Keeping Cancer Patients Safe During COVID-19: Q & A from Our Most Recent Webinar

Tune in every Friday as we present a webinar featuring Roswell Park experts tackling questions about cancer concerns during the COVID-19 pandemic. Each week will focus on a different topic, and you’ll have a chance to submit questions in advance or during the live broadcast.

This week, Friday, April 24, at noon, Jennifer Hydeman, PhD, will discuss “Mental Health During COVID-19.” Register here. If you can’t tune in for the live program, you can watch it here later at your convenience.

Last week, Boris Kuvshinoff II, MD, MBA, Chief Medical Officer (and a cancer survivor himself), and Katherine Mullin, MD, Director of Infection Control and Prevention, answered questions about keeping cancer patients safe during the pandemic. Rebecca Vogt, Media Relations Specialist, moderated the program and shared viewers’ questions with the team. Here’s what they said.

Dr. Kuvshinoff: I’ve been at Roswell 18 years and I’m currently the Chief Medical Officer. I’m also a practicing surgeon, and I specialize in cancers of the pancreas and liver, and neuroendocrine tumors.

Dr. Mullin: I am an infectious disease physician here at Roswell Park, so I spend some of my time seeing patients who have infections — or there’s a concern that they may have infections — and I’m also the Director of Infection Control and Prevention, so I spend a lot of my time thinking about how we can minimize any risk of infections for our patients.

Dr. Kuvshinoff: Absolutely. We have made some decisions about decreasing the volume of traffic at the cancer center. We are abiding by the social distancing rules, and we’ve developed our own policies to make sure that we avoid crowding.

We started by trying to identify any patients who could be managed through what we call “virtual visits.” Rather than coming to the hospital for an appointment, we have visits with the patient using telecommunication, especially using video chat technology, so we can continue with their care without their having to be physically here. In some cases, patients need to be here. If you’re getting therapy or you need scans or you need surgery, obviously care of the cancer is foremost in our concerns.

Right now it’s a blend of having patients come in if we need to see them, and being able to manage their care from home if that’s safe and feasible.

Dr. Mullin: Phlebotomy is still open for blood work. As Dr. Kuvshinoff mentioned, there are patients we need to take care of, so we need to stay on top of their lab results and other tests. And we have taken a lot of measures to decrease traffic in the hospital, which will allow optimal safety for patients who do need to come in to get blood work or CT scans, or, in some cases, to see their physician.

Dr. Mullin: Yes, we are providing masks. The recommendation is that any time you’re going anywhere and you may have to interact with someone at a distance closer than six feet, you should have a mask with you, so we hope our patients also plan to wear masks even when they’re not at Roswell. But when you do come to Roswell, we will provide masks for you and your caregiver, if your caregiver accompanies you.

Dr. Kuvshinoff: As you know, the Governor sent out a health care advisory that all employees of public-facing businesses need to wear masks. At Roswell Park, we take that to a higher level. Right now we have a universal masking policy. That means that everybody who comes into Roswell is wearing a mask, especially in any area where we’re providing health care — the hospital, the clinics, the Scott Bieler Clinical Sciences Center. That includes employees, health care workers, patients and their visitors or family members who come with them. Everybody is wearing a mask.

Dr. Mullin: No. Hand hygiene is the most important thing. We provide multiple opportunities to practice good hand hygiene at Roswell in terms of having hand sanitizer available everywhere. But if you wear gloves, you’re touching a lot of surfaces and you can actually spread contaminants, so I would recommend not wearing gloves.

Dr. Kuvshinoff: I agree. It’s safer to keep your hands clean than to wear gloves all day. You can manage the sanitation of your hands much better if you’re not wearing gloves.

Dr. Mullin: I would say that’s not necessary, but that depends on your personal comfort level. Some healthcare workers are actively taking care of patients who are infected with COVID-19 — patients who do have infections, or patients who might be infected, but we’re unsure because the test results haven’t come back yet — but that’s different from someone comes to Roswell from the outside who isn’t sick and who just needs routine cancer care. We are doing our utmost to prevent those patients from having any interaction with anyone who could put them at risk of infection. So I don’t think that’s necessary.

However, if you feel more comfortable doing that — if that’s going to make you less anxious — then feel free to change your clothes. One trick I learned is to put your clothes in a pillowcase and just dump everything in the washer and dryer, including the pillowcase, so you can wash everything at once. But again, I don’t think that’s necessary.

Dr. Kuvshinoff: For inpatients — patients who have been admitted to the hospital — we have a restricted visitor policy. If a patient needs a caregiver for a medical reason, or if somebody is at the end of life, a spouse or caregiver would be allowed, but for most of our inpatients, visitors are not allowed.

Roswell Park has ambulatory clinics where outpatients come in for chemotherapy, radiation and doctor’s visits, and in those cases we do allow one visitor or companion or caregiver to accompany the patient. We treat those visitors just like the patients in terms of giving them a mask and taking precautions to protect them from infection, including distancing.

So basically one visitor is allowed on the outpatient side, but there is restricted visitation on the inpatient side.

Dr. Mullin: We’re checking everyone who comes into the institution, whether they’re an employee, a patient or a caregiver who’s with a patient. That’s part of our standard screening. If it’s a patient, they may have a fever because they have other issues going on. Complications related to cancer care can include fevers, and we need to take care of that.

That would be a separate process than if a caregiver had an elevated temperature or other symptoms of COVID-19. If a caregiver has any of those symptoms, they should not be coming into the institution.

Dr. Mullin: If there’s a concern that any of our patients have symptoms that could be related to COVID-19, we are testing them, yes.

Dr. Kuvshinoff: We are testing employees when they show symptoms. Actually, at this point, when you look at the total number of employees we have, well under 1% of our employees have tested positive. We haven’t linked any of those positive tests to employees involved in taking care of COVID-19 patients.

Dr. Kuvshinoff: We do have a floor that’s focused on patients who are diagnosed with COVID-19. We try to put the patients with COVID-19 together so we can decrease the risk of spread to other patients — and so the staff who take care of those patients can do it in one designated area.

We’re taking care of patients with leukemia, bone marrow transplants, patients who are having complex surgical procedures. They still need cancer care, and we want to put them in the safest environment where we can take care of their cancer while also decreasing the coronavirus risk in the hospital overall.

Dr. Mullin: The vast majority of the patients we’re testing for COVID-19 are testing negative, because there are other reasons that they have symptoms that can mimic COVID-19 symptoms. It’s really important that we make sure that our patients who are here to get oncology care are getting the best care for their underlying malignancy.

Dr. Kuvshinoff: We’re also testing all the patients who are being admitted to the hospital. Whether it’s a planned or unplanned admission, all those patients are now being tested.

Dr. Kuvshinoff: Absolutely. We are focused on treating cancer, and whether or not you have COVID-19, it’s just another medical issue we have to deal with. Just because you have COVID-19 doesn’t mean we aren’t going to take care of your cancer problem or your surgical problem.

Dr. Mullin: This is just one of a number of infectious diseases that we may encounter in the setting of cancer care. We are very well attuned to dealing with patients who have infections on top of oncology issues. It’s something we have to factor into treatment, but we absolutely want to make sure that patients are getting the best care possible for their cancer.

Dr. Mullin: Obviously our patients want to minimize any known exposures to people who have tested positive for COVID-19, or when there’s a concern that they may have COVID-19, so minimizing contact is key. However, we would take this on a case-by-case basis in terms of the recommendations related to your cancer care. Just because you have close contact with that person doesn’t mean you’ll necessarily develop the disease, but we would want to make sure that you’re not at increased risk for developing the disease because of that exposure.

Dr. Kuvshinoff: If you’ve had COVID-19, you’re not cleared to have contact with your loved ones who are going through cancer treatment until you’ve had a negative COVID-19 test.

Dr. Kuvshinoff: I think it depends on what type of radiation it is. There are many different kinds of radiation. In general, I would say focal radiation — radiation to a particular area — would not cause general immune suppression, such as you would see with chemotherapy, for example.

Dr. Mullin: I agree.

Dr. Mullin: If you’ve had a history of cancer in the past and you have white blood cell counts that are lower than usual, we would consider you more at risk than the general population, but again, “immunocompromised” covers a broad spectrum. The general message is that we should be doing everything to protect anyone who has any vulnerability from exposures. The key to that is diminishing the number of cases in our local community, which is why there has been a big push regionally, nationally and internationally for extreme social distancing, so we minimize that burden on people who may have a variety of different susceptibilities.

Dr. Mullin: There is no approved therapy for COVID-19. I want to be clear about that. There are some trial drugs that it was thought might help in some way, either by diminishing the virus or diminishing the immune response to the virus; we think a lot of the damage actually comes from a hyper-immune response to having the virus. We are engaged in a number of clinical trials related to treating COVID-19 patients. The patient’s underlying profile determines whether or not we are able to treat them with certain drugs.

Dr. Mullin: We do not know enough about that to say yes or no. But we do know that any person who has any other medical condition is at increased risk for having a severe case of COVID-19. I would consider immunotherapy patients to be in that bucket because they have a significant medical condition that requires immunotherapy, so I would say they’re more at risk. But we don’t have any definitive data about immunotherapy compared with standard treatments.

Dr. Kuvshinoff: It’s a complex question, because some of the immunotherapy drugs that are used — for rheumatoid arthritis, for example — are being considered as therapeutics. On the other hand, patients who are immunosuppressed because they’re on different cancer immunotherapy drugs may be at greater risk. As Dr. Mullin said, it’s very complicated, and unfortunately, we have a lot more to learn.

Dr. Mullin: The key is staying healthy, doing best practices in terms of washing hands, making sure you’re not having high-risk exposures and minimizing time in busy places where you can’t stay six feet away from people. But in terms of boosting your immune system, if there was something like that, everyone would be taking it. I wish we could say we had some sort of secret vitamin or something, but in general, try to keep as healthy and safe as possible, to put yourself in the best position in case you do have an interaction with this virus.

Dr. Kuvshinoff: Typically, the things that boost your immune system are getting rest, maintaining some level of activity — all the things we normally do to stay healthy.

Dr. Mullin: And not watching the news 24 hours a day. With everything that’s going on right now, if you are just watching the news about COVID-19 every day, it would be understandable if your anxiety was sky-high. That could keep you from sleeping well.

Dr. Kuvshinoff: Unfortunately, I think this is going to be with us for a while. We all have to adjust to what the new normal is going to be. Someday we are going to have a vaccine and we are going to have treatments, as we’ve done for many of the other viruses that have come down the pike.

We have to have patience; we have to exercise social distancing and wear masks when it’s appropriate. If we lower our guard and we become complacent and stop doing those things, we’ll put ourselves at risk of not flattening the curve but having the curve go back up again. We have to stay vigilant.

Dr. Mullin: Over the next couple of months, we’re going to have to talk about a graded approach as we hopefully smother any viruses in the community, but it’s going to take a while, and we’re going to have to reintegrate in a slow, step-wise fashion to do it safely and protect all our patients.

We have been very proactive about taking measures to keep our patients safe, and their safety — and that of our employees — is of the utmost importance to us. If people need to come to Roswell for care, they’re going to be taken care of very well. We’re putting 100% of our efforts into making sure that they will continue to get top-notch cancer care.

More Information

The COVID-19 situation is evolving rapidly. To read the latest information on Roswell Park’s response and find additional resources, visit our Coronavirus (COVID-19) web page.

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