Dr. Reckamp on Navigating Challenges Posed by COVID-19

Karen L. Reckamp, MD, MS, director of the Division of Medical Oncology, medical oncology director of the Women’s Guild Lung Institute in the Department of Medicine, and associate director for Clinical Research, Cedars-Sinai Cancer Center, provides insight on how she is navigating challenges posed by the COVID-19 crisis.

The COVID-19 situation continues to evolve, says Reckamp, and practices continue to change as more information is brought to light. At Cedars-Sinai Cancer Center, the staff has somewhat adapted to new routines, which include more telehealth visits and less in-person appointments, says Reckamp. The institution is working to limit the risk of exposure to the virus for both patients and staff. Everyone in the clinic must be conscious of the fact that social distancing is essential at this time.

The rising number of patients who have medical needs, in addition to the influx of patients with COVID-19 who have new kinds of needs, is concerning, says Reckamp, and all these patients need to be treated appropriately. Balance is needed so that those who have medical conditions outside the realm of COVID-19 are still acknowledged and receive the necessary care, Reckamp adds.

With that being said, institutions need to protect their staff, patients, and visitors from any kind of potential exposure to the virus. To ensure that everyone stays healthy and safe, temperature screenings have been put into place at Cedars-Sinai Cancer Center for everyone who enters the premises. Also, everyone is wearing mandatory masks. Additionally, a very limited visitor policy has been instated. Essentially no visitors permitted, says Reckamp, although there are some criteria on areas where visitors are allowed. Limiting the number of people coming through the clinic is also working to minimize exposure to the virus and to preserve personal protective equipment, according to Reckamp. These are just some of the actions that are being taken at Cedars-Sinai Cancer Center.

Although there was a resounding interest in telehealth prior to the pandemic, many institutions did not have the appropriate methods available to conduct virtual visits, says Reckamp. COVID-19 and the need for social distancing has really moved telemedicine into the next wave. Any patient who does not require an in-person visit will receive a telehealth visit by video or phone. The available physician will assess patients and address adverse events and any other issues the patient is experiencing, says Reckamp. Telehealth meetings also serve as a touch point for any anxiety; it becomes an important type of visit where physicians can stay in touch with their patients at a time when things are rapidly changing, explains Reckamp.

What is known about patients with cancer who are most at risk of infection is very little, adds Reckamp. Some of these data have come from China and Italy. Overall, it appears that patients with cancer who have had recent surgery or chemotherapy are at higher risk of infection; however, the numbers are incredibly small, Reckamp stresses. There are also data from a group in China suggesting that patients who are receiving ongoing therapy may be at a higher risk, and that may be because they are in the system more frequently. Again, the numbers are so small that it is hard to make any judgments based on that data, says Reckamp. What is known for a fact is that patients who have other comorbidities are in need of therapy more often and they are also at higher risk for potentially developing more severe complications from the virus, adds Reckamp.

Some data also suggest that patients with lung cancer are more at risk than the average patient with cancer with regard to COVID-19; however, again, the data are small, says Reckamp. This may also be because when patients were screened they were coughing and had shortness of breath; they may be more likely to showcase symptoms similar to that of the respiratory effects associated with COVID-19. Any patient who is receiving treatment and has compromised lung function needs to be careful because the consequences of becoming infected with COVID-19 may result in additional consequences.

At this point in time, no delays in biomarker testing have been observed, adds Reckamp. Generally, the question of when a patient needs to be treated is an area of active discussion, according to Reckamp. One of the questions that often arises is, “Should they be treated with cytotoxic therapy that may compromise their immune system?” Every patient and every decision is unique and requires a lot of discussion and deliberation because it is not known when the pandemic will end and when everyone can return to their daily practices. As the benefits of cancer treatment are weighed with the potential risk of COVID-19 infection, each discussion is personalized for each patient, explains Reckamp.

The biggest challenge has to do with uncertainty, adds Reckamp. How long and how severe will things get? At what point will everyone be able to return to their normal routines? That uncertainty is compounded when dealing with a cancer diagnosis and whether or not to move forward with or delay treatment of any kind, says Reckamp. For example, if someone needs to wait 2 weeks for a biopsy, that may be acceptable; however, if this goes on for 8 weeks, then it becomes less acceptable, explains Reckamp. This poses a daily challenge.

A vaccine at this time would be spectacular but this is a longer term goal, postulates Reckamp. Everyone needs to cooperate and work together in the fight against the virus, says Reckamp, and a lot of compassion is needed at this time. Everyone is experiencing more stress than ever before. Compassion will help get everyone through the situation until a vaccine or other therapeutics are developed to assist providers in a more effective way, concludes Reckamp.

Please visit www.OncLive.com to watch the entitreity of the MJH Life Sciences News Network, which provides the latest news across a variety of healthcare specialties, and a number of interviews with experts in the medical field, many of which are focused on the ongoing COVID-19 pandemic.