Experts Discuss Strain on Oncology Staff, Patients During COVID-19 Pandemic

In addition to industry-wide financial strains during the COVID-19 pandemic, experts in a session at the Association of Community Cancer Centers (ACCC) 47^th Annual Meeting and Cancer Center Business Summit said staff and patients have faced many challenges and have felt a lot of strain.

Leigh Boehmer, PharmD, BCOP, medical director for ACCC, noted pay cuts, salary freezes, staff reassignments, and a general fear of catching or spreading COVID-19 among some of the major stressors oncology staff have faced over the past year, in both inpatient and outpatient settings.

Many of the panelists said they had faced a myriad of staffing issues, including losing many nurses to traveling positions. Mary Miller, MSN, RN-BC, OCN, oncology nursing manager for Franciscan Health Indianapolis, said they lost 14 intensive care unit nurses to traveling positions, for example.

In an effort to mediate staff fears and keep them updated, however, Miller said she started a video program where she could speak about concerns or updates that the nurses needed to know. This communication helped staff understand what was going on in the wider health system and how it impacted their work, and also helped update them on any policy changes or things they should be made aware.

Still, Miller said staffing concerns are ongoing.

“We’re very short-staffed in the hospital setting, and it’s had a very dramatic impact on all of the nursing staff, support staff, and everyone, just because we’ve been so busy and so full,” Miller said.

Postponed cancer screenings during the pandemic have also been a major concern over the past year, and the panelists said the impacts of this will only be understood over the coming years. Miller said they are seeing some later stage ovarian cancer patients and others who postponed screenings at the beginning of the pandemic, and who are now having challenging situations with worse outcomes.

Luis Isola, MD, a leader of the Bone Marrow Transplantation service at Mount Sinai, said the true impact of the lack of screenings will be felt for years to come and will not be entirely evident in the next few months. He added that the effects will linger even more for slower-progressing cancers.

All of the panelists agreed that outreach and patient education are essential to return screenings to their pre-pandemic rates. Ensuring that patients are aware of safety precautions and other policies will make sure they feel safe and return to necessary appointments. Isola said his institution held a virtual town hall event that was very well attended, where experts discussed safety concerns and answered questions from patients.

Similarly, Adam Riker, MD, FACS, chair of oncology for Luminis Health, said his institution produced some simple videos to educate patients on safety measures and when it is important to get screened or go to the emergency department, such as when patients may be experiencing chest pains but are hesitant to go to the hospital. Sibel Blau, MD, president and CEO of the Quality Cancer Care Alliance Network, said a major takeaway from the pandemic is not to shut down necessary screenings, but rather to find ways to make patients feel safe.

When the panelists turned to a discussion of patient experiences during the pandemic, they agreed that isolation and visitation issues have been a key challenge. Miller said her institution began, at the end of February 2021, allowing 1 visitor per patient, although she has justified a visitor in other situations, such as when a patient is receiving a new diagnosis or is at the end of life.

“I had to justify it, but I always did because that’s important for their healing and everything,” Miller explained.

Jody Pelusi, PhD, FNP, AOCNP, an oncology nurse practitioner at Honor Health Research Institute, said she has a unique perspective on the patient experience as she herself was admitted to the hospital with COVID-19. She said that although she could have video chatted with family or friends, she was too exhausted and short of breath to even call, which exacerbated the isolation she already felt in the hospital. As a health care worker, she said she also could not have any contact with patients or colleagues, which further added to the isolation.

When she was discharged, Pelusi said, she had to quarantine because she was still infectious. Because she lives alone, she said, it was a struggle just to get up and move around her home. However, staff at the hospital sent 5 meals to her doorstep, which Pelusi said was incredibly helpful during her recovery. With her personal experience in mind, Pelusi said considering patients’ isolation and fear is essential to providing comprehensive care.

“We forget the isolation is huge,” she concluded.

Ultimately, returning to normal levels of patient visits and screenings and ensuring they feel safe will be essential to beginning the financial recovery from the COVID-19 pandemic. Boehmer asked the panelists to estimate how much longer health practices can expect to feel the financial impact of the pandemic, and they agreed that 2022 or 2023 will be the earliest that institutions can expect to begin seeing some margin of net profit.

As oncology care returns to some semblance of normalcy, however, the panelists said health system overall should adjust and consider long-term lessons learned from the pandemic rather than simply reverting to old approaches. For example, Isola said he has learned that waiting areas are a wasted space for both patients and providers, and Riker pointed out that they are routinely listed as one of patients’ biggest dissatisfiers. Better managing these spaces and patients’ flow through the offices should be a long-term shift after the pandemic, Isola said.

Similarly, David W. Dougherty, MD, MBA, said telehealth and some level of asynchronous care are here to stay, where appropriate. For example, patients who need 6-month or 1-year follow-ups or those who are in survivorship care may not need to come into the office, and virtual appointments can effectively meet their needs.

“We really have to embrace those lessons learned so that we don’t fall back into our comfortable place of how we used to provide care,” Dougherty said.

REFERENCE

Blau S, Miller M, Isola L, Riker A, Boehmer L, Dougherty D, and Pelusi J. Cancer Care in the COVID-19 Era; March 1, 2021. ACCC 47^th Annual Meeting & Cancer Center Business Summit.