Joshua Bauml, MD, on Providing Lung Cancer Care During the COVID-19 Pandemic

jbIn an interview with Oncology Learning Network, Joshua M. Bauml, MD, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, discussed how he and his lung cancer patients have adapted during this unprecedented time.

What are the biggest challenges that could potentially inhibit delivery of optimal care to patients with cancer amid the COVID-19 pandemic?

COVID-19 is unprecedented in modern times. The primary means of preventing COVID 19 is with social distancing, but the treatment of cancer requires close collaboration between a patient and a multidisciplinary team. As a result, we have a real struggle with the best approach for each patient at a given time.

If we delay chemotherapy and thus minimize patient exposure, are we putting the patient at higher risk for a poor oncologic outcome? If we continue our treatments without consideration of COVID-19, are we putting the patient at higher risk for severe pulmonary complications from the virus?

Please briefly describe ways that healthcare providers in the oncology space can mitigate these adversities.

At our center, we are actively taking advantage of telemedicine. Nearly all of my visits (including those for patients receiving intravenous therapies) are conducted as telemedicine visits. I speak with the patient (either using telephone or videoconferencing) and complete a full history, just as I would in the office.

Of course, we cannot do a physical exam, but we have used videoconferencing and our electronic medical record patient portal thoughtfully to share relevant pictures of rashes and similar issues. If a patient does need to come in, we have a screening questionnaire they complete before coming in to ensure we are minimizing the healthcare risk for our staff.

We use personal protective equipment thoughtfully; we reserve N95 masks for procedures that involve aerolization of droplets. When I am on site at the hospital I wear a mask in all common areas, and wash my hands very frequently so that when I see the patient I am at lower risk of acting as a viral vector.

What approaches can clinicians and other providers adopt to help cope with staff shortages and avoid staff burnout? Are there any resources you’d recommend healthcare providers tap into during this time?

This is a central issue – our work is very rewarding, but we are taking away one of the most rewarding aspects – the human connection of knowing you are helping someone in their time of need. Our division has set up frequent virtual meetings to discuss both professional updates and simply social connections. I have similarly set up frequent videoconferences with my friends and family. Social distancing is very important, but its impact is substantial. It is critical to remember that healthcare providers are people too – if you need support, ask your village!

I am lucky to have received a grant from the LUNGevity Foundation and to​ have a close relationship with this great organization. I have referred many of my patients to the LUNGevity Helpline as well as the LUNGevity website, where there is a lot of patient-level support information. 

Additionally, LUNGevity has created an online module explicitly for individuals affected by lung cancer during the COVID-19 global pandemic. These online patient support resources are constantly being updated to incorporate Q&As and video interviews with medical experts, including members from the Scientific Advisory Board, and a COVID-19 glossary. All videos and information featured on the website are also available in Spanish and will soon be available Mandarin. 

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