AVBCC Webcast Highlights: COVID-19 Impact on Cancer Care and Road to Recovery

TON - June 2020, Vol 13, No 3

To address the impact of the COVID-19 pandemic on oncology delivery systems and the management of patients, the Association for Value-Based Cancer Care (AVBCC) has held several webcasts as part of its series titled COVID-19 Impact on Cancer Care and Road to Recovery. Below are highlights from select AVBCC webcasts in this series. The complete set of articles is available at www.TheOncologyNurse.com.

Patient Advocacy During the COVID-19 Crisis

Addressing the significant physical and psychosocial needs of patients with cancer during the COVID-19 crisis remains a top priority for healthcare providers. In a discussion on patient advocacy, Elizabeth Franklin, PhD, MSW, Executive Director, Cancer Policy Institute, Co-Chair, Policy & Advocacy Committee, Academy of Oncology Nurse & Patient Navigators, moderated a panel of specialists in the healthcare provider and charity sectors.

Dr Franklin opened the session by providing an overview of the pandemic’s impact on patients with cancer. She said that it has been difficult for “virtually everyone, but cancer patients in particular have many added stressors that could lead to even more of a psychic burden.”

“They are worried about getting the virus, they are anxious or isolated, they are concerned about delays in their cancer care. And they are fearful that they will not be able to access necessities of daily living,” she said, underscoring the ways in which patients with cancer are bearing additional psychological strain.

Next to speak was Lillie Shockney, RN, BS, MAS, HON-ONN-CG, University Distinguished Service Professor of Breast Cancer and Professor of Surgery, Johns Hopkins University School of Medicine. Ms Shockney said that one of the biggest challenges that healthcare workers are facing is alleviating patients’ fears about their cancer spreading while they are waiting to have treatments or surgeries that have been delayed because of the virus.

Ms Shockney discussed the number of patients now dying in hospitals, who, in their last hours, are cut off from their loved ones, acknowledging that this is an area of intense stress for patients, families, and caregivers, as well as healthcare providers. “They are dying in the presence of strangers,” she said.

Dan Klein, President & CEO, Patient Access Network Foundation, and Patricia Goldsmith, CEO, CancerCare, who work for charities that provide financial assistance and other forms of support for patients with cancer, stressed that the greatest effect of the crisis has been food insecurity among their clients. They noted that the grants that typically go to patients to offset physician copayments or the costs of medicine are now being used to pay for groceries.

“Our goal over the next weeks and months is to try to keep funding available,” said Mr Klein. “At this point it is too early to know what kinds of medical and healthcare expenses people are going to be facing,” he added.

Ms Goldsmith echoed Mr Klein’s remarks regarding the challenges that patients are facing, such as losing their healthcare coverage because they have been furloughed from their jobs. Transportation to physicians’ offices or treatment has emerged as another area of difficulty for many patients because mass transit is off limits, and patients who have lost their jobs or who face other financial peril may be without other options.

Ms Goldsmith explained that these are not the only difficulties. Concerns about shelter, childcare, and other expenses are also mounting for patients with cancer.

“Our helpline continues to be operational, and our volume in any given week is up between 40% and 70%—the volume is absolutely staggering,” she said.

“This pandemic has exposed the fault lines and the inequities in our healthcare system,” said Dr Franklin. “It really has made people who maybe were not paying attention open their eyes and see what is going on.”

Challenges Facing Community Cancer Care Providers

Large community care centers remain committed to providing necessary treatments to patients with cancer during the COVID-19 pandemic. Ted Okon, MBA, Executive Director, Community Oncology Alliance, Washington, DC, moderated a panel of healthcare executives to discuss how the crisis is reshaping the ways in which community cancer centers provide care for their patients, the challenges that providers are facing as they navigate an evolving healthcare ecosystem, and how practices can continue to deliver care in the months ahead.

“There has been a myriad of challenges that practices have faced trying to keep patients out of the hospital while trying to continue treating them and communicating with them,” said Mr Okon. He then asked the panelists to identify the top challenges they have faced as the crisis continues.

Lucio Gordan, MD, President, Florida Cancer Specialists, and President, American Oncology Partners, described the current situation in Florida, where his practice sees approximately 75,000 patients in a year. Dr Gordan said that a significant factor among providers is “fear for their own health, that of their families, team members, and their patients.” He also indicated that obtaining an adequate amount of personal protective equipment, even simple things, such as antibacterial wipes, sanitizers, and masks, was a challenge.

Debra Pratt, MD, PhD, MBA, Executive Vice President, Policy and Strategic Initiatives, Texas Oncology, said, “In community oncology, we see the most vulnerable patients in America, and we needed to reduce the volume so we could socially distance and provide a safer environment for our patients who need to continue to have treatment.” She said that telemedicine was essential in achieving this goal, and that seeing new patients via this technology kept them out of the hospital, which she referred to as the “area of highest risk.”

Mr Okon asked the panelists to assess the new regulations related to telemedicine and the degree to which the technology is working in their practices. Jeff Patton, MD, CEO, Tennessee Oncology, stressed that, “protecting our most vulnerable patients and moving to telehealth is huge. I think it is critically important.”

“We have to deliver solutions and safety and security,” said Dr Gordan. Cutting down telehealth would pose a “severe problem” going forward, he added.

Regarding the topic of social distancing and the effect that it may have on the relationship between oncology providers and pharma, Dr Pratt said that the pharma representatives provide useful information and “make data related to FDA approvals and prescribing information readily available.” She added that since the current restrictions are not likely to change, the challenge of integrating all the pieces of the healthcare ecosystem still needs to be met.

Using Telehealth to Provide Care During the COVID-19 Crisis: The New Frontier

Telehealth has emerged as an essential component of healthcare during the COVID-19 crisis. In a wide-ranging discussion, a panel of experts discussed the benefits and ongoing challenges of using this technology, as well as its potential impact on patients and practices in the years to come.

“It has taken this crisis to push us to a new frontier, but there is absolutely no going back,” said the moderator of the panel discussion, Rick Lee, Executive Chairman, Healthy Platforms and CancerLife, as he referred to the speed with which patients and providers have embraced telemedicine. He provided a summary of the changes that have occurred since the beginning of the pandemic, including decisions by the Centers for Medicare & Medicaid Services (CMS) that have allowed expanded use of telehealth services. These changes have led to a significant increase in the number of telehealth visits that have occurred, contributing to the widespread acceptance of this modality.

Although telehealth is now widely accepted, there are certain complexities related to administration and practice that must be managed for continued success.

“Having regulatory experience is imperative, in particular during this time when things are very fast-moving and fast-paced and we are seeing changes in CMS rules and regulations almost biweekly,” said Chevon Rariy, MD, Director, Telehealth, Cancer Treatment Centers of America. In particular, “medical records maintenance is key” when deploying a telehealth program that is embedded within a larger healthcare system, he noted.

Brian Leyland-Jones, MD, Chief Medical Officer, National Foundation for Cancer Research, pointed out that in the delivery of specialized healthcare in a rural environment, where patients were required to travel up to 500 miles to a clinic, systems were already in place and functioning well. “We have all adjusted so rapidly,” he said.

During the discussion, the experts also considered the ways in which telehealth services can be used to address patient needs beyond the immediate impact of the coronavirus. For example, the use of these services for patients with illnesses other than cancer is a potential area of expansion. It is already being used in some programs to mitigate loneliness among patients whose illness or geography results in social distancing that is not solely pandemic-related. “Loneliness is disease agnostic,” Karen Keown, RN, Co-­Founder, Vida Healthcare, said, referring to these patients.

The panelists also explored how telemedicine could potentially affect clinical trials and other multidisciplinary applications. “There is a concern that they cannot get enough

patients into clinical trials and it is hurting research. And then there is the retention aspect.” Rethinking protocols could have a positive impact on areas of research going forward, said Bob Gold, Chief Behavioral Technologist and CEO, GoMo Health.

Although proposed expansions in telemedicine show promise, they are not without drawbacks. One crucial factor is the extent to which payers would be open to covering these services.

Burt Zweigenhaft, PhD, DLitt, Founder, AVBCC, acknowledged that it may be more complex in a post–COVID-19 environment. “I am hoping that the combination of government, private enterprise, and providers will be the solution,” he said.

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