Cancer Care in the Time of COVID-19

By Randall A. Oyer, MD

For resources on COVID-19 as it applies to the oncology community, please visit ACCC’s continually updated Coronavirus Resource page. ACCC members can also access ACCCExchange, a listserv that allows them to communicate in real time with their colleagues about how the COVID-19 virus is affecting their communities and their patients.

As a community-spread disease, coronavirus 2019 shows us the importance of community—from a global, national, state, local, workplace, and individual perspective. 

On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 was a global pandemic. This brings home the reality that across borders and boundaries, we are not only part of a global economy, but also members of a global community. COVID-19 has brought to the fore health challenges that have needed a concerted response globally and locally.

Our national response to this threat has focused us not on our differences, but on our common needs, requiring cooperation and participation from everyone in response to the imperative to “flatten the curve” of COVID-19 spread. Local communities across the country have come together, putting the common good foremost in their behaviors, following local restrictions to dampen the effect of coronavirus disease. 

The Association of Community Cancer Centers (ACCC) represents all individuals involved in the delivery of cancer care in all settings—from small private practices and clinics to large academic centers and tertiary care facilities. ACCC is a community dedicated to ensuring patient access to quality care close to home. As a population, cancer patients, most of whom are above age 65, often have additional comorbid conditions, and—if in active treatment—are immune-suppressed and at greater risk of worse outcomes from COVID-19. 

As events have unfolded over recent months, ACCC members have connected through ACCCExchange—our online member community—asking questions, sharing resources and experiences, and offering support in delivering quality cancer care during this unprecedented health crisis. 

Member programs in the areas hardest hit have posted their in-the-trenches advice to those just beginning to feel the impact of COVID-19. From Atlanta to Northern California, New Jersey to Oregon, and Houston to Pennsylvania, our members have responded to queries such as, “What is your practice doing in the time of COVID-19?” “How are financial advocacy staff navigating COVID-19?” and “Should we provide PPE to patients in infusion?” Ongoing discussions address tips for managing virtual cancer conferences, conducting curbside screening, managing workflow, and more. 

Past ACCC President Jennie Crews, MD, MMM, FACP, shared these practical tips from the Seattle Cancer Care Alliance, which has been in the thick responding to the COVID-19 outbreak:

• Take social distancing seriously.
• Formulate your policies and procedures now on testing algorithms.
• Establish testing locations, such as drive-through screenings.
• Screen all patients at the door so you can isolate symptomatic patients and evaluate for testing.
• Limit visitors and do not allow symptomatic visitors to enter your facility.
• Consider telehealth options.
• Have patient education materials available.
• Inventory personal protective equipment and test kits and ensure you have a good supply chain.
• Define “out of work” and “return to work” for those who are identified as a person under investigation or anyone who has tested positive.
• Define essential and non-essential personnel at your cancer program so you can determine who can feasibly work from home.
• Create a labor pool from non-essential personnel who may be called in to back up staff in areas that do not require practice licensure.
• Establish Human Resource policies on how you will pay furloughed employees.
• Look at increasing your capacity by moving routine patients out, and develop the criteria you will use to decide which patients can be deferred.
• Cancel business travel and consider vacation freezes.
• Examine childcare options as schools and daycares will close. Consider setting up a site like Craig’s List where staff can identify needs and others can offer help.
  

ACCC’s continually updated COVID-19 resources page brings together knowledge, experience, and information from leading organizations in oncology (e.g., ASCO, ASTRO, ONS), healthcare and public health (e.g., AMA, CDC), and regulatory agencies (e.g., CMS, FDA).

In the months to come, ACCC will continue to support and connect oncology stakeholders locally, at the state level, and nationally. Together we are stronger.

Randall A. Oyer, MD, is ACCC President 2020-2021