Information Session: Navigating Your Cancer Care

Patient Information Session: Navigating Your Cancer Care

Presentation

Operator: Good afternoon and welcome to the Memorial Sloan Kettering Information Session Navigating Your Cancer Care.

Our host and moderator for today’s call is Dr. Lisa DeAngelis, Physician-in-Chief and Chief Medical Officer at MSK.

I would now turn the call over to Dr. DeAngelis, please go ahead.

Lisa DeAngelis: Thank you, and welcome to this MSK Information Session on Navigating Your Cancer Care (technical difficulty). I am also a neuro-oncologist who cares for people with brain tumors and the neurologic complications due to cancer.

Thanks to those of you who have joined our call today. I want you to know that MSK is working hard to keep you and your loved ones safe when you come for an appointment or treatment at any of our locations.

Cancer treatment and screening are critical, but we understand that you may be feeling particularly vulnerable during this time. Together, with our panel of experts, we’ll answer some of the many questions you’ve shared with us in advance of this call. We will try to get to as many of the questions you sent in as possible.

I want to remind you that your MSK doctors and care teams are ready and willing to talk to you directly about your concerns. I encourage you to reach out to them to discuss the next steps in your care and to ask them any questions that do not get answered here today.

I want to start with one of the questions we heard the most, which is what steps are you taking to protect patients and staff at MSK? I’m going to ask Jeff Drebin, Chair of our Department of Surgeries, to start us off by answering that. Jeff?

Jeff Drebin: Thank you, Lisa, and good afternoon to everybody who’s on the call today. Certainly, the safety of our patients and of our faculty and staff is a primary concern for all of us at MSK, and really there are multiple things we’re doing, beginning with the fact that all patients receive a phone call prior to presenting for a test or a procedure or being admitted to the hospital for any reason to review symptoms that might be related to COVID, and are asked to hold off and get tested rather than coming in if they have symptoms.

Our staffs also do a daily questionnaire online which addresses symptoms, and again, we ask symptomatic staff to not come in. In addition, we were the first program in the region and maybe in the nation to do routine testing of all patients before surgeries and procedures or admissions to the hospital for COVID. And everyone is tested within 72 hours of admission and again every 72 hours while in the hospital.

We also test all our staff on a weekly or every other weekly basis based on their risk of being exposed to COVID. And it’s worth noting that the asymptomatic rate of COVID with our mandatory screening program back in March and April when it was so prevalent was 5 percent. That is 1 in 20 patients we were scheduling for surgery had it and didn’t know it.

That rate currently is running less than half of 1 percent, so it’s dropped over 20 fold.; And so the chance that someone has it is quite low, but we are still being meticulous in looking for it. And if we find people who have COVID, we generally are able to help them with COVID care, and then when they clear the virus in a couple weeks, go ahead with their cancer care.

Lisa DeAngelis: Thank you Jeff. We know it’s so important to have a loved one or caregiver with you at your appointment if possible. I’d like to ask Liz Rodriguez, Director of Nursing Ambulatory Care services, to share the details of MSK’s current visitor policy. Liz?

Liz Rodriguez: Thank you, Dr. DeAngelis, and good afternoon, everyone. We are allowing visitors to our in-patient units for four hours per day at specified times. We also allow caregivers to accompany patients’ surgeries, interventional radiology and endoscopy procedures. And they can remain with patients in a (technical difficulty) patient at their discharge.

This week we expanded upon these visitation policies to now permit caregivers to join patients at their clinic visits with their physicians, advanced practice providers and nurses. In all of these cases, we ask that visitors register in advanced with the visit using our online visitor registration form. In the form, we collect the name of the visitor, the contact number, the name of the patient being visited and the date of the visit.

We are also doing symptom and travel screening on our visitors. Upon arrival, visitors are also screened for temperature and are not permitted into the facility if they have a temperature of 100 degrees or higher. Visitors are also asked to comply with our standards for PPE, including a face mask and performing hand hygiene upon arrival.

All this being said, we also recognize that sometimes in-person visitation is not possible. And in those cases, we are assisting both our patients and caregivers into facilitating virtual visitation through video so that patients and caregivers can stay connected. This can be done with your own device; and also at all of our MSK locations, we can provide tablets and phones for patients to use if needed.

Lisa DeAngelis: Liz, many people travel to MSK from out of state and often from very far away. Given New York’s travel restrictions when it comes to certain states, how are we helping those people and anyone traveling to see us get their care safely?

Liz Rodriquez: Well, in response to the travel advisories issued by New York and New Jersey, we’ve implemented additional screening and testing protocols for patients coming to MSK from the impacted states. We are not requiring patients to undergo a 14-day quarantine period, but instead we require that they undergo COVID swab testing within 72 hours of their first scheduled MSK appointment.

Lisa DeAngelis: And what about lab work and other tests? Several listeners have asked if these types of appointments could be done locally before coming to MSK for treatment.

Liz Rodriquez: Absolutely. We have a number of ways that patients can have lab work and other diagnostic testing closer to home, including we can arrange appointments at one of our regional care network locations in Westchester County, Long Island or New Jersey.

Additionally, patients can have testing done at local non-MSK lab facilities such as Quest Diagnostics. I would recommend that it’s best to check with your doctor about your specific needs and what options may be available to you.

Lisa DeAngelis: Thank you. I want to introduce Tobias Hohl, Chief of our Infectious Disease service and ask him what precautions our patients need to take before, during, and after treatment. Tobias?

Tobias Hohl: Lisa, thank you for the introduction and welcome. They obviously understand (technical difficulty) cancer therapy during COVID-19 is very, very challenging for patients who wanted to stay safe. I think an important message that I want to convey to everyone is that treating your cancer is the best possible thing that you can do for your long term health during the COVID-19 era.

We have looked very carefully at our cancer therapies and found that receiving a (technical difficulty) therapy [safe] even in the COVID era and generally does not worsen outcomes of COVID if a patient develops a COVID. So it’s very important to undergo treatment for you cancer for your long term health even in this COVID era.

We regard to precautions, we want patients to wash your hands frequently at home, anytime you go outside and really engage in social distancing and just to take precautions about -- to minimize risk for exposure of getting COVID in the first place. So we want, obviously, all the physical barriers to be in place to minimize risk and they’re in place at our treatment facility. And we want also to emphasize frequent hand washing to minimize transmission risk.

Lisa DeAngelis: Tobias, one listener asks, what it MSK’s recommendation for the safest method of transportation for those without cars who must come in regularly for treatments. Can you talk about the best way to protect yourself if you need to use mass transit?

Tobias Hohl: Yes and I think that’s a very, very, very important question and highly relevant for many of our patients. Of course before patients come in to be seen or be treated by MSK staff, it’s very helpful to have a conversation to make sure the visit is necessary.

If you are coming in, again, it’s very important to wear a mask while you are outside and traveling to MSK. There are travel options for patients, if a patient -- if you are able to take a car service and many for hire vehicles now have a physical barrier between the driver and the passengers, I think that is a good way.

But for patients who do need to take public transportation, taking the subway, you wear a mask, I would also recommend wearing gloves and bringing hand sanitizer so that you can just clean your hands when getting on and coming off the subway.

Dr. Fauci spoke today about wearing eye protection and I think that’s appropriate as well. So for those of you who wear glasses, obviously wear them. But it is appropriate to wear face shields or goggles as well to minimize risks to your eyes and transmission through that pathway.

Lisa DeAngelis: One more question on transportation, Tobias, another person asked, for those of us living across the country and receiving care at MSK, when will it be safe to fly?

Tobias Hohl: I would again advise such a patient to first have a conversation with the treating physician to see if any necessary care could be delivered on site or locally. If the decision is to come to New York City and to take an airplane, I would use very similar precautions that I just outlined for riding the subway meaning a mask, eye protection, gloves and hand sanitizer with frequent washing.

There are airlines that have a policy of keeping the middle seat open on flights, and I would -- if I had the choice, I would prefer to fly with such a carrier than airlines that have less strict policies about separating passengers.

When I was talking with Dr. Drebin this morning, he made an excellent point that is that many of the airflow devices, the cooling air that comes into the airplane cabin, it's all HEPA filtered air, and that can be used to move air in front of your face so that prevents air from -- that other people exhale from reaching your face.

I would also advise patients to board either first or last if possible, and get off the plane either first or last, to avoid the commotion that occurs during getting on the plane or deplaning.

Lisa DeAngelis: (Technical difficulty) telemedicine appointments as Liz mentioned earlier. Liz, can you talk a bit more about how these appointments work and when they might be appropriate?

Liz Rodriguez: Sure. Telemedicine visits can actually very easily be conducted over your smart device like a smart phone or a computer. We will send links to the appointments in advance of the appointment, using our patient portal or e-mail.

In most cases, a telemedicine visit can provide a comprehensive assessment of the situation for a patient, but in some cases where a physical exam is required, we would prefer the patients to come in person and a telemedicine visit wouldn’t be the most appropriate choice.

Lisa DeAngelis: And Liz, to give a little more detail, do we offer new patient telemedicine consults, and are these appointments available to people who haven’t been seen at MSK before?

Liz Rodriguez: Yes, most definitely. In fact at the beginning of the pandemic, we made quite a big shift to offering new patients a visit via telemedicine, and in fact, a significant proportion of our new visits in the department of medicine continued to occur over telemedicine.

In some cases again, a physical assessment may be required in particular prior to surgery, and in that case, we would ask patients to come in. But that could be following an initial consult over telemedicine.

Lisa DeAngelis: Jeff, one question we got was, does it make sense to get a second opinion from MSK? Can you answer that? Jeff, are you muted?

Jeff Drebin: I'm sorry, I was muted and I apologize, most common mistake in this era. It certainly does make sense for people to get a second opinion following a cancer diagnosis.

I have some data regarding review from radiology of films from outside, or pathology slides from biopsies outside, are both changed approximately 15 percent of the time when they are reviewed here. That is, the pathologist who see unusual tumors commonly are better able to make a call than community pathologists who may not see these things very often.

Similarly, surgeons, and medical oncologists, and radiation oncologists may have a different approach to treatment for tumors that we deal with here on a frequent basis that are uncommon elsewhere.

I would say, quite honestly, we most often overcall patients who are already booked for surgery elsewhere (technical difficulty) surgery at that point, which would be unhelpful in curing their cancer and doing an alternative form of treatment either as the main [treatment] or potentially before surgery. So I think for both accuracy and the best possible treatment, a second opinion makes a lot of sense.

Lisa DeAngelis: So Jeff, many of our listeners asked about the importance of getting a mammogram, colonoscopy or other screening procedure at this time. Can you talk about how we balance the risks of cancer with the risks of COVID-19 in these situations?

Jeff Drebin: COVID is certainly a problem. You can't go anywhere or turn on the TV without hearing about it. But we have to recognize that with the exception of two weeks in April, more patients have died of cancer every week in 2020 than have died of COVID and that will continue. So the cancer problem overall is a much greater cause of death than COVID.

Furthermore, the screening for common cancers with things like colonoscopy, mammograms, blood tests like PSA checks have been associated with marked reduction in cancer deaths. That is, when we find cancer early we're better able to treat it effectively and cure it. And so, by delaying these types of cancer screenings, patients may not be identified with cancer until they're at a more advanced stage, when the chance of being effectively treated is less.

The mortality for cancer in the U.S. over the 40 or 50 years has gone from 50% to 30%. That is, most patients are now cured. And a most reason for that is better screening and finding cancer earlier.

So if people are delaying because of fear of COVID at this time, and particularly in our region where COVID is fortunately and I hope continues to be very uncommon, the risk of missing a cancer is certainly much higher. And if it was postponed back in February or March, now is the time to get it taken care of.

Lisa DeAngelis: And on a related topic, Jeff, another listener asked, "Is it safe to have minor elective surgery within the next month?"

Jeff Drebin: So as long as that questioner is from the New York, New Jersey, Connecticut region, the answer is absolutely. For the reasons I mentioned, the virus is quite uncommon and virtually every hospital in the region has followed our lead and is doing what we're doing with the pre-op testing. So your risk of being in a bed in the recovery room near someone with COVID or having a patient on the same floor is extremely low.

We could not do elective surgery back in March and April following the governor's edict that non-essential surgeries should be postponed, but that has been lifted. And so now, again, is a time when the institutions have availability. There are no longer concerns about infection or having adequate PPE reserved and so on and so forth. So I think it is a very safe time to have a minor or elective surgery in this region.

Now, of course, in Florida, in California, in Texas, where this is flaring like it did for us in the spring, they have postponed those sorts of things because they are overwhelmed with COVID patients.

Lisa DeAngelis: Several listeners asked about how we sanitize between appointments, particularly between treatments, such as radiation therapy, which are done in tight spaces. Liz, can you speak to that?

Liz Rodriguez: Yes, so this is a really important question. And I'm happy to share that we have nursing assistants and technicians that are wiping down rooms and our equipment in between each patient using very strong disinfectant wipes.

Additionally, we have (technical difficulty) on our floors frequently and are doing disinfecting of high touch areas, as many as five times throughout a day. These areas are included in our public spaces and our bathrooms, and impact things like elevator buttons, door handles, bathroom grab bars, waiting area tables, keyboards, phones and window sills.

In addition to the work that we’re doing throughout the day, we also have cleaning staff conducing deep cleaning and disinfecting of all our clinical and public spaces overnight, and we even have a system in place that verifies the effectiveness of the areas that have been cleaned to ensure that the cleanings have been done properly.

Lisa DeAngelis: Tobias, many of our questions have asked when a vaccine might be available, what’s the latest on that front?

Tobias Hohl: This is a very exciting area and I’m sure that many listeners who have been reading “The New York Times” and other media know that there are some vaccine candidates now that have entered Phase 3 trial, and that’s a very significant development and a phenomenal achievement since it’s only been about six or seven months since we’ve known about the virus.

What this means is that by the end of the year, we may know if a vaccine candidate is effective at reducing the transmission, or the severity of COVID-19 in patients who do acquire the disease and that obviously would be -- is very exciting and we are all clamoring for a vaccine that we can give to patients.

In parallel, we have institutional efforts to understand the immune response to COVID in cancer patients so that when a vaccine is available that we will be able to use it in our cancer patient population and to understand the potential benefits that a vaccine could provide.

Lisa DeAngelis: Tobias, generally what can patients with cancer do to boost their immunity? This is a question several of our listeners asked.

Tobias Hohl: Well, I think this is a very timely question and particularly in this era of COVID. There are things -- there are clearly things that patients can do to boost their immunity. Some of these are clearly very, very important in general, but particularly so now.

So for example if a patient is a smoker or vapes, that is really important to address right now because that compromises the immunity in the lungs and makes patients more vulnerable to severe COVID disease.

Also maintaining a healthy weight and boosts immune defenses, and also leads to better outcomes if a person is unfortunate enough to develop COVID-19. So smoking cessation, a weight management and also physical exercise are very, very important ways in which cancer patients can actively participate in boosting their immunity and resistance to COVID-19.

Lisa DeAngelis: One listener wanted to know how does nutrition influence cancer. [Can you] take this on?

Liz Rodriguez: Sure, and I think the advice is much the same as to what Tobias just emphasized. Staying physically active is very important and maintaining a healthy weight, but also healthy eating patterns, such as eating fresh whole foods and limiting the processed foods can help to ensure a healthy weight and avoiding or limiting alcohol intake can also be very important.

I do recommend, however, that patients speaks with their doctors to find out if there are other specific actions they can take for the type of disease they have.

Lisa DeAngelis: Thank you. I want to wrap up with a general question we received from one of our listeners. How do you know you are getting the best care for your type of cancer? Jeff, can you talk about MSK's overall approach to treating cancer?

Jeff Drebin: Sure, Lisa. Cancer care is all we do and we do more of it than anywhere else in the country. We do more cancer surgery, we see more patients requiring radiation or chemotherapy, and because of that we have more experience and it's been shown that places that are specialized and do a high volume of care deliver better care, more timely, in our case, multidisciplinary, most of our patients are actually reviewed by a group of disease management specialists in their particular tumor type, including medical oncologists, radiation therapists, and surgeons, and of course now with immunotherapy, sometimes with immunotherapists as well to make sure that they are getting the best possible care.

The care is driven by the most recent data, the standards are frequently set by the trials that are run here at MSK, and we try to offer our patients not the best current treatment but the best of tomorrow's treatment that they can get today by being at the institution that is setting those standards.

Lisa DeAngelis: Thank you, Jeff. I want to thank everyone who submitted questions, and thanks to all of you who joined this call today. We hope you found it informative and helpful, and I also want to thank our speakers. We plan to host more calls like this in the future and we look forward to speaking with you again.

A replay of this call will be available soon on our website, which I urge you to visit often for the latest updates at MSKCC.org.

As always, we are dedicated to moving your cancer care forward and encourage you, again, to be in touch with your MSK doctors and care teams. Please be safe and take care of yourself and your loved ones. Thank you.

Operator: Thank you. This concludes today's call. Thank you for joining Memorial Sloan Kettering's Information Session for patients and caregivers. Have a good evening.