Cancer care during COVID-19
A whirlwind of emotions set in for Christi Wendel when her Stage 4 cancer returned in the middle of the COVID-19 pandemic on March 23.
Wendel, a Fredericksburg resident who has battled cancer for three years, was sitting in the doctor’s office alone with no family members when she was told it had come back after a year-and-a-half of being in remission.
“I was scared, worried, I started to cry,” she said. “I thought, how will I do my job and take care of my kid and my family? What if I lose my hair again?”
Wendel usually has a family member to accompany her and ease worries, but because of the new guidelines set by the START Center for Cancer Care in Boerne, that wasn’t allowed.
Oncologists in Fredericksburg and around the nation have been faced with having to enforce these types of distancing rules during this pandemic in order to keep patients, family members and staff safe.
“That’s a big challenge,” said Mark C. Deleon, M.D., a medical oncologist and hematologist at Texas Oncology — Fredericksburg, where they allow only one family member at a time.
Deleon said he’s seen as many as 12 family members accompany patients.
“There’s so many family members that want to know the information and are very concerned about their family member,” Deleon said.
Deleon said he tries to talk to the rest of the family on the phone outside of typical clinic hours.
While Wendel can’t have any family members with her at appointments, she’s still gotten a lot of family support.
“My aunt drives me to my appointments and she’ll stay in the parking lot and wait, and then we’ll sometimes go to lunch after,” she said.
Another new precaution being taken is pre-appointment screening.
“We’re calling patients the day before, and kind of doing a telephone triage screening,” Deleon said.
He asks patients if they’ve had a fever or respiratory symptoms, if they’ve come in contact with someone who has COVID-19 and if they have traveled. If someone answers yes, then the physician gets involved to figure out what steps should be taken.
Wendel was happy about the new screenings.
“I think they just don’t want to get anyone sick or put anyone in danger, so I’m thankful for that,” she said.
Deleon said he’s also asking patients to follow guidelines set by the Centers of Disease Control and Prevention, such as wearing a mask, washing hands and staying home as much as possible.
Another struggle Deleon and other oncologists face is trying to aggressively fight cancer while not completely compromising the patient’s immune system to an “excessive or unacceptable risk.” Most of the cancer drugs are known to lower a person’s immune system.
“For example, if every time I give a patient chemotherapy, that patient ends up in the emergency room or in the hospital with pneumonia, then we really have to rethink those situations and, on a case-by-case basis, talk to the patient about the goals of the treatment and rethink so that you can strike that balance,” Deleon said.
Another challenge oncology centers face, Deleon said, is trying to keep a sufficient amount of Personal Protective Equipment.
“Although the supply chain is good, like every hospital and clinic, it’s not unlimited equipment,” Deleon said.
To preserve PPE, Texas Oncology tries to keep non-clinical employees working remotely, and using only one mask per day.
Locals living with cancer, including Wendel, said they haven’t experienced a change in their treatments. While Deleon couldn’t speak for Wendel’s doctor, he said Texas Oncology — Fredericksburg has worked with local surgeons to determine cancer-related surgeries as “urgent.”
“Each medical staff has a process or procedure in place to determine what’s an emergency, what’s urgent and what’s routine,” Deleon said. “For my patients, if they’ve already been diagnosed with cancer and they need surgery, we here in Fredericksburg have deemed that those are urgent to prevent worsening of cancer by having any delay.”
Deleon fears the biggest impact will be in patients not yet diagnosed.
“For example, if a woman would have gotten her routine mammogram in April, and let’s say that woman would have had a breast biopsy and then would have had breast cancer surgery. None of that is happening,” Deleon said.
While doctors are obligated to follow Gov. Greg Abbott’s order to delay routine procedures for now, it may cause a delay in the diagnosis for someone without symptoms.
“Until there is a full executive order on what routine procedures can be done, we’re certainly telling everybody to avoid doing those things for the time being,” Deleon said.
During this pandemic, some patients might have increased anxiety about getting sick with COVID-19 while receiving cancer treatment. To alleviate this, Deleon lets patients know they are behind them.
“The doctors are here, the offices are open, the clinic is available to see you,” Deleon said.
He also wants people to know that not every fever turns out to be the coronavirus.
“We get a lot of people that have regular infections, especially while they’re on chemotherapy or having fevers,” he said. “We often need to do an assessment and alleviate their fear by simply making a diagnosis.”
Wendel also offered some words of some words of support and some advice.
“You’ll get through this,” she said. “Just take it one day at a time, make sure you have support from family and stay positive.”