Alicia Morgans: Hi, this is Alicia Morgans, a medical oncologist from Northwestern University. And I am so, so honored to have here with me today, Dr. Elena Castro, who is joining us from Malaga, Spain. She also does lab work in Madrid and is really giving us some understanding of what the people of Spain are experiencing right now as we all move through this period of the COVID-19 pandemic. Thank you so much for joining us today, Dr. Castro.

Elena Castro: It's a pleasure to talk to you.

Alicia Morgans: Thank you. So, can you give us, as the majority of our audience does not live in Spain, can you give us the perspective of what you are seeing in your clinical practice right now and what you have done to try to adapt to support the other people on your clinical team as well as the patients as experience COVID-19?

Elena Castro: Well this is a very difficult situation for all of us, healthcare professionals, and patients. Patients are really concerned and anxious because they are very worried that this unusual situation may hamper their cancer treatments and we want to reassure them that our top priority is actually their wellbeing. So everything is being done in order to keep them safe and to try to continue their treatments in the best condition. But it's true that a high number of professionals are being infected across the country and are being put in quarantine, so at the moment is around 9,000 healthcare professionals in Spain that have been infected. The intensive care units are full of patients with coronavirus, so many major surgical procedures have to be postponed, and I understand that this may affect some cancer patients also. All hospitals are trying to make all the efforts to minimize these issues for these patients.

The other thing that we are trying to do is trying to balance the risk-benefit of any treatment that we can give to our patients, so maybe this is not the best time to start chemotherapy for some angry patients that may get toxicities, neutropenias and may require to be in the hospital, as at the moment the hospitals in Spain are almost reaching their capacity.

Alicia Morgans: I completely agree and really think it's so wise of you to say that it's always communicated to patients that we are trying to care for their overall wellbeing, that their wellbeing is actually first. that part of that is that they need to have their cancer care, but part of that is that they actually need to stay well enough so that we can care for them. So that's a really important message. And to get to your point about the healthcare providers who are being affected in Spain, how are you dealing with that? Do you know yet? Because I think that we're still trying to figure out how long isolation and quarantine needs to take and what we need to do to allow these workers to kind of come back to the workforce to continue to care for patients. What's been laid out in your clinical practices so far?

Elena Castro: We've been very lucky that in our department none of my colleagues have been infected, so they continue to do their work. But in other hospitals nearby, half of the oncology staff were infected. So they have to be isolated for almost two weeks. So it's true that we don't really know whether we should be isolated for one week or two weeks and in different hospitals people are doing different things. And this also generates some anxiety because we are putting at risk our patients and also we are putting at risk our families, so it's difficult to manage all these issues. We have a problem here is that we are lacking adequate protective masks and clothing. And as I see in the news, this is something that is happening globally, there is a lack of materials for everyone. So this is something that I understand is going to happen everywhere.

Alicia Morgans: I think it is happening everywhere. It is happening in our center and we're very much rationing or using our supplies as carefully as possible, trying to limit the use of this personal protective equipment when we don't have to use it. But each day we learn a little more and recognize that we probably need to use it more than we have been the day before. So we end up using it and we're reusing our PPE as we call it in our centers. But, so you are not alone in that for sure. And with all of the stress that you are going through as a clinician, as someone who is putting herself on the front lines and then coming home to her family and certainly one who cares for all of her patients, what have you learned that you find might be helpful for people to think about as hopefulness within all of this that we're going through?

Elena Castro: I think the most important thing is to consider the risk-benefit ratio. Seeing carefully whether that patient would benefit from one more cycle of chemotherapy if it's for elective engagement or whatever we have to modify the doses or the schemes for patients who really need that treatment because we are doing that with curative intention. So it's a risk-benefit balance.

We have tried to do telephonic consultations, as many as possible. And I think patients found it very reassuring for them that the staff called them asking how they are feeling, whether providing instructions on what to do or when they need to go to the hospital. Otherwise, they are reminded to stay at home and they feel that they are not alone and this is very important in this situation.

Alicia Morgans: So I agree and I love that message of patients not being alone, that they can always connect to their clinic and that the telephone has made things so close. That we are able to do a lot of our visits, a lot of the work that we do, particularly for prostate cancer, we can do a lot of that over the phone. And we are, in that phone interview, doing our best to keep people safe, that that is part of us protecting them from potential exposure. And so I'm glad that your patients are taking part and hopefully mine are too because we're doing the same thing. So sorry, go ahead.

Elena Castro: I was going to say that my impression is that prostate cancer patients are particularly worried as they are often over 70 and with the data that we are having, this is over 70s or 80s is where the mortality rate is higher. So they are really, really worried and I think it's very important that we minimize the number of visits that these patients do to the hospital, so to minimize that as much as possible.

Alicia Morgans: I completely agree. So as you move forward from here, we're ending a week and we're going into the next, any advice you have other than staying away from healthcare if you can at all, making those smart decisions. Any other advice as we wrap up with you and your perspective from Spain?

Elena Castro: Yeah, that is to just follow the instructions that you are given. Stay at home, please. This is the best way you have to help your doctors, your nurses. If everyone goes to the hospitals they will collapse. It's just impossible to attend everyone, so stay at home. If there is anything that worries you then see for assistance, call, there are lots of numbers for a lot of helplines. But I mean, if you have any... What we are learning here is that the symptoms that patients infected can have are very different. Most of them have a fever, most of them have a cough, shortness of breath, but sometimes things are strange as feeling unwell. And anything that worries you, then you should ask for help.

Alicia Morgans: I completely agree. Thank you so much for providing your perspective. We will do our best to get back in touch with you in a few weeks as things continue to evolve and you'll be able to give us some updates, some things that you may have learned, and let us know how things are going with the strategies that you're currently using. We wish the best to you, your family, all of your patients, and everyone you work with. Take care.

Elena Castro: Take care, take care.