Impact of COVID-19 on Cancer Care — timeline and updates in the Philippines [02:34]
Cancer and COVID-19: changing the landscape in cancer care — [03:58]
COVID-19 infections in cancer patients — higher rates of hospitalization and deaths, outcomes, and impact [05:23]
Treatment of cancer patients during the COVID-19 in the Philippines — [08:39]
Prioritization of patients — cancer patient management in response to COVID-19 [10:19]
Cancer and COVID-19: Functional Cure in Metastatic Cancer – Hope or Hype? — [18:05]
Cancer and COVID-19: Effectiveness of Telemedicine in Cancer Care — [34:41]
Opening of World Cancer Day 2021: Closing the Care Gap on Cancer and COVID-19
Moderator 00:10Good evening. So World Cancer Day 2021 is in February. It is timely that tonight, in association with the Philippine Society of Medical Oncology, Singapore Society of Oncology, and the Indonesian Society of Surgical oncology, we present the Regional Cancer Congress through Docquity. Good evening, I am Hiyasmin Alejandro, and I will be the moderator for tonight. And we are fortunate to have with us three excellent speakers to help us close the care gap in cancer care.
Moderator 00:45So our first speaker is Dr. Arnold John Uson. He is the President of the President of the Philippine Society of Medical Oncology. He's also the Associate Professor in Oncology at Cebu Institute of Medicine, University of Cebu – School of Medicine, Mindanao State University – College of Medicine, and a Research Technical and Ethical Reviewer at Institutional Ethics Review Board of the Perpetual Succour Hospital in Cebu City, and the current Section Head of Medical Oncology at Cebu Velez General Hospital.
Moderator 01:15Our second speaker is Dr. Toh Chee Keong, Consultant at Curie Oncology. He's an Assistant Professor at Yong loo Lin School of Medicine at NUS and Duke-NUS Medical School and the former Director of Research at Raffles Cancer Center. And he's the Lead of the Lung Cancer Consortium at the National Cancer Center, Singapore, and the Lead Co-Investigator in the Next-Generation Clinical Trials and Integrative Research for Fighting Lung Cancer, awarded by the National Medical Research Council.
Moderator 01:49And our third speaker is Dr. M. Yadi Permana. M. Yadi Permana is a Consultant at the Fatmawati Hospital Jakarta, Indonesia, and is the Head of the Indonesian Medical Association, South Jakarta chapter, and the current Secretary of the Indonesian Society of Surgical Oncology.
Impact of COVID-19 on Cancer Care
Dr. Arnold John Uson 02:34Good day everyone. I'd like to thank Docquity for inviting me to talk about the Impact of the COVID-19 Pandemic on Cancer Care.
COVID-19 timeline
Dr. Arnold John Uson 02:47We all know that COVID-19 is a contagious respiratory illness caused by the SARS-CoV-2 virus. It all started as an outbreak of respiratory infection in Wuhan, China, in December 2019, thus the word COVID-19. On the 30th of January 2020, it was declared a Public Health Emergency of International Concern (WHO). The first case in the Philippines was on the same day, the 30th of January 2020, and the first case of our community transmission was on the 7th of March 2020. Several days after, it was already declared a pandemic by the World Health Organization.
Impact of COVID-19 in the Philippines
Dr. Arnold John Uson 03:32 Now, these put us into a lockdown. In the Philippines, we call that "Enhanced Community Quarantine," where all people were advised to stay home, and almost all sorts of transportation were suspended. And you can imagine the Philippines as an island nation composed of three big groups of islands; you see that this can be a logistical nightmare.
Cancer and COVID-19: Changing the Landscape in Cancer Care
Dr. Arnold John Uson 03:58So this changes the landscape of cancer care or almost all sorts of health care because this put us in the restructuring of some government hospitals into COVID-19 referral centers. And since most of the government cancer centers are also located in these hospitals, there were temporary closures of these cancer centers. There would be the conversion of hospital beds to COVID ICU and COVID-dedicated beds.
Dr. Arnold John Uson 04:37Because of this, there would be a shift of hospital manpower to COVID personnel. And there would be a halting of face-to-face consultations on an almost outpatient basis, particularly in our COVID patients. And there was limited access for our cancer patients to diagnostic tests and procedures. During this time, almost all CT scans were used to diagnose and procedures for COVID-19 infection patients, there was limited communication among various stakeholders, and there were logistical problems in the transport of cancer medicines during the time.
COVID-19 Infections in Cancer Patients
Dr. Arnold John Uson 05:23Cancer patients also have a higher risk of developing severe COVID-19 infection. And because of this, family members or even the cancer patients themselves became sick of COVID-19. And there was a worsening financial hurdle due to unemployment of the cancer patients or even those of their family members.
Cancer patients have higher rates of death from comorbidity with COVID-19
Dr. Arnold John Uson 05:49Data shows that there is a higher risk of COVID-19 related deaths for patients with cancer, almost twice that of those without cancer. And when they do have COVID-19 infection, they have a higher rate of hospitalization and a higher rate of COVID-19 related death.
Outcomes patients with cancer and COVID-19
Dr. Arnold John Uson 06:12A registry in the US consisting of about 73 million patients found out that those patients with cancer generally have a significant increase of COVID-19 infection, and they have a significantly higher chance of developing severe COVID and COVID-related death. It is particularly true in patients with hematologic diseases or cancer like leukemia, non-Hodgkins lymphoma, and lung cancer patients.
Dr. Arnold John Uson 06:51And here is also a slide that shows that the hospitalization rate of COVID infection among cancer patients is around three times that of those without cancer, and they have a higher risk of having COVID-related infections or mortality, three times that of the patients without cancer.
Impact of COVID-19 infection in cancer patients
Dr. Arnold John Uson 07:16The impact of COVID-19 infection on cancer patients has increased hospitalization when they do have COVID infection. And even if they don't have the COVID infection, because of logistical problems and because of the aforementioned changes in health care—there is a delay in cancer treatment, and thus they have a high chance of disease or cancer progression and a high chance of having death either COVID-19 related death or that of cancer-related death.
Dr. Arnold John Uson 07:53In a study by Abdul Rahman Jazieh on the impact of COVID-19 infections in various countries, they found out that cancer patients have a high chance of missing their chemotherapy or cancer treatment. Cancer patients also had difficulty accessing medical care during the first few months of the pandemic. They have an increased risk of cancer disease progression because of the delay in treatment, and they have particularly prone to have high levels of depression and anxiety.
Treatment of Cancer Patients During the COVID-19 in the Philippines
Dr. Arnold John Uson 08:39Because of this, the Philippine Society of Medical Oncology made a statement and guidelines for the treatment of cancer patients during the COVID-19 pandemic in the Philippines. This provides a guide among the medical oncologists on cancer management during these times of the pandemic. The recommendations are divided into three:
we should ensure patient safety and healthcare safety work environment,
we prioritize patients and the continuum of cancer care, and
organize the transition of cancer care to the nearest to them.
Dr. Arnold John Uson 09:19We ensure patient safety and a safe workplace for the healthcare workers, and this is by doing and enforcing controlling foot traffic by limiting one entry and exit to cancer centers. We set up triage and screening systems both outside the hospitals and inside the Cancer Center. We also strictly enforce social distancing in the waiting area as well as in the infusion unit. We also enforce proper appropriate personal protective equipment for our personnel, the doctors and the nurses, in the control unit and in the preparation of the medication compounding to that of infusion during in for the cancer patients.
Prioritization of Patients
Dr. Arnold John Uson 10:19We prioritize our patients and provide guidelines for urgent conditions and non-urgent conditions. The urgent conditions are those cancer patients who have active disease. These patients with the early disease haven't completed their treatment and have to undergo adjuvant and curative intent. Patients with advanced disease with a high risk of disease, high-grade tumor, and high tumor burden with their high chances of disease progression are put into an urgent condition and thus need urgent treatment as patients with oncologic emergencies.
Dr. Arnold John Uson 11:02On the other hand, those patients who have non-urgent conditions are those who already had completed their treatment and are already in stable condition with no evidence of the disease, thus may be put into delayed hospital visits and put into oral medications.
Dr. Arnold John Uson 11:23So what we do is individualize treatment and management. We weighed the risk of COVID infection and the risk of cancer progression, and the benefit of the treatment at the risk of patients contracting the COVID-19 infection. And patients with the disease state, we delayed the treatment and visits to the hospital for low-risk early-stage disease. And we consider logistical concerns and regional differences.
Dr. Arnold John Uson 11:58We also advocate multidisciplinary discussion and referral to the non-COVID hospital cancer care centers and for those who have non-urgent conditions to delay their procedure and advocate telemedicine conferences.
Dr. Arnold John Uson 12:18For those non-urgent treatments or non-urgent conditions, we consider treatment breaks. Consider switching them to an oral regimen so that they will not be able to visit hospitals and run the risk of having a COVID infection. We consider consultation via telemedicine and SMS, and emails. And at this time, we were already also doing e-prescriptions.
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