Oncologists adopt new practices in response to COVID-19 threat

By Mardi Chapman

17 Mar 2020

Novel treatment models including telehealth are being adopted for the routine management of patients with cancers against the background of an increasing prevalence of COVID-19.

Associate Professor Nicholas Wilcken, Director of Medical Oncology at at the Westmead Cancer Care Centre, told the limbic they were already doing fewer face-to-face consultations with patients.

“We are all trying to reduce traffic through the hospital so we are all going through our clinic lists and identifying people who we think it would be reasonable and safe to call on the phone rather than get them into the hospital,” he said.

“I’ve got a number of breast cancer patients who are on endocrine therapy and really, it’s a regular chat I’m having with them about how they are coping or have they got any side effects or changes. I can do that on the phone and document it.”

He said the concern was not just about reducing risk to individuals but also lightening the load overall and specifically for cancer nurses.

“… because we are anticipating that we will have staff that are sick. And we’re already essentially at capacity.”

“If a bunch of oncology nurses suddenly goes into quarantine, we will suddenly lose our capacity to treat so we are working out how to identify in some people how we can delay their chemotherapy or postpone non-urgent treatments such as bisphosphonate treatments.”

He added that other options included relocating treatments such as blood transfusions, which didn’t necessarily have to be done in chemotherapy units, to free up nurses with the specific training to give chemo.

“It’s all about trying to lighten the load and having fewer people standing around in the waiting rooms.”

“It might get worse than that and we’ll have to do some kind of triaging exercise if it gets grim.”

Scaling up telehealth

Myeloma specialist Associate Professor Simon Harrison, from the Peter MacCallum Cancer Centre, told the limbic that the Centre was actively scaling up its telehealth services in response to COVD-19.

“We already offer telehealth to patients as an option for them to be seen without needing to come to the hospital. So we’ve rolled that out for regional, interstate and international patients as a routine and we are offering that to patients in the metropolitan area as well now, just to try and minimise high-risk patients collecting in waiting rooms.”

However he said that in many ways it was business as usual, such as in advice to new patients about good hand hygiene, avoiding crowds and in particular, avoiding people with active infections.

“The usual advice applies to any patients likely to be immunosuppressed. I guess the additional advice that we are giving at the moment is to avoid close contact with the general public and hand shaking is being discouraged.”

The Centre has made some of that advice clear on its website.

However Associate Professor Harrison said there was really no discussion around issues such as deferring chemotherapy for patients.

“Those kinds of decisions are made at a higher level than individual patients and those decisions haven’t been made at the moment. Which is the best treatment for the individual patient at a given moment in time – those factors are already built into the treatment decision algorithm.”

He said managing infection was something haematologists already specialised in.

“Many of our patients are going through very intense treatment processes such as acute leukaemia induction therapy where the patient is severely cytopenic for long periods of time and are in hospital.”

“And that’s why we’ve become pretty expert at managing prolonged periods of immunosuppression where patients are prone to normal infections but also infections that wouldn’t normally affect people with normal immune systems.”

“We deal with these things every day. We have patients with other significant infections and deal effectively with those everyday to protect ourselves – using the right precautions – and protect other patients in and around the institute.”

“There’s nothing unusual about this infection except it is much more prevalent in the population therefore we just need to scale up our efforts to help protect ourselves and our patients.”

Telehealth MBS items

Meanwhile new MBS item numbers for telehealth consultations have been rushed through to help protect  vulnerable Australians, including the elderly, those with chronic conditions and people in Indigenous communities, from COVID-19.

The package includes “Bulk-billed video-conference consultation services, which can be provided by GPs, specialists, consultant physicians, consultant psychiatrists, nurse practitioners and allied mental health workers for certain vulnerable people…”

The new item numbers applicable to specialists and consultant physicians include an equivalent telehealth item number for a 110 (an initial attendance), a 116 (subsequent attendance) and a 119 (minor attendance).

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