In the Cancer and COVID-19 CME event hosted by Penn Medicine and featuring Dr. Anthony Fauci, Dr. Lawrence N. Shulman, Director of the Center for Global Cancer Medicine, summarizes the national response to the COVID-19 pandemic in regards to cancer patients. He elaborates on the evolution of the knowledge about cancer patients and COVID-19 and guidance on cancer care during pandemics.
Twitter @PennMDForum Dr. Schulman’s physician profile so I wanted to talk a little bit about the national response, and I think the reason that this is important to think about is we need to learn, like all the other things we have heard about this evening, what we've done well and what we could probably do better. And, you know, we've done some well and there's some areas of improvement. You've heard a lot about what we've learned over the last eight or nine months, but I think it's important to go back in your mind and think about where we were in March. And what do we know about Kobe? What do we know about infection and cancer patients? And how is it going to affect the patients who had cancer but didn't have cove it? And the answer is we really knew little to nothing. We really had no idea what was happening, how this was going to affect their health care systems and how we were going to best manage our patients. Onda. We're in a much better place now, but just think back to what we're all thinking about. Back then, papers like this came out and this came out in April on. This is from China. And these were studies that were observational. They were small numbers. There were anecdotal. We learned a little bit from them, but we didn't learn a lot. And Karoo and others have gone through what we've learned that I'm not gonna cover that again. But again, you have to remember back, uh, in days when we were really much less informed, um, than we are now. So what happened? We did do a lot of things. Well, Andi, you've heard a little bit about them. We did. Um uh, we did form consortiums. The N C I. The cooperative groups you've heard about the c c C 19 study. Esco ash. The American College of Surgeons all turned around and formed registries that looked at the effect of Kobe 19 infection on our cancer patients. But I think one thing to think about as Lynn and others have talked about, is the majority of our cancer patients were not infected, but they were affected by what was going on in our health care system, and we needed to concentrate on them as well. Andre was much less of an effort nationally and internationally to understand what the effects of the pandemic were on screening on patients who were diagnosed with cancer and so on. We didn't do quite as well there. Dr. Fauci mentioned the study that Net Sharpless, RNC I director, published uh, in science earlier in the year, which, um hypothesized that there would be excess deaths from colorectal and breast cancer over the next decade due to delays and diagnosis and delays in treatment. And this is a pretty scary set of numbers on though it's a hypothetical construct. It was important for us to start thinking very hard about what the effects of the pandemic were on our cancer care. Overall, one of the first groups to really think about this was cancer Care, Ontario. They're very organized and very quality driven group, and they published a pandemic planning guide for care patients with cancer. Actually, in mid March, while we were just starting to think about things in this country and they developed a priority scheme, three layers priority priority A, which was critical requiring immediate care priority be where some delay or altered care could be undertaken without compromising overall survival and priorities. See where patients could, in fact, have delayed care without compromising their ultimate outcome. And many of us around the US used this priority scheme to develop pathways on how best to care for our patients in the context of what was going on in your local environment. The infection burden and the stress on hospital resource is our professional organizations did rapidly come together and these were group of organizations that traditionally didn't work all that well together and they're listed here. But the professional societies, the Commission and Cancer and CCN and countless cancer programs, including pen and others rapidly came together to try to figure out what the best way forward waas and managing our patients we develop guidance documents on. I'll show you one example of that in a minute and we held webinars often put together within 72 hours. And some of the webinars that I and others participated in in spite of the fact that they were only advertised for 48 72 hours, had greater than 1000 participants that people were clearly looking for guidance from the national organizations. We had individual programs like the University of Chicago, who partnered with the American College of surgeons and developed medical necessity time sensitive prioritization scheme for surgery with the scoring system that looked at the procedure score. What was involved in hospital resource is what the urgency of the disease waas and what the patient status waas and this system was used it 10 and many other institutions rapidly adopted and extremely helpful. Uh, this is just an example of some of the webinars that we were running through the American College of Surgeons in the Commission of Cancer. Thes were occurring in late March. Onda again. These were heavily subscribed, often with more than 1000 participants began put together very quickly, advertised very widely. We had a number of the societies that came together with disease specific recommendations. This was a consortium that I was part of that included the American Society of Breast Surgeons, N A. P B. C, the N. C. C. N Commission in Cancer in the American College of Radiology. And we help Webinars and we published papers again, giving guidance for how to prioritize our breast cancer patients and manage them through the stress of the pandemic. The infection risks the restriction and hospital resources, or time, and so on, um e think worthwhile to note if you look down at the lower left hand part of the slide. We submitted this for publication on April 8th. It was accepted by the Journal two days later and published on line three or four days after that. These were very rapid turnaround times because people really needed have guidance on how to manage their patients. Uh, the N C C N A Z, you know, is a consortium of 30 academic cancer centers in the U. S. We formed the Best Practices Committee Covert Task Force. We met virtually obviously weekly on shared information. And from my point of view, this was one of the more helpful forums that I participated in because very rapidly, we exchanged information about how we were managing the Covic pandemic and our cancer patients across many of our major institutions around the country. We put this information together and published it. This is one example of one of our publications that came out in May Onda again, people coming together, working hard together and learning. So one of the lessons learned we came together, I think, quickly is it's a profession and put aside differences and rivalries between professional organizations. But American medicine still remains somewhat fractured and siloed, and the approaches were not consistent across the whole country. We learned that our national clinical data systems were woefully inadequate. Toe optimally meet the needs of a crisis such as the covert pandemic. What did we really need? We needed a way to analyze the data lifetime riel time throughout the country to better understand what was happening not only to her co been affected patients but, equally importantly to our patients who were not coping infected. But we're having impacts on their care, and we needed to learn from this experience to improve the standard of care and crisis care. I'm hoping that I never see anything like this again in my profession. But is Lin mentioned we're not through this yet? We don't know whether there's gonna be a second wave. We don't know what's in our future. We need to learn from this experience to carry us forward better the next time we're confronted with something like this. Um, I just want to mention and other people have mentioned this is, well, the physicians and nurses, the health care providers in the front line were amazing. What we were in the background tryingto give advice. Uh, there were countless people in the front lines caring for our patients. The national organizations did put differences aside, and I've never seen the degree of cooperation between them as we've seen recently. And obviously the patient's worked with us during these unimaginable times. I just wanted to also say, um and other people have mentioned this Doctor Fauci has been, um, true leader in this has shown what leadership is on what wisdom is and has given us incredible guidance. So thank you very much, all for your attention, and I will.