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Increased Spread of COVID-19 Challenges Continued GU Cancer Care

Global pandemic forces hospitals to reassess visitation, non-essential service

Amid the increasing global health risk and strong restrictions set in place to mitigate the COVID-19 pandemic, cancer patients must still seek care. 

As of March 20, there were over 250,000 recorded cases of COVID-19 globally.1 In the United States, the first case was reported on January 20. By March 20, there were over 14,000 cases spanning all fifty states — five times the number of cases reported one week earlier.2

In response to this exponential growth, restrictions have been set in place nationwide and worldwide to reduce the spread of COVID-19. Restaurants, bars, gyms, and museums have shuttered. In California, Governor Gavin Newsom issued a statewide “stay-at-home” order, mandating that residents leave their homes only out of necessity — a measure that has been alluded to by other state and local leaders.3 

Nationwide, hospitals have suspended visitation and have asked that patients and providers reschedule non-essential appointments and surgeries. Mount Sinai hospital in New York City has been pre-screening cancer patients intending to come in for appointments via texts and phone calls, asking patients to report potential COVID-19 symptoms.4

In a conversation with UroToday, Toni Choueiri, director of the Lank Center for Genitourinary Oncology at the Dana Farber Cancer Institute explained that Dana Farber has transitioned 3,000 staff members to remote work. 

He highlighted how doctors are working to meet their patients' needs, while also being mindful of the rapid spread of COVID-19. “The most important thing is how we are screening patients and what type of question we are asking. This is a very dynamic process and the screening that we started ... a week ago, by screening patients ... that were exposed to COVID-19, now expanded into screening anyone with symptoms ... such as fever, cough, shortness of breath, sore throat, myalgias (muscle aches) as well as nasal congestion and runny nose.”

This begs the question: How will the COVID-19 pandemic affect cancer treatment and research? A preliminary study of patients who contracted COVID-19 in China found that of 2,007 patients analyzed, 18 had histories of cancer. Those 18 patients were found to have an increased rate of severe events. Of those evaluated, only four had received chemotherapy or treatment within the previous month, 12 were cancer survivors receiving follow-up care and two had an unknown treatment history.5 Preliminary data from the Chinese (Centers for Disease Control and Prevention (CDC) suggested that there is a 5.6% fatality rate for people with histories of cancer. This data is of course very limited, and broad conclusions cannot be drawn from studies with such low sample sizes.6 As Mini Kamboj, MD, outlined on New York’s Memorial Sloan Kettering Cancer Center website, cancer patients often have weakened immune systems due to their malignancy and the treatment they have received or are receiving, including bone marrow transplants, chemotherapy, radiation or even surgery. Being immunocompromised makes it more difficult for the body to fight a virus like COVID-19.7 To combat this risk, the study’s authors proposed three provisions: That cancer patients postpone adjuvant chemotherapy or elective surgery for stable cancer, follow strong protective provisions, and that more intensive treatment and surveillance be conducted on infected patients with a history of cancer.

In an interview with UroToday, Brian Rini, MD, Clinical Trials Director at Vanderbilt University, emphasized that he and his colleagues were evaluating the risks their patients faced and determining which appointments could be avoided for the time being. “We're trying to keep people away as much as possible and do things at a distance. And that's a priority and it takes some getting used to and some operational considerations,” Rini said.

“We're trying to define what is elective, what needs to be addressed right away, what can wait. And these decisions, probably, we'll make case by case,” Petros Grivas, MD, Ph.D., clinical director of the Genitourinary Cancers Program at the University of Washington, told UroToday. 

In order to take these steps, cancer care providers must first overcome the challenges imposed by the speed and intensity of the pandemic including hospital bed and supply shortages. 

Earlier this week, Buzzfeed News reported that Memorial Sloan Kettering Hospital was facing a medical mask shortage — noting that an internal memo suggested that the hospital only had a week’s worth of masks left. This limitation is rooted in the pandemic itself, arising because of production delays in China.8 While the hospital has canceled non-essential appointments and begun utilizing teleconferencing, this report comes as New York Governor Andrew Cuomo has doubled his estimate of how many hospital beds will be necessary to fight COVID-19 in the state of New York. On Thursday, the number was a staggering 110,000, double the current capacity of 53,000 beds.9

A report published in the Annals of Internal Medicine tracking the treatment of a single COVID-19 patient found that in the process of stabilizing the patient, 41 health care workers were exposed to aerosol-generating procedures for at least 10 minutes. At the time of exposure, 85 percent of these health care workers were wearing surgical masks, while the remaining 15 percent wore N95 respirator masks. Following a two week quarantine, not one of the exposed providers developed COVID-19 symptoms, proving the necessity of personal protective equipment (PPE) for health care workers.10

In some places, the need for PPE is already dire. Bloomberg News reported that some doctors in Washington State, where the first U.S. cases of COVID-19 were reported in late January, have resorted to making their own PPE, constructing medical masks out of marine-grade vinyl, foam, industrial tape, and elastic.11
As the pandemic continues, the risk of further shortages rises. While The Asco Post noted that the FDA has so far only indicated that one drug company has reported production shortages, preparations have been set in place by hospitals in the case of future production problems.12

Written by: Elise Ryan, Brown University, Providence, Rhode Island 

References: 

  1. Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering at Johns Hopkins University. Retrieved from: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 
  2. Yeung, J., McKeehan, B., & Kottasová, I. (2020, March 15). March 14 coronavirus news. Retrieved March 19, 2020, from https://www.cnn.com/world/live-news/coronavirus-outbreak-03-14-20-intl-hnk/index.html
  3. Helsel, P. (2020, March 20). California issues statewide stay-at-home order in coronavirus fight. Retrieved March 19, 2020, from https://www.nbcnews.com/news/us-news/california-issues-statewide-stay-home-order-coronavirus-fight-n1164471
  4. Cavallo, J. (2020, March 17). Mitigating the Spread of COVID-19 and Its Impact on Cancer. Retrieved from https://www.ascopost.com/news/march-2020/mitigating-the-spread-of-covid-19-and-its-impact-on-cancer/
  5. Liang, W., Guan, W., Chen, R., et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Onc. 2020, (Epub ahead of print Feb 14, 2020) DOI: https://doi.org/10.1016/S1470-2045(20)30096-6
  6. Akpan, N. (2020, March 11). These underlying conditions make coronavirus more severe, and they're surprisingly common. Retrieved from https://www.nationalgeographic.com/science/2020/03/these-underlying-conditions-make-coronavirus-more-severe-and-they-are-surprisingly-common/
  7. Stallard, Jim. (2020, March 3). The 2019 Novel Coronavirus (COVID-19): Key Facts and What It Means for People with Cancer. Retrieved March 19, 2020, from https://www.mskcc.org/blog/2019-novel-coronavirus-covid-19-key-facts-and-what-it-means-people
  8. Adams, R. (2020, March 17). A Top Cancer Hospital Faces Mask Shortages As COVID-19 Cases Show Up In Staff And Patients. Retrieved March 19, 2020, from https://www.buzzfeednews.com/article/rosalindadams/a-top-cancer-hospital-faces-mask-shortages-as-covid-19
  9. Noah Higgins-Dunn, W. F. (2020, March 18). Cuomo: New York needs 110,000 hospital beds for coronavirus patients in 45 days and we only have 53,000. Retrieved March 19, 2020, from https://www.cnbc.com/2020/03/18/cuomo-says-trump-is-dispatching-a-floating-hospital-to-new-york-state.html
  10. Ng K, Poon BH, Kiat Puar TH, et al. COVID-19 and the Risk to Health Care Workers: A Case Report. Ann Intern Med. 2020; (Epub ahead of print 16 March 2020). doi: https://doi.org/10.7326/L20-0175
  11. Eglin, B., & Tozzi, J. (2020, March 18). Hospital Workers Make Masks From Office Supplies Amid U.S. Shortage. Retrieved March 19, 2020, from https://www.bloomberg.com/news/articles/2020-03-18/hospital-makes-face-masks-covid-19-shields-from-office-supplies
  12. Cavallo, J. (2020, March 17). Mitigating the Spread of COVID-19 and Its Impact on Cancer. Retrieved from https://www.ascopost.com/news/march-2020/mitigating-the-spread-of-covid-19-and-its-impact-on-cancer/