Weiss, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina. In Philadelphia, the situation is no different, according to Maurie Markman, MD, who said that there is “no major concern as of this moment” in the state. At the time of these 2 physicians’ comments, North Carolina had between 1 and 5 reported cases of COVID-19 and Pennsylvania had 6, according to the CDC.

Verified cases of COVID-19 appear to correlate with patient concern about the virus in the clinic. On March 1, New York governor Andrew Cuomo announced that the state had its first confirmed case of the novel illness.² At New York University Langone Health’s Perlmutter Cancer Center, as in the California oncology clinics, patients are fervently seeking guidance from their clinicians on how to best protect themselves from COVID-19.

“Essentially, every patient has been asking about COVID-19 and how they should address risks for exposure,” said Arjun V. Balar, MD, director of the genitourinary medical oncology program at Perlmutter.

Nabil F. Saba, MD, FACP, director of the Head and Neck Medical Oncology Program at the Winship Cancer Institute at Emory University in Atlanta, Georgia, attested that his patients, too, are actively inquiring about COVID-19. Of note, on March 6, Georgia governor, Brian Kemp, announced that a third person had tested positive for COVID-19.³

Patient concern is to be expected, but it is “important to put [COVID-19] in perspective for patients,” Saba said. “The best practices to follow to avoid exposure to the virus are the same that we have been recommending in cold and flu season.”

What Are They Telling Their Patients?

The CDC guidelines for the prevention and treatment of COVID-19 contain critical preventive practices that patients can follow to minimize their exposure to SARS-CoV-2, the virus that causes COVID-19, OncologyLive advisory board members said. These include washing one’s hands often with soap and water for at least 20 seconds and avoiding touching one’s eyes, nose, and mouth.⁴

COVID-19, which originated in Wuhan, China, in December 2019, is thought to spread from person to person.⁵ Therefore, basic hygienic actions such as washing one’s hands are important to avoid transmitting the virus.

Beyond these measures, UCSF Helen Diller Family Comprehensive Cancer Center has a variety of recommendations that they make to their patients, according to Rugo. For example, UCSF encourages patients to call to speak with their clinician if they are ill rather than to come to the clinic. Clinicians also advise “special precautions for those with respiratory compromise,” said Rugo, director of Breast Oncology and Clinical Trials Education.

UCSF additionally cautions patients to follow the national travel advisories. The CDC grades health risk by 3 levels to identify high-risk locations. Level 1, Watch, indicates that travelers should exercise usual precautions; Level 2, Alert, indicates that travelers should take enhanced precautions; and Level 3, Warning, indicates that travelers should avoid unnecessary travel to the area.⁶

Currently, the CDC has issued and continues to uphold a Level 3 Travel Health Notice for China, Iran, South Korea, and Italy. The CDC has also established a Level 2 Travel Health Notice for Japan, and a Level 1 Travel Health Notice for Hong Kong.⁷

Corey J. Langer, MD, said he not only encourages his patients to heed the CDC’s travel advisories but also to limit interaction with those who have traveled to a location with a warning in place. “I advise my patients to minimize contact with individuals who have recently traveled to or been in contact with people from endemic areas like Wuhan, Iran, and Milan,” said Langer, director of Thoracic Oncology at the Hospital of the University of Pennsylvania in Philadelphia, Pennsylvania.

Acquainting patients with the risk of contracting the virus in crowded environments, such as waiting areas and large cruise ships, is also important, according to Alessandra Ferrajoli, MD, an expert in leukemia at The University of Texas MD Anderson Cancer Center.

Although the CDC’s guidance for the prevention and treatment of COVID-19 contains useful directives for the general population, virus management protocols specific to patients with cancer could help guide care decisions in the oncology clinic, according to Saba.

“Cancer centers should take the initiative to offer guidelines to our patients and [ensure] that they are disseminated throughout the clinics,” Saba said. Saba added that the Winship Cancer Institute at Emory University has begun this process and expects that fellow institutions will follow suit if they are not already doing so.

References

1. Coronavirus disease 2019 (COVID-19) in the U.S. Centers for Disease Control and Prevention website. cdc.gov/coronavirus/2019-ncov/cases-in-us.html#reporting-cases. Updated March 6, 2020. Accessed March 6, 2020.
2. West MG. First case of coronavirus confirmed in New York state. Wall Street Journal website. wsj.com/articles/first-case-of-coronavirus-confirmed-in-new-york-state-11583111692. Updated March 1, 2020. Accessed March 6, 2020.
3. Governor says 3rd Georgian tested positive for coronavirus. News4Jax website. Published March 6, 2020. www.news4jax.com/news/georgia/2020/03/06/governor-says-3-georgian-tests-positive-for-coronavirus/. Updated March 6, 2020. Accessed March 6, 2020.
4. Prevention & Treatment. Centers for Disease Control and Prevention website. cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html. Updated February 15, 2020. Accessed March 6, 2020.
5. Coronavirus disease 2019 (COVID-19). Centers for Disease Control and Prevention website. cdc.gov/coronavirus/2019-ncov/about/transmission.html. Updated March 4, 2020. Accessed March 6, 2020.
6. COVID-19 in China. Centers for Disease Control and Prevention website. cdc.gov/travel/notices/warning/novel-coronavirus-china. Updated March 4, 2020. Accessed March 6, 2020.
7. Coronavirus disease 2019 information for travel. Centers for Disease Control and Prevention website. cdc.gov/coronavirus/2019-ncov/travelers/index.html. Updated March 4, 2020. Accessed March 6, 2020.