In an interview with Oncology Learning Network about the provision of care for patients with cancer during the COVID-19 pandemic, Steven A. Pergam, MD, MPH, Medical Director for Infection Prevention at Seattle Cancer Care Alliance (SCCA), Washington, shares insight on the challenges potentially inhibiting delivery of optimal care, methods for avoiding staff burnout, and evidence-based resources to which healthcare providers can refer.

What are the biggest challenges that could potentially inhibit delivery of optimal care to patients with cancer amid the COVID-19 pandemic?

Not surprisingly, we are evaluating potential supply shortages closely—from medications, cleaning supplies and personal protective equipment, focusing on maintaining a reliable supply. However, no matter what you do there are surprises of items that become hard to get. Nasopharyngeal swabs for SARS-CoV-2 testing were suddenly a gap we hadn’t expected, nor was viral transport media or pipette tips. We could anticipate some, but even with planning and looking at multiple different vendors, supplies were already low due to global use in China, Europe, and elsewhere. It continues to be a problem for personal protective equipment, which we watch very closely. This equipment is critical to preventing transmission, detecting infected patients and assure environmental cleaning after patients visits—all of which are essential in preventing the spread of the virus among our patients and staff.

We were lucky to plan ahead, and we have a phenomenal lab (University of Washington Virology) that developed one of the first assays in the United States. So we have adequate tests for patients and staff, however, we have proactively and preemptively developed creative solutions to conserve supplies and avoid shortages from increased consumption. We have requested staff to wash their hands with soap rather than use hand sanitizer, and we are limiting the number of team members entering rooms with patients. We keep close eye on our supplies and share with others in the community who are running low.

One surprise that we didn’t anticipate was blood and blood products. Blood drive cancellations due to the COVID-related closures of schools, businesses and events are jeopardizing our region’s blood supply. A healthy blood supply is vital to cancer treatment. We are encouraging people to donate blood so we can avoid a shortage, and our center has taken a leadership role in encouraging donation. Many of our staff participated in these drives.

Ensuring adequate staffing is a priority as well. We have established a multi-layer coverage system to address potential staff shortages due to the number of challenges this pandemic has created from school closings, to staff members being quarantined on short notice. Some staff even got stuck outside the United States—so it is important to cross-train staff and prepare for absences.

Please briefly describe ways that healthcare providers in the oncology space can better prepare for and mitigate these adversities.

We serve a population with many immunocompromised individuals, so we must be open and transparent with our patients about COVID-19 and its impact and offer as many resources as we can to educate them about and protect them from the virus.

Education and patients learning how to best protect against getting infection in the community is a major step for their protection. These efforts at education must also include family and other caregivers that take care of them. Being upfront that their care has to change in this environment is necessary. For example, telling them that seeing their doctor may occur on a computer screen instead of an office. We need to prepare them for a new normal with COVID-19.

SCCA has created a dedicated webpage, which has become a repository of our most up-to-date information related to COVID-19 and the measures we’re taking to ensure the health and safety of our patients, staff and community.

We established a nurse triage line for patients to call with their COVID-19-related concerns. We are asking patients to call that line in advance of their appointments if they are experiencing symptoms related to the virus.

Our trained nurses provide guidance about whether the patient needs to reschedule or cancel their appointment. They can also direct them to get tested at a drive-up station we developed near campus, so we can avoid bringing in symptomatic patients for appointments if possible.

We also further strengthened our respiratory prevention plan to assure that patients could be screened at the front door, and those with symptoms could be tested. This allows us to mask patients, rearrange appointments for patients who show up with symptoms, and to assure family and caregivers follow our policies.

Our oncologists had to change their operations and policies to protect patients as well. To reduce potential COVID-19 exposure and reduce PPE consumption, we modified our visitor policy. This was a difficult decision for our patients, families and medical staff since we recognize the important contributions of family/friend support for our people with cancer.

Our center also made the very difficult decision to reschedule non-essential patient visits out of concern for our patients’ health and to make sure that we are well-positioned to care for our patients already in active treatment. We felt it was necessary to assure that we treated the patients who needed therapy, and delayed follow-up visits, or elective procedures so we could prepare for an expansion in the number of COVID-19 cases in our area or to be ready for a large cluster in our community.

We are exploring new ways to care for patients, too. We have rapidly expanded telemedicine efforts and have begun conducting many of survivorship, routine follow-ups and other consultations by this method. We still see patients on our campus, but if we can convert a visit safely into one on-line, it is not only convenient for patients (who often travel long distances to our center), but it also safer during this pandemic.

What approaches can clinicians and other providers adopt to help avoid burnout?

We have to take care of ourselves and it isn’t always easy. SCCA is doing everything we can to ensure the health, safety and well-being of our staff. With providers on the front lines of care, we are proactively addressing the emotional and physical wellbeing of our staff and making a conscious effort address the impact of the challenging and ever-changing situation.

Our leadership team frequently shares information with clinicians and staff members at the clinic, and we have encouraged staff to use the multiple internal channels to communicate any concerns.  Weekly Town Halls keep staff up to date of new developments, and we share daily communications from leadership. We encourage staff with concerns to speak up and try to modify approaches to when we can. We have even cross-trained multiple individuals to lead our “Incident Command” so that individuals shift every two weeks to assure needed downtime to rest.

We are constantly considering current and future staffing issues – such as policy and compensation development for furloughs and mandatory isolation, creation of a back-up labor pool and reassignment of duties for staff who are immunocompromised or have significant comorbidities that put them at increased risk with COVID-19.

What has been wonderful is seeing how our community has stepped up to help. We have had restaurants deliver food, community members donate masks, and many have helped share our messages of “stay home, stay safe” on social media.

We have also had leadership in our communities who have made difficult choices to save the most vulnerable, form our Mayor, Governor to our elected representatives in Washington, they have all listened to our clinicians and scientists to address the pandemic.

What are some resources healthcare providers can refer to for evidence-based recommendations on how to manage cancer care during the COVID-19 pandemic?

People should turn to reliable sources such as CDC.gov and their local health departments to get up-to-date information on COVID-19, while avoiding websites that promise a quick fix or treatment to protect them from the virus. Many cancer centers have developed fantastic protocols and screening tools, so reach out to your local cancer center to see how they are handling these situations. We can all learn from others and adopt best practices to ensure the best care for our patients.

For anyone other there, SCCA is sharing resources for staff, clinicians and the public at: www.seattlecca.org/blog/2020/01/what-we-know-so-far-about-covid-19-coronavirus. Our center published our early experiences in the Journal of the National Comprehensive Cancer Network, and recently posted our updated experiences and forecasting the future on the American Society of Hematology’s COVID-19 website. We also have lots of important guidelines on our University of Washington COVID-19 webpage.

Continued collaboration and cooperation will help us all improve our practices to ensure the health, safety and wellbeing of our communities. I encourage anyone with new or innovative ideas to send them our way, and make sure you listen to your staff—some of our best ideas originated from people on the frontline.

Is there anything else pertaining to your research and findings that you would like to add?

We continue to work and address and prepare for potential challenges in this ever-evolving situation. Coordination is occurring across all SCCA departments, and we continue to work closely with our alliance partners: Fred Hutchinson Cancer Research Center, University of Washington Medicine and Seattle Children’s.

We also are sharing our approach and best practices with other cancer centers across the country. We are happy to be a resource, and no doubt will be learning from others as we all continue to address this unprecedented situation. I encourage emailing, calling and asking for help when you need it. We have all called numerous friends and colleagues to talk about policies, to debate strategies and to share our experiences. We are all in this together.

Most importantly, take time to step away from the pandemic. Take a walk outside, bake bread or play a board game with your kids. Stay in touch with friends and colleagues and reach out to others if the stress and challenges of the current situation are getting to you. You need to recharge to save your strength. It is going to be a long fight.