Enhanced Care during Chemoradiation
The population of patients who have the greatest need for immediate care
includes patients currently undergoing radiation therapy with or without
chemotherapy and immunotherapy. Approximately 30 to 40% of HNC patients
undergoing radiation treatment experience a toxicity-related
hospitalization.11, 12 We had established a new
program of enhanced care that had initially been developed to assess
symptoms, including pain, swallowing, and weight loss, twice weekly.
This program was designed to have symptom assessment conducted via face
to face interactions; however, in light of the pandemic, modifications
to the protocol have occurred.
In accordance with our Institutional Review Board, we have suspended
recruitment but continue to follow patients that have previously been
consented. To maintain social distancing, we modified our bi-weekly
assessments from meeting our enhanced care patients face to face to
scheduling phone visits. Alternatively, participants have asked to
complete symptom assessments via survey software (i.e., REDcap), which
are reviewed by the research staff, and an update is provided to the
oncology care team. While participants have provided preference
regarding mechanisĀm of symptom assessment delivery, some participants
have been difficult to reach via phone or email. Several obstacles have
been identified when transitioning this program to telephone or
electronic completion, including the time to complete questionnaires,
lack of interest, feeling ill, lack of internet, and residency (e.g.,
nursing home). While the pandemic has altered clinical practice, it has
also halted or slowed the progression of research designed to improve
quality of life and symptom management in HNC. As clinical scientists,
we need to continue to remain abreast of the pandemic progression and
changes to research practices dictated by our institutions.