Medical Oncology and Radiation Oncology
The COVID-19 pandemic has led to changes in medical oncology and radiation oncology care, including surveillance after completion of treatment, in an effort to still provide the care needed, but also reduce risks as much as possible. Each physician evaluates his/her clinical schedule to determine what patients need to be seen in person, what patients can be triaged to telemedicine, and what patients can be re-scheduled for a clinical appointment at a later date. New consults or active patients are being seen in the clinic with continued care as per normal circumstances. Active patients are those who are currently receiving systemic therapy and/or radiation, or undergoing active recovery from therapy, necessitating in-person evaluation and possible supportive care such as intravenous fluids. The outpatient clinical area has developed a screening process for patients. Patients are screened in the lobby of the building, including those receiving daily radiation therapy, for signs/symptoms of infection, the temperature is taken, and all patients are required to wear a mask. If a patient screens positive, a dedicated location for the treatment team to evaluate the patient is available. Currently, there is no visitor policy, with an exception if needed for communication issues, which applies to some of our patients who have undergone a total laryngectomy. The treatment teams engage those family members who are not able to attend the initial evaluation via telephone or video conferencing. Additionally, for example, for those patients receiving traditional chemotherapy alone in the recurrent/metastatic setting, growth factor is being used more regularly in an effort to avoid immunosuppression. Patients in the long term follow-up are being re-scheduled to a later date if possible, with also delay in surveillance imaging. Patients that fall in between these categories are offered a telemedicine visit at the physician’s discretion. If a patient cannot do a telemedicine visit or prefers an in-person visit, the patient is able to come into the clinic for their appointment.
Prior to the COVID pandemic, our goal as a head and neck program has been to offer at least one visit with medical oncology and radiation oncology at the main cancer center in order to help develop the plan and offer clinical trials if applicable for all patients. However, in light of the pandemic, those patients that have expressed interest in being treated more closely to home at a Hillman affiliate are being triaged straight to local providers. An additional strategy to decrease exposure has been that radiation oncology completes a telemedicine visit first. Then the in-person visit occurs when the patient is brought for simulation, with medical oncology meeting the patient on that day as well.