With the onset of COVID-19 cases in South Florida, the University of Miami Health System ramped up cleaning and disinfecting practices in all facilities, initiated screening of all patients before they enter any clinical locations, and implemented a no visitor policy that meant patients could no longer bring a companion to treatment. At Sylvester Comprehensive Cancer Center—South Florida's only NCI-designated cancer center—the team is well-versed in infection prevention and control and trained in caring for patients with complex health conditions. They know these measures are especially important for cancer patients because they are considered at higher risk for COVID-19.
“Cancer does not stop during a pandemic,” said Nancy Nahmias, executive director of clinical research services. “Most of our patients are able to continue on experimental treatment, and we are still able to provide life-saving research therapies.”
As one of the largest and busiest cancer clinical trial programs in South Florida, with more than 250 cancer patients currently participating in clinical trials, the research team has made considerable effort to continue to evaluate each trial participant for enrollment and ensure that patients who require clinical trial-based therapy receive it.
Limiting patient exposure to COVID-19 also meant changing the way some visits and services are delivered. Routine follow-up appointments were converted to telehealth sessions, and cancer support services and resources shifted online. Working with doctors on an individual basis, many cancer patients have continued treatment while closely following health guidelines from official local and global organizations. “We are shipping oral drugs or other self-administered therapies to patient homes, so they do not have to come in to physically pick up their investigational therapies,” said Nahmias.
When patients do come in for treatment alone, the clinical nursing team steps in. Many have taken time to sit with cancer patients and offer them some company while they wait for labs, therapy, or during treatment as a way to provide comfort for those who may feel anxious and alone. “We have become part of their family at work, and they have become part of ours,” said Emily Panzner, M.S.N., A.G.N.P.-B.C., O.C.N., an advanced practice registered nurse in hematology/oncology.
Research nurses continue to see patients onsite, but with a majority of the clinical trial staff telecommuting, many patient visits have moved to telehealth if possible. “We have had to develop many new ways to work. But it has been rewarding, because we are still able to have clinical trials as an option for patients in South Florida,” said Jonathan Trent, M.D., Ph.D., professor of medicine and associate director of clinical research. “Knowing that I am still able to take care of patients and continue research toward finding a cure for sarcoma keeps me going.”
Since mid-March, Dr. Trent has relied fully on telemedicine for routine patient visits, which has made it possible for him to see even more out-of-state and international patients. In the process of adapting to this virtual environment, he has made some adjustments, including learning how to break bad news to patients. “Since I cannot place a reassuring hand on their shoulder nor give them a hug, I have placed more emphasis on making eye contact and choosing the right words at the right time,” he added.
With a disease where patients face so many unknowns and are not always able to visit their doctors, virtual access to care can make a long-lasting impact. “I think this will really change health care in the future in a positive way, particularly for cancer patients who are not always able to come see us,” said Cristina Pozo-Kaderman, Ph.D., Psy.D., director of clinical operations at Sylvester’s Cancer Support Services.
As part of her clinical work, Dr. Pozo-Kaderman specializes in psychosocial oncology and provides direct care to cancer patients. She is thankful to be able to bond with her patients, including new ones she has only met virtually. Her patients are very grateful to have continued access to counseling services—via phone or Zoom—and she appreciates that they are willing to participate despite all the changes.
The multidisciplinary team that runs Sylvester’s Cancer Support Services—which includes psychologists, psychiatrists, acupuncturists, an exercise physiologist, yoga/wellness instructors, art and music therapists, dietitians, chaplains, massage therapists, wellness/wig consultants, and volunteers—has found creative ways to reach their patients. Leaning on each others’ skill sets, including video and sound editing, the group continues to collaborate while physically apart.
“It was initially challenging because so much of what we do involves touch, human contact, and direct interaction,” said Dr. Pozo-Kaderman, who oversees the program.
For many, tools like Zoom were brand new. But by the second week of offering virtual programming—and after contacting patients to let them know these support services were available—the team saw an increase in participation as patients became more comfortable with telehealth. Many have been able to benefit from continued individualized therapy through virtual one-on-one sessions that include demonstrating modified techniques that can be done at home.
From her experience, Dr. Pozo-Kaderman shares that “cancer patients were already accustomed to dealing with a lot of uncertainty given their diagnosis. Many of them are coping better than anticipated, because they have already developed the skills to cope with the unknown.” She pointed out that some cancer patients have been able to communicate and share their coping skills with others who may be struggling with anxiety during these uncertain times.
“I feel that, as a health care community, we have stopped being so quick to blame or be upset by things or people that we have no control over,” said Panzner. “We are all simply doing the best we can with the resources we are given and the situation we are in. It has brought some more humanity into our lives and I think we all have a little bit more patience.”
Sylvester’s team of experts continues to address patients’ physical, emotional, social, and spiritual needs before, during, and after cancer treatment. The cancer support services team operates a full calendar of virtual classes and events—which includes acupressure, seated yoga, songwriting, and pet therapy—along with videos available on YouTube. Learn more about cancer support services and how to request an appointment.