Interviews with Dr. Alexandre Chan and Dr. Raymond Chan
COVID-19 has affected every aspect of our lives. In the oncology setting, patients in follow-up are tentative to visit cancer clinics for fear of possible infection. To help bridge the gap between these patients and their providers, Dr. Alexandre Chan and Dr. Raymond Chan discuss the need to maintain a high-level of care for patients during the pandemic in the context of their recent publication in collaboration with VieCure’s Chief Scientific Officer, Dr. Fred Ashbury, and others.
What concerns about COVID-19 prompted you to survey clinicians about cancer survivorship issues?
Patients / clinicians have expressed concerns about the potential of patients contracting the virus, which has resulted in delays or missed routine visits and disruptions in care seeking behaviors.
There are interruptions in face-to-face care delivery that have caused many patients to have their treatment or follow up appointments altered to a telehealth visit or, in some instances, cancelled.
There has been inconsistent or no messaging regarding how institutions should be handling follow up care during COVID-19, and it was important to provide evidence and guidance to our peers on the subject.
What results and conclusions can be drawn from the response with regard to changes in clinical practice? Would you offer any specific strategies to help cancer survivors deal with these changes?
Triage of Immediate Needs of Cancer Survivors
Standardized methods are lacking to triage survivors’ immediate physical, psychosocial, and spiritual needs for urgent care during COVID-19. A standardized method is urgently needed, tailored to local conditions.
In light of expanded international adoption of telehealth in both the cancer and primary care communities, the development of standardized recommendations on broader use of tele-survivorship follow-up (with or without supporting mobile health technologies) is a priority.
Alternative Models of Care
The limitations of survivors’ ability and willingness to attend tertiary care centers during COVID-19 have created an opportunity for cancer care practitioners to de-centralize or delegate care from the specialist setting. Innovative methods of service delivery have alsobeen explored during the pandemic (e.g. home rehabilitation of survivors and delivery of oral maintenance therapies, such as anti-hormonal treatments, by pharmacies, psychosocial and spiritual support, and the like). Alternative models of post-treatment follow-up care (i.e., shared-care models; primary-care led models etc.) should be tested and implemented where supported by evidence and must be contextually and culturally appropriate.
What is the long-term impact of COVID-19 on clinical practice to support cancer survivorship?
We have not fully considered ALL the long-term impacts of virus, yet. However, the immediate, most notable impact is the COVID-triggered, rapid uptake of telehealth in cancer survivorship, and cancer care more widely, it is important that high-quality, evidence-based and practical clinical guidelines are developed to guide practice. Many guidelines with guidance resources concerning telehealth focus on the technical use of telehealth. While there are on-going research studies being conducted about the safety and efficacy of tele-survivorship models, it is extremely important that further guidance on “when telehealth should be used”, “how it should be used”, and “how it should be best implemented” in the context of cancer survivorship is available.