Experts Discuss Cancer Care in the COVID Era at the ACCC Annual Meeting – Part I
At the 2021 Virtual ACCC 47th Annual Meeting & Cancer Center Business Summit, a panel of healthcare professionals discussed real-world experiences on the challenges of COVID-19 and its effect on cancer care. Even in today’s COVID-vaccine environment, there are still dramatic shifts taking place in staffing, revenue, digital health, and more.
The session titled “Cancer Care in the COVID-19 Era”—which was moderated by Leigh Boehmer, PharmD, BCOP, Medical Director, Association of Community Cancer Centers—began with a focus on the pandemic’s impact on digital healthcare.
Luis M. Isola, MD, Director, Cancer Clinical Programs, Mount Sinai Health System & Tisch Cancer Institute, said that the COVID-19 crisis impacted telehealth dramatically at his practice. At the start of 2020, the number of telehealth visits for his center was small; these numbers then rose to 600 by March, skyrocketed to 3000 by April, and stayed at that level until the beginning of the summer. By the end of the summer, visits decreased to around 1500 and have remained steady since then, he said.
“Obviously telehealth is here to stay. It has now become part of the fabric of care we provide at our cancer center,” Dr Isola said.
On top of experiencing enhanced telehealth usage, Dr Isola said Mount Sinai was awarded $1 million for a COVID-19 telehealth program focused on procuring tablets and remote monitoring licenses for cancer patients.
“This has provided us with a wealth of new data that we did not have access to before, ranging from vitals to oxygen saturation. This is really an increase the ability in the cancer center to deliver more of our care remotely at home,” Dr Isola said.
David W. Dougherty, MD, MBA, Medical Director, Dana Farber Cancer Institute Network, said he also experienced an impact on digital health care, with MyChart enrollment up at his institution from about 15% to 20% usage pre-COVID to >60% at some locations.
“The byproduct of that is that it’s armed our patients with a higher degree of self-advocacy,” Dr Dougherty said.
Sibel Blau, MD, Medical Director, Northwest Medical Specialties, and president and CEO, Quality Cancer Care Alliance, said in response to shift to digital health care, she hired technology coordinators to provide telehealth access and support via iPads to those in nursing homes (or the homes of patients).
Dr Dougherty was keen to point out although technology is an important disruptor, COVID-19 in and of itself has forced the industry to reconsider the paradigms of care.
“We really have to embrace those lessons learned so that we don’t fall back into a comfortable place of how we used to provide care,” he said.
The pandemic has also affected staffing levels, according to Jody Pelusi, PhD, FNP, AOCNP, Oncology Nurse Practitioner, Honor Health Research Institute.
She said the impact on employee schedules was hard to navigate at start, but eventually all fit together nicely, with survivorship follow ups and high-risk groups benefitting the most. Several days a week, she said, her practice only saw patients in exam rooms in the morning and did telehealth in the afternoon.
Dr Blau agreed, saying within a short span of time her practice had to change its entire scheduling system to work around COVID-19, and now utilizes telehealth for anything from survivorship to pre-chemotherapy evaluations, to providing iPads for patients to video chat with their loved ones.
Over the last year, furloughs, pay freezes and cuts, reassignments, and stay-at-home mandates have placed major strain on those working at hospitals and health centers around the country.
Mary Miller, MSN, RN-BC, OCN, Nurse Manager, Franciscan Health Cancer Center Indianapolis, couldn’t agree more. Her center’s been a hotbed for COVID from Day 1, stressing out its workforce. For a year now, she said, she’s been trying to keep her staff happy, hoping they don’t quit or jump on the travel nurse bandwagon.
“Our census went from 26 to 4 because we didn’t have oncology patients. So, then I had to deal with the staffing upset about floating.…Now we’re constantly full and we don’t have enough staff because I couldn’t hire anyone when I was floating everybody,” Ms Miller said. “The whole travel nurse thing has been very traumatic for us. I actually have 2 travel nurses right now. We lost 14 nurses in our ICU alone to the travel nursing world and it's been difficult trying to find staff.”
When the census dropped, Ms Miller said, it put a disconnect between the outpatient and inpatient world, so physicians took it on themselves to connect with inpatient nurses and keep them updated on what’s going on.
Adam Riker, MD, FACS, Chair of Oncology, Anne Arundel Medical Center, DeCesaris Cancer Institute, said the experience at the DeCesaris center was similar, impacting its bottom line: “It’s hard because I’ve got operating rooms that we are not able to staff to the full extend because they are just not here. These traveling nurses will go out and they literally can make 5 times what they're making. It's really difficult and I don't blame them. As you know, they're going to go where the money is.”
Dr Pelusi agreed it was difficult to hire staff, but made note of another perspective: the individual staff member and ensuring they have the resources they need.
“We found several of our staff were in need of food, they needed help just paying the electric bill because their lives have been upset with the furloughs,” Dr Pelusi said.
Dr Dougherty said the Dana Farber institute was able to retain all of its employees amid the crisis and found recognizing employees at the individual level was just as important as being connected to them.
“I’ve been reminded of the Victor Frankel quote that says, ‘That which is to give light must endure burning,’ and I think that our teams coming to work as their best selves every day to take care of their patients and families and one another has just, from my perspective, been one of the most beautiful aspects of this whole experience. This selfless cancer care work that we do is really is highlighted,” Dr Dougherty said.—Emily Bader