By Sibel Blau, MD

As the COVID-19 pandemic continues to devastate our homes and businesses, its fallout on our economy and health system is growing. Our healthcare system is fragmented and costly, particularly within the cancer care sector. The pandemic has highlighted how challenging it is for cancer care providers when healthcare resources are limited. All practices and programs, whether a small community practice in a rural area or a large hospital-affiliated specialty program in an urban area, have been deeply affected by the pandemic. As the need for cancer care has, of course, never stopped, we have been compelled to provide the same care with new limitations, including reduced personnel, changes in operations with the requirement of PPE use, physical space limitations, the expansion of telehealth, and limited access to clinical trials.

To proactively mitigate the ongoing negative impact of the pandemic on cancer care, cancer organizations including the American Society of Clinical Oncology (ASCO), the Community Oncology Alliance (COA), the Quality Cancer Care Alliance Network (QCCA), and others have assembled task forces to address the problems posed by COVID-19.

Northwest Medical Specialties

Located in the picturesque pacific northwest in Seattle, Washington, Northwest Medical Specialties (NWMS) is a mid-sized independent oncology practice and member of QCCA. Washington boasts significant cancer care resources, including a world-class academic cancer center, numerous community cancer practices, and hospital systems with affiliated cancer programs. As a founding member of QCCA and the organization’s president, I am active in working with all member practices to bring value-based oncology care to patients in their local communities across the country. NWMS is also a member and supporter of ASCO, ACCC, and COA. As such, NWMS has participated in several COVID-19 task forces formed to rapidly provide needed resources in the wake of the pandemic.

The Road to Recovery

In December 2020, ASCO released its Road to Recovery report, the result of the work of a task force in which I participated that came together to evaluate the adaptations in care delivery, research operations, and regulatory oversight the oncology community has made in response to the coronavirus pandemic. Specifically, task force members presented a series of recommendations for moving forward in cancer care as the pandemic recedes.

This collaborative work is the product of the contributions of a diverse group of individuals with different professional backgrounds, but all focused on clinical cancer research. Some of their recommendations were of long-overdue changes that were proven effective by the pandemic, including the use of telehealth during clinical trials and the movement toward electronic signatures and documentation. Task force members also noted that the willingness of clinical trial sponsors and CROs to interact with clinics remotely has enabled patients to access clinical trials more efficiently, expanding access. 

Some of the significant realizations I took away from my participation in the task force include:

• Regardless of the size of a cancer program or practice, collaboration in matters important to the quality of cancer care can provide great insight and guidance.
• Collaboration is most effective when the focus is on patient care.
• Human adaptability to major crises is incredible; this is especially true in oncology practice.
• Insights from task forces such as these can reveal new venues of care not understood or tried before.
• Open-mindedness to change is critical for progress.

Clinical Trials

ASCO’s Road to Recovery report describes the challenges to conducting oncology clinical trials during COVID-19 and the importance of using lessons learned during the pandemic to improve such trials. NWMS has a large research department and is affiliated with the newly formed QCCA research network. As this network was preparing to launch in early 2020, it was faced with the coronavirus crisis. The participating cancer practices, CROs, and sponsors that are associated with the QCCA Network quickly implemented changes to their programs after collectively deciding to go ahead with their research during the pandemic. Since launching its clinical trial program in summer 2020, QCCA members, including NWMS, have strengthen it by incorporating the ongoing lessons learned during COVID-19.

Telehealth

The collective work of the task force that produced Road to Recovery has also yielded insights about telehealth to the benefit of cancer practices across the country. Telehealth is a relatively new tool that has expanded during the pandemic, enabling cancer practices to continue to provide high-quality care without interruption. Because cancer practices and programs incorporated telehealth services into patient care much faster than other specialties, oncologists were able to communicate their lessons learned early on during the pandemic.  

As with many other oncology practices, NWMS implemented telehealth services in March 2020. As cases of COVID-19 rapidly increased in Washington state in the early days of the pandemic, NWMS physicians began using telehealth for patient care. Patients suffering from both COVID-19 and cancer received their services via telehealth, which was especially important when patients were symptomatic and support staff had to make critical decisions (such as whether to send patients to the hospital for care). When patients were deemed safe to receive cancer treatment in person, telehealth enabled physicians to proceed with treatments in isolation clinics, avoiding further delay in care. The ability to effectively use telehealth saved lives by enabling cancer care to continue without interruption.

The pandemic has forced all of us to think outside of the box about the way we provide cancer care, and collaboration among cancer institutions and practices has provided guidance during this journey. The cancer community has responded well to the challenges presented by COVID-19. We hope that we can continue to take these lessons we learned from the pandemic and make the world a better and easier place for all patients with cancer wherever they live.  

Sibel Blau, MD, is a medical oncologist who is in clinical practice in the Pacific Northwest. Dr. Blau has taken on several leadership roles, including developing a breast cancer program of excellence in her region. She is involved with clinical research programs as a PI and sub-PI in clinical trials at Northwest Medical Specialties, where she is the medical director of the hematology-oncology division and the clinical research program. Dr. Blau is also the editor-in-chief of Oncology Issues, the peer-reviewed journal published by ACCC. She is one of the founding members and the president of the Quality Cancer Care Alliance Network, a national clinically integrated oncology organization devoted to bringing value-based oncology care to patients in their communities. Dr. Blau is a past president of the Washington State Medical Oncology and a member of All4cure.