How I Practice Now: Treating Lung Cancer and Staying Well During COVID-19


Kristin Higgins, MD, Winship Cancer Institute, Emory University, Atlanta, Georgia, shares how the treatment of patients with lung cancer has been impacted by the COVID-19 pandemic.


Kristin Higgins, MD:  I'm Kristin Higgins. I'm a radiation oncologist at Emery University. I'm the medical director of our main campus radiation oncology department and I'm an associate professor. I specialize in the treatment of lung cancer.

The last weeks have certainly been challenging in the treatment and delivery of cancer care. There's a lot of uneasiness amongst our patients on what are the next best steps in their care.

We have experienced many patients who were teed up to get a resection of their lung cancer and now they're not able to get that resection, so what next? Those are some of the challenges we're dealing with.

We are, thankfully, able to offer patients that can't get a resection, we're able to offer them stereotactic body radiation therapy as an alternative to surgery, and we've been doing that with several patients over the last few weeks.

Thankfully at Emery our thoracic surgeons are starting to be able to do cancer surgeries. Just some at the end of this week and next week, so that will be coming back online soon. I just want our patients to know that our teams are working really hard to get you the best treatment.

This is where our multi‑disciplinary tumor boards are really essential in deciding the next best alternative for a patient if something needs to change based on what's going on with the COVID pandemic. That's where we've seen a lot of changes in the treatment of lung cancer.

In terms of patients that are getting radiation therapy for lung cancer, we have recommended that they continue to get their treatment as planned. Our institution and the vast majority of institutions across the country have put in place strict protocols to ensure the safety of our patients that are coming into our cancer centers for treatment, including no visitors allowed, just limit any exposures, of course frequent hand washing, screening for unique COVID-related symptoms and so forth. We've been able to continue to deliver radiation therapy for really all of our patients during the COVID pandemic.

There are some patients that were able to delay treatment. For example, some patients with prostate cancer and early stage breast cancers and all of that. All of those decisions are being made by those multi‑disciplinary care teams that involve the surgeons, our medical oncologists, and our radiation oncologists. These multi‑disciplinary platforms that we have set up are really crucial during times like this.

Of course, there are challenges when we have patients that are found to be COVID positive. In radiation oncology, if a patient has started radiation therapy it's really important that the treatment is carried out with an attempt to minimize the amount of days that are missed as much as possible because if there's a long lag in treatment it can make the treatment less effective.

In patients that have been diagnosed as COVID positive, we've been certainly making sure that they're able to recover, athen coming together as a team and deciding what is the next best step in terms of how they're able to restart their radiation treatment. Some centers are retesting and getting a negative test and then bringing the patients into restart.

There's also been some recommendations put forth by infection control at various institutions that support having a patient restart if it's been 14 days since the onset of their symptoms of their COVID illness. There's some guidelines that are being developed around that.

That's been one of the challenges for me, as a medical director, just to make sure that when we are looking at restarting a patient, that we're doing it in the safest way to protect the patient, our staff, and of course, all of our patients that are getting treatment within our center.

Other challenges are how to keep our staff anxiety levels down. Certainly, it's just a time that's really unprecedented in anybody's life. Some of the things that are helpful are just to acknowledge the fact that it's OK that everybody is feeling uneasy, and that makes it easier for everybody to acknowledge that the days are hard, and that's OK.

I think, as a physician, it helps me to stay on a routine as much as possible when it comes to things like exercise and those sorts of things. Even small things are becoming more difficult. In my hospital, for example, it's getting harder to eat healthy because they've taken away the salad bars and closed a lot of the cafes that have fresh food available for lunch.

Those are some of the things that just make the day-to-day a little more difficult, but we're trying to keep a routine and stay healthy, and continue to do those pieces of wellness that are critical to really make sure that we can keep up this pace.

Because I think we're still at the beginning of the coronavirus pandemic and there's a long road ahead, so we need to make sure that we don't burn out too early. It's a struggle. It's not easy, but our teams are working together and trying to keep everybody's spirits up.

It helps to have the support of the communities. Some of the applause at 7:00 PM in different cities. They're doing that in New York City, and even here in Atlanta, and I think that can be helpful for people to feel that their work has value.

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