How I Practice Now: Lung Cancer and the COVID-19 Climate
Joshua M. Bauml, MD, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, shares first-hand insight on the management of patients with lung cancer during the COVID-19 pandemic.
My name is Joshua Bauml, I'm an assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania. I'm a medical oncologist who specializes in the treatment of lung, head, and neck cancers.
The COVID-19 outbreak has completely changed the way that we need to manage our patients with lung cancer. Here we have a virus that is spreading widely all around the world. Specifically, causing substantial morbidity and mortality amongst patients who have coexistent comorbidities and, notably, if you look at the data out of China, and more recently, out of Italy, it seems that patients who have cancer in general and lung cancer in particular are at very high risk for the development of severe toxicity from COVID19 infection.
So, it is absolutely essential that we create workflows to minimize the risk to our patients while at the same time, continuing necessary life sustaining treatments for our patients with lung cancer.
One of the things that a lot of my colleagues have asked, as they say, “Well, how are you guys doing it and Penn? What are you doing to help your patients?”
So I'll answer that on a couple of levels. So first, from a clinic perspective. My clinic, normally, I have two very full and busy days of clinic where I can see my patients and interact with them. To minimize the risk of exposure to other healthcare workers, as well as to the healthcare environment in general, my clinic as terms of being on campus has been reduced to one day a week. Most of those visits are now being done with telemedicine, either through telephone calls or through video conferencing.
That includes even on the day that I'm there. So, you know, one of the people that if a patient is coming into the healthcare environment, one of the people that's highest risk for them to see is me, because I am a person who is exposed to a lot of other patients.
And so as a result, we want to minimize the risk of exposure. So, the patient will often have that video conference or telephone call with me before they come in. Then we will go down and see the patient if something is needed for a physical exam at that time, or if there's a specific concern, and that happens you know. Patients are sick and they have other comorbidities which we need to deal with.
In terms of other changes that have happened, we need to look carefully at how frequently we're administering treatments, and what treatments we are administering. If I have two options for the treatment of a cancer and one is oral where they don't need to come in, well, that is a lot more appealing that we can provide continued social distancing
And similarly, one of the topics that will have to be considered and we are now considering it on a case by case basis, is the use of adjuvant chemotherapy after curative intense surgery. We know that adjuvant chemotherapy can improve survival by somewhere on the order of five to 7%.
But we also know that these patients are at high risk for COVID 19 and so we need to balance those risks and talk to each patient on an individualized basis to determine what makes the most sense. I suspect that over the next couple of weeks to months there may be some patients who would otherwise have received adjuvant chemo, who we will decide, you know, it's not a good time for us to be doing that.
Other topics which come up a lot: our clinical research. That's why I do what I do is to help bring novel therapies to my patients, and it's really hard for us to do clinical research right now because many of the research labs are closed down because of COVID-19 and trying to minimize exposure. So, we are trying to figure out novel ways to get patients access to trial agents and make sure that we're doing it in a safe way, and make sure that we're still able to proceed with our important clinical and translational research efforts to try to improve outcomes from patients with cancer, beyond this outbreak.
Above all else, the critical point is remembering that patient safety is the central aspect to what we do. We need to make sure that all decisions that we make are focused on “how can I make this safer for my patients?” That requires some creative solutions to things that we're very used to over time.
This is a very fluid situation. It feels like every second, every minute, every day, something new changes and we need to change the way we're approaching this. I think it's really important that we keep the lines of communication open.
One of the ways that I've been talking to my patients in terms of getting access to information is the LUNGevity Foundation—which is a lung cancer advocacy foundation I have been honored to receive a grant from—have set up a lung cancer helpline for patients to call if they have questions.
And that number is 844-360-5864, and this has been very helpful. They have a lot of great resources for patients.
That's something that I've been advising my colleagues to share with their patients so that they can help answer some of these difficult questions in this scary time.