Getting breast cancer treatment during COVID-19
To protect ourselves from COVID-19, also called the coronavirus, we’re being told to stay home and avoid contact with other people. But what do you do if you’re in treatment now or newly diagnosed and need to visit doctors and get treatment at the hospital or cancer center?
Living Beyond Breast Cancer CEO Jean Sachs, MSS, MLSP, speaks with Pallav Mehta, MD, about what he is telling his patients right now – where they can go for trusted information and how to care for their emotional health during this outbreak. Listen to the audio, or read the full transcript below.
Pallav Mehta, MD
Dr. Mehta is a hematologist/medical oncologist and director of integrative oncology and director of practice development at the MD Anderson Cancer Center at Cooper in Camden, New Jersey, and a member of LBBC’s Board of Directors. Read more.
Jean A. Sachs, MSS, MLSP
Chief Executive Officer, Living Beyond Breast Cancer
Jean began her work with LBBC in 1996 when she became the organization’s first executive director; she was named CEO in 2008. Jean brings a lifetime of women’s advocacy experience to her role as CEO. She lives LBBC’s mission everyday by speaking with newly diagnosed women about their needs and gaps in support. Read more.
Jean Sachs (00:00):
Hi everyone. It's Jean Sachs, the CEO of Living Beyond Breast Cancer. I'm really pleased that I'm having an opportunity to talk with Dr. Pallav Mehta from MD Anderson Cancer Center in Camden to give a little bit of a status update of where we are with the COVID-19 outbreak. He's been generous enough to answer a few questions, so thank you, Dr. Mehta. What cancer patients specifically are wondering is, when should they be going in for appointments? How are you dealing with that?
Pallav Mehta (00:48):
The situation is pretty dynamic and recommendations are changing by the day, if not by the hour. But for our oncology patients, we're trying to make the distinction between patients who are on treatment, active treatment, versus those who are just following up, for visits where they've completed all their treatments. For a lot of our follow-up patients, as long as they're feeling okay, our nurse or nurse practitioners are making phone calls and ensuring that they don't necessarily have any new issues going on. For those folks, we're telling them they really don't have to come in. They can just make sure that if they need blood work, they've gotten their blood work, which we will look at and if they need other tests, they can go as long as where their tests are done is open and is following appropriate policies, they can get their mammogram or their x-ray or whatever other tests are needed. But for patients on treatment, the issue is that [the COVID-19 situation] is the sort of thing where it won't be a one or two week delay when it comes to chemotherapy, for example. One week [of delay] usually doesn't change anything in terms of benefit of the treatment, but we know that [the outbreak] really will be probably [last] at least four to six weeks. And for chemotherapy, that just doesn't work. For those folks, we are telling them to come in and we've established multiple protocols from a hospitalwide initiative to the cancer center itself, around patients and visitors. As most places are doing, we're limiting the number of people that a patient can come in with, two, one visitors, for chemotherapy. Often, [in regular times] you'll see three or four family members or friends sitting there. We are not having that right now. We're separating patients and we're trying to abide by a six-foot rule. That's tough in infusion rooms, particularly in centers where maybe the infusion chairs are closer together. We're screening everyone at the door. Some places are doing temperature checks. We're doing more just a screening around symptoms and recent travel and recent exposure to anyone who may be assumed or confirmed positive [for COVID-19].
Jean Sachs (03:44):
What are you telling patients who may be immune compromised because of treatment? Are you giving them extra precautions?
Pallav Mehta (04:03):
The sort of advice we're giving them is similar to the advice we give them in general around being immunocompromised. Some of our patients are immunocompromised and older. So sort of a double whammy. [It's to do] what you're hearing on the news, to be vigilant about really trying to limit interactions with lots of people and making sure that the people with whom you interact regularly also are trying to limit interactions with other people. If you live with your son or if you've lived with your parents or whatever, and if you're on chemotherapy, they also need to be aware that they can't come into contact with lots of people, because they could be carriers and we're just not sure right now about asymptomatic carriers. This is still such a fluid situation.
Jean Sachs (05:10):
If you are someone who maybe three weeks ago just learned that you were diagnosed with breast cancer and were planning to go through all the testing, are you finding that you're slowing down on some of the next steps? Is there a delay in getting people into treatment?
Pallav Mehta (05:31):
We're looking at it case by case. It depends on the diagnosis. Some diagnoses with breast cancer really can't wait. They just need to start and we will practice all common sense. In radiation oncology, we've had some conversations around low risk patients for radiation--people with pre-invasive [disease], DCIS for example--that maybe they really can wait three to four weeks because that shouldn't make any difference in their outcomes. It's an individual diagnosis. Patients just need to really be in touch with their treatment team, almost on the day they're about to go because things are changing in the centers' recommendations every day.
Jean Sachs (06:30):
Okay. Thank you. I just have two other questions. One is, how can people control the amount of media they're consing right now about the Coronavirus? And if they're going to consume information, where would you suggest that they look?
Pallav Mehta (06:50):
The CDC website is the gold standard. They readily admit on the website that they are a little behind in the numbers. Often the departments of health for your individual state are more reliable in terms of the actual numbers and where there might be more cases versus less cases. You want to steer clear of politically motivated sites on either end. Everyone's got an agenda and unfortunately in these situations we're seeing some errors and mistruths coming out about various treatments that kill the virus. If it sounds too good to be true, it usually is. I stick with the CDC, with organizations that are dealing with this. Departments of health for most states have been pretty up to date.
Jean Sachs (08:09):
Great. And if you would give us your assessment of where we are in the course of the epidemic and what we might expect in the coming week.
Pallav Mehta (08:20):
Well, I think as most people know, the issue in this country has been testing. We just haven't been testing enough people. And over the last few days, there suddenly has been a large increase in availability of testing. The testing that we have is still the kind that has about a two- to three-day turnaround time. There is a faster, FDA approved test available that has a four-hour turnaround time. I don't know when the availability of that will be, but hopefully soon. For now the idea is that as we're testing these people over these last few days, those tests are going to come back in the next few days, which means people shouldn't panic that we're seeing a sudden rise in numbers over the next several days because a lot of that is detection. Some of it is new cases. Absolutely. But I think we all are expecting a spike [in diagnoses] over the next week or so. What's heartening here is that people, organizations, state and local governments, have all decided to just shut everything down. And that is, as every infectious [disease] epidemiologist will tell you, the best way to limit the spread of these pandemics. People just can't be around each other. Find time at home, spend time with your friends, your family, your dog, your Netflix, whatever it is. It's okay to be bored, particularly people with children. I think my kids are finally bored, which is good. They can get creative. It's just going to take a little while, but we are going to turn the corner eventually. I think we'll know more by next week where we are in this country.
Jean Sachs (10:25):
Right. That is really helpful. Do you have any advice about how to reduce the anxiety that seems to be in the air?
Pallav Mehta (10:40):
Part of it is consuming too much media. The media has some obligations, obviously. They have to give us statistics. But whenever you open up your phone to your website of choice or the TV and all you see are numbers and everyday you see those numbers going up. Obviously that's just going to heighten people's anxiety. To some extent, try to limit some of that. Also important is that I'm hearing from psychologists, clinical social workers, mental health therapists, a significant rise in phone calls from their patients around this [issue]. Try to do things, try to recreate to some extent a routine you can do at home. But yea, maybe limiting media, and just getting the news when you need it. Then stop having a TV on in the background the whole time. I'm trying to learn these practices too. Because do you have to actually get an update right before you try to fall asleep? Me knowing something isn't going to do anything to stop this [outbreak]. The most important thing is to stay away from people, and hopefully you like your family. It's also important to understand who is in the home with you. For me, I want information, so I will have my phone on but I have to realize that not everyone in my family reacts the same way with that information. Others are more anxious about it. Just to be aware that when you have a teenager or when you have a child, you may think they're not listening, but they are, and it may really stress them out. We're all going to learn a lot through this experience.
Jean Sachs (12:41):
Thank you so much, Dr. Mehta, for your time and for being so good to Living Beyond Breast Cancer and to the entire breast cancer community.