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.