Coronavirus outbreak means tough decisions for cancer patients, physicians

On March 16, Alison Krupnick was supposed to have surgery to remove early stage cervical cancer.

Just days before her procedure at Swedish hospital, Krupnick was told it had been canceled, along with other non-emergent procedures, as hospitals in the region prepared to respond to the coronavirus.

It’s the only time she’s cried since her diagnosis.

“At one point I was on the phone with someone in the hospital surgery office, the schedulers, and I just started to cry and a I said, ‘I have cancer, wait a minute, how can you do this?’”

Krupnick has since learned more about the crunch hospitals are facing, and she said there are others out there facing far more dire situations than hers.

She’s still nervous not knowing when her surgery will be able to go ahead, but Krupnick said everyone is sacrificing in some way during this outbreak.

“This happens to be my thing that I’m going to have to do, and I’m OK with that for right now because I would not want to take up any resources in the hospital that could go to somebody who needs them more.”

Krupnick said she’s confident that she’s not in a life threatening situation right now, and that her doctor has made a calculated decision based on evidence.

As cancer patients throughout the country face a two-pronged attack from cancer and COVID-19, they and their physicians are facing the need to adapt and make these kinds of tough decisions.

Cancer patients are at greater risk of becoming ill and facing complications from COVID-19, the disease caused by the coronavirus. A report from the World Health Organization puts them in the category of people at highest risk of severe disease or death.

Physicians are imploring the broader community to take the outbreak seriously, to stay home when they can, and to practice social distancing to protect those who are most vulnerable.

Hospitals and cancer centers are trying to strike a balance, continuing care while keeping patients safe and hospital beds free.

“We’re really trying to figure out how we can decrease the number of people that are coming to the center while still maintaining active care for patients who have life threatening diseases,” said Dr. Steve Pergam, director of infection prevention at the Seattle Cancer Care Alliance (SCCA).

Pergam said they’re working hard to educate patients and make preparations. Some of those preparations are simple, like screening everyone who comes in for symptoms and testing patients and staff.

Others are more complicated, like considering which patients could undergo outpatient treatment, instead of coming to a hospital setting, risking infection, and who can have treatments delayed without major impacts.

Treatment is time sensitive for some cancers, and less so for others, according to Dr. Christine Lee, interim medical director of Swedish Cancer Institute’s breast program.

“Any time you get the diagnosis of cancer, or the big C, it feels emergent,” Lee said.

But she said there’s a lot of data to help providers decide whether timeliness of care is critical. For some patients, care can be deferred without changing their long term outcome.

That’s an option being weighed in light of the risk of COVID-19 and the stress on hospital systems.

“So one of our jobs is helping those patients understand that and then helping them receive the care in the timeframe that is safest for them,” she said.

For those who do need continued or emergent care, Lee said they’re receiving it at the moment, hospitals are simply coordinating care differently than they might otherwise.

“It’s not business as usual out there and it is not going to be business as usual for probably a lot longer than we would like,” Lee said.

Dr. Pergam with SCCA said the decisions they’re making now are in preparation for a peak in COVID-19 cases in the community.

Pergam said they’re doing all they can, but he knows it’s tough on both physicians and patients.

“Certainly, there are patients who are disappointed. There’s patients who wanted to come here and get bone marrow transplants that we’ve had to turn away because we don’t think it’s safe in this current environment,” he said.

The added complication of an outbreak on top of cancer treatment can take a toll. One Seattle-based organization has worked quickly to ensure things like in-person support groups, stress relief programs and gentle exercise classes are still available during a time when social distancing is paramount.

“We were able to really focus our efforts on bringing programs online, and we did so by the first week of March,” said Joseph Yurgevich, director of Cancer Lifeline.

“Last week, we held a meditation class for stress management for 23 people online.”

Yurgevich said serving clients online allows them to reach a broader geographic region, and he encourages people who need support to reach out.

The reality of this crisis is that the outbreak in the Seattle area impacts patients far beyond this region, with some patients traveling from other areas for treatment being asked to stay away.

Jan Lovett is one of them. Last September she was diagnosed with a brain tumor. In about a month, she was supposed to travel to Seattle for an MRI.

She and her husband Terry planned ahead, choosing a week during her chemo cycle when she’d be feeling good.

“We picked a date that coincided with home baseball series with the Mariners, and we could see friends, and go and do my MRIs and meet with Dr. McGranahan,” Jan said.

“None of that’s happening.”

The Lovetts are from Alaska. But, for the moment, they’re staying in Bend, Oregon. They’re unsure travel is wise at this time.

They exercise while practicing social distancing, Terry does the grocery runs and washes his hands every time he enters the house. They’re focused on supporting their kids. They’re adapting, but they are seeing impacts.

Jan is already seeing small changes in her care, she goes to a different site for blood draws to avoid the hospital these days, follow up visits are on the phone, and her MRI will now be done in Bend.

The risks that the coronavirus outbreak has brought means the plans Jan and Terry had in place, like returning to Alaska, are on hold.

“Our world changed in September when this diagnosis happened for us. So all the plans you might have made for your future went out the window,” Terry said.

They made new plans to get them through the year and a half of treatment. Those went out the window when the coronavirus hit.

“I think we’ve kind of quit making plans at this point and we’re just trying to get through one day and plan for the next,” he said.