Providing Safe Cancer Care in the Time of COVID
How the Rogel Cancer Center is protecting patients while adapting to the challenges presented by the coronavirus pandemic.
ANN ARBOR -- For those newly diagnosed with cancer and those in active treatment, the COVID-19 pandemic couldn’t have come at a worse time. Others have delayed having worrisome symptoms checked out. Clinical trials have been disrupted. And routine screenings -- mammograms, colonoscopies, Pap tests -- to catch the earliest signs of cancer have been postponed.
The challenges for patients and providers have been unprecedented. That’s why leaders and care teams across the University of Michigan Rogel Cancer Center have been working tirelessly in recent weeks to chart a safe, sustainable path forward -- innovating across the entire organization to provide nationally recognized cancer care while protecting patients and staff from the spread of COVID.
"As hospitalizations due to COVID have fallen at U-M, we’re resuming care in a very methodical, incremental way -- starting with patients who need treatment most urgently," says cancer center director Eric Fearon, M.D., Ph.D. "And we’ve been adapting how we work at every level to ensure timely, safe, cutting-edge treatment moving forward."
By early summer, Fearon says, the goal is to be back to as close to normal operations as possible with a number of changes in place. While some of these changes will be visible to patients, many will be behind-the-scenes.
"Being diagnosed with cancer or having a loved one with cancer is scary enough on its own," says radiation oncologist Lori Pierce, M.D. "Right now, the thought of going to a hospital or clinic might be causing some additional anxiety -- so we want to reassure those patients that we are putting every possible precaution in place."
Making the Rogel Cancer Center Safer
The changes in the wake of COVID include reducing interpersonal contacts by creating more physical distance in waiting rooms and infusion centers, spacing out visits by extending clinic days and hours, adjusting workflows to reduce the use of limited resources like masks, gowns and other protective equipment, and limiting the number of visitors and companions.
"It’s just not going to work anymore to see several hundred patients in our clinics between the hours of 10 a.m. and 2 p.m.," says oncologist David C. Smith, M.D., who oversees the cancer center’s clinical operations. "And we’ve had to get creative because any change you make has a ripple affect across all the interlocking components it takes to provide truly multidisciplinary cancer care."
Some of those creative measures include shifting some types of work offsite.
"Patients often receive radiotherapy treatment for 3-6 weeks," Pierce says. "And just because they’re healthy at the beginning of treatment, doesn’t mean there’s not a chance they will get sick during treatment -- which presents a risk to other patients and to our staff. While working remotely, our radiation therapists can check in with them before their appointments to see if they are experiencing any potential COVID symptoms, and to reinforce the importance of distancing and other actions to stay healthy."
And when a patient has COVID but still needs urgent cancer care, additional protocols have been put in place to minimize the chance of spreading infection, notes Pierce, who is president-elect of the American Society of Clinical Oncology and recently participated in a global webinar on cancer care experiences and lessons during the pandemic.
"At the Rogel Cancer Center, we don’t think resuming services will be as difficult as it will be for some places because we’ve continued to provide many vital services even during the height of the pandemic," Smith adds.
The changes also include seeing many more patients for virtual appointments through video and phone visits.
Over the last few months, the cancer center went from 95% of clinic visits being in-person down to around 30% -- with the majority instead taking place remotely.
"We had been doing a limited number of virtual visits previously, but faced with the challenge of COVID-19, Michigan Medicine came together to make them happen on a large scale faster than anything I’ve seen in my career," says oncologist Daniel F. Hayes, M.D., who treats patients with breast cancer. "Working through the barriers that were preventing us from doing more video visits is one of the silver linings to come out of all of this." [Note: Dr. Hayes retired from clinical practice in 2023]
Virtual visits have allowed Hayes to conduct regular six-month or one-year check-ins with long-standing patients, without their needing to travel to the hospital.
"We see patients from the Upper Peninsula, Ohio, Indiana -- all over the Midwest," he says. "We can talk about any symptoms they’ve been experiencing and whether they need their prescriptions refilled. I’ve asked my patients what they think of the video visits, and most seem to appreciate them, especially lately when they’ve been limiting their public contacts."
That’s not to say that video visits are a substitute for all in-person visits, Hayes acknowledges. Doctors aren’t able to conduct a physical examination of lumps or swollen lymph nodes, for example. And many people are diagnosed with cancer later in life, when operating the technology or being able to hear well on a video call can present a barrier.
"The hardest part for me is that you can’t look a patient in the eye, hold their hand or give them a hug," says Hayes, a past-president of ASCO. "Building relationships with patients and their families is one of the most rewarding parts of being an oncologist."
Still, Rogel Cancer Center doctors see virtual visits for some types of appointments taking on an increased role, even after COVID.
For example, urologic oncologist Todd Morgan, M.D., has been heading up an effort to reduce the time it takes for new patients to be seen, largely through increased virtual visits.
"Our goal is for most new patients to be offered an initial visit within a few days, instead of having to wait while we are simultaneously gathering medical records, imaging, pathology reports, tissue samples, and so forth," Morgan says. "We can start gathering the information we need and working with the patient on a game plan and timetable while all of that is still going on."
Morgan’s team is also looking at ways to accelerate and streamline the intake process by tapping into the expertise of the cancer center’s highly trained physician assistants and nurse practitioners.
"If a patient has a particular type of leukemia, for example, we want to shorten the time it takes to get them paired up with a provider here who is the expert in that type of cancer," he adds. "So, scheduling an initial virtual visit with one of our advanced practice providers may help us get a care plan for a new patient developed faster."
The bottom line, adds Fearon, the cancer center’s director: "We’re all in this together."