Published May 6, 2020

Too Many Cancer Patients Ignoring Serious Life-Threatening Symptoms, Says NYU Oncologist — ‘Just Call Us’

As telemedicine becomes the norm for treatment during COVID-19, oncologists talk to SurvivorNet about what the future of cancer care will look like after the outbreak

Shelby Black

Details

Cancer Patient Care After COVID-19

Telehealth gives patients a way to talk to medical providers about symptoms and possible health issues they may have, but physical checkups are still crucial in detecting diseases such as breast or lung cancers.
There’s no physical data on how immunotherapy treatment reacts to COVID-19, but oncologists are following guidelines in how to determine whether starting or resuming immunotherapy is safe for patients.
Patients should never ignore symptoms they’re experiencing, and try to consult a physician through virtual clinics or in-person

“One of the things we’re concerned about is that patients and people are afraid to leave the house, and a product of this is that people who have serious, life-threatening illnesses are not seeking medical attention in a timely fashion,” says Dr. Abraham Chachoua, a medical oncologist specializing in lung cancer at NYU Langone Health’s Perlmutter Cancer Center.

Due to the coronavirus outbreak, cancer screenings have dropped, elective surgeries have been delayed, and some primary care facilities have closed their doors in accordance with the Center of Disease Control and Prevention (CDC)’s recommendation of social distancing. In order to still provide care, some hospitals have been increasing telemedicine options for patients through virtual clinics such as NYU Langone Health’s Perlmutter Cancer Center’s new Suspicion of Cancer Virtual Clinic. In these clinics, patients will be able to explain their symptoms with nurse practitioners over a video call and may be referred to other doctors for further discussion.

“Don’t ignore symptoms that would be significant, just call us,” Dr. Chachoua says.

Telehealth has been prevalent amid the pandemic as it provides a virtual face-to-face interaction with medical workers, and Dr. Chachoua that it also makes getting second opinions on a diagnosis easier, but telemedicine also comes with significant drawbacks. In order to detect diseases such as lung or breast cancer, oncologists must physically examine the patient by listening to their lungs or feeling over their breasts for lumps.

“One of the things that bothered me during this time is that you can do some things with teleheath, but you can’t do everything,” Dr. Chachoua says. “I think we’ll find that there’s no real substitute for the physical exam. So some people will need to come in and be examined and evaluated.”

Dr. Senayet Agonafer, a radiologist at Montefiore Medical Center, explains why mammograms are still the best tool in detecting breast cancer

The Immunotherapy Debate

In order to care for cancer patients, a debate between oncologists throughout COVID-19 has been whether immunotherapy treatments will benefit or diminish patients’ immune systems from the respiratory virus. However, Dr. Chachoua admits there’s no easy answer to that question, especially since oncologists are still unsure how the virus and treatment will interact with one another.

“It’s a good question with no good answer,” Dr. Chachoua says. “When you give someone immunotherapy you warn them that immunotherapy can cause lung inflammation. So therefore the concern we would have if someone has COVID-19 related lung inflammation, called pneumonitis, and if you give them an agent which can cause pneumonitis, you may end up with worsening the situation. Nobody’s actually proven that, so we’ve tried to come up with a guideline for our patients.”

The guidelines in question outline how oncologists should approach giving patients who exhibited COVID-19 related symptoms immunotherapy treatment if that’s an option. Dr. Chachoua says patients should go through a CT base line scan, and if the scan shows no inflammation then patients can start or resume treatment. On the other hand, if the scan does show lung inflammation, then patients would have to wait for treatment until the inflammation is resolved. In order to do this, oncologists examine inflammation markers, and for patients who have high levels of inflammation markers, it’s suggested that they should wait to receive immunotherapy.

“In essence, we are a little worried about giving immunotherapy, that can cause lung inflammation, to someone who has preexistent lung inflammation as shown by a scan when you recover from COVID,” Dr. Chachoua explains. “We’re in the middle of ruling out testing for COVID, and we picked the immunotherapy patients as being one of the groups we’re going to look for, whether they’ve had prior infection with COVID or current infection with COVID, as a way to see what the risk is going to be.”

Dr. Brendon Stiles, a thoracic surgeon at Weill Cornell Medical Center, says his patients are doing “remarkably well” despite COVID-19

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