Medical Oncology and Radiation Oncology
The COVID-19 pandemic has led to changes in medical oncology and
radiation oncology care, including surveillance after completion of
treatment, in an effort to still provide the care needed, but also
reduce risks as much as possible. Each physician evaluates his/her
clinical schedule to determine what patients need to be seen in person,
what patients can be triaged to telemedicine, and what patients can be
re-scheduled for a clinical appointment at a later date. New consults or
active patients are being seen in the clinic with continued care as per
normal circumstances. Active patients are those who are currently
receiving systemic therapy and/or radiation, or undergoing active
recovery from therapy, necessitating in-person evaluation and possible
supportive care such as intravenous fluids. The outpatient clinical area
has developed a screening process for patients. Patients are screened in
the lobby of the building, including those receiving daily radiation
therapy, for signs/symptoms of infection, the temperature is taken, and
all patients are required to wear a mask. If a patient screens positive,
a dedicated location for the treatment team to evaluate the patient is
available. Currently, there is no visitor policy, with an exception if
needed for communication issues, which applies to some of our patients
who have undergone a total laryngectomy. The treatment teams engage
those family members who are not able to attend the initial evaluation
via telephone or video conferencing. Additionally, for example, for
those patients receiving traditional chemotherapy alone in the
recurrent/metastatic setting, growth factor is being used more regularly
in an effort to avoid immunosuppression. Patients in the long term
follow-up are being re-scheduled to a later date if possible, with also
delay in surveillance imaging. Patients that fall in between these
categories are offered a telemedicine visit at the physician’s
discretion. If a patient cannot do a telemedicine visit or prefers an
in-person visit, the patient is able to come into the clinic for their
appointment.
Prior to the COVID pandemic, our goal as a head and neck program has
been to offer at least one visit with medical oncology and radiation
oncology at the main cancer center in order to help develop the plan and
offer clinical trials if applicable for all patients. However, in light
of the pandemic, those patients that have expressed interest in being
treated more closely to home at a Hillman affiliate are being triaged
straight to local providers. An additional strategy to decrease exposure
has been that radiation oncology completes a telemedicine visit first.
Then the in-person visit occurs when the patient is brought for
simulation, with medical oncology meeting the patient on that day as
well.