Reflections on caring for cancer patients during the COVID-19 pandemic

I think the coronavirus (COVID-19) pandemic is one of the most serious – and important – times of our generation. Right now, as the U.S. heads toward the peak of daily new cases, we’re in the thick of long and lonely days. I’ve seen and lived this firsthand the last couple of weeks while I’ve been rounding on MD Anderson’s inpatient leukemia unit. When it’s all said and done, I think we’ll truly recognize the enormity of what we’re going through.

Appreciating the power of human connection during the coronavirus pandemic

Since I started my April rounds, I’ve realized the power of human connection and touch. Even though most of our patients don’t have COVID-19, they are all still greatly affected by it. Leukemia patients often have to be hospitalized for extended periods of time. They may be in the hospital for weeks while facing complications from their cancer and treatment.

Like most other hospitals in the U.S., MD Anderson has temporarily restricted visitors to protect our patients and workforce from COVID-19. Cancer patients are particularly vulnerable to COVID-19 and other infectious diseases. And our leukemia patients and stem cell transplant recipients are uniquely vulnerable because the rigorous treatment they undergo weakens their immune system, often for a long time.

It’s necessary, but devastating, for most of our leukemia and stem cell transplant patients to be alone right now due to social distancing and other COVID-19 precautions. Over the past few weeks, I’ve witnessed how hard it is for someone to receive bad news without a loved one beside them for support, and I have seen our faculty and staff step up to provide compassion that goes above and beyond in these difficult times for our patients. Cancer treatment is already a complex process, and it’s even more complex to navigate alone.

I think this era will help health care providers fully realize the power of the loved one at the bedside and how important they are to the care team. A loved one’s calming presence and physical touch is soulful communication that can’t be fully replaced virtually.

Even the simple, physical interactions I’m used to as a physician – handshakes, hugs, physical exams – are limited or no longer allowed to prevent the spread of COVID-19. The lack of these physical interactions creates a barrier to connection that’s more powerful than I expected.

COVID-19 has rapidly altered the way we deliver cancer care

On the other hand, not allowing visitors inside the hospital also means we’ve adapted to involve family members virtually in real time. It’s allowing discussions to take place in a way that never happened before.

For example, in the past, if a caregiver wasn’t available when we were rounding or if the patient wasn’t able to fully comprehend their treatment plan by themselves, I’d talk to the patient first, then another team member would talk to the family afterward to bring them up to speed. We’d communicate with everyone, but not necessarily at the same time. 

Now, during the COVID-19 pandemic, when we get to a patient’s room, we put their care partner on speaker phone or a video call right away and conduct the same conversations remotely. That’s something we should continue doing.

I have a new appreciation for the importance of using telemedicine to provide outpatient follow-up visits or consults to patients while they’re hundreds of miles away at their own homes. While there’s no replacement for the sort of in-personal interactions we had before the COVID-19 pandemic, telemedicine is helping us provide meaningful, clinically significant interactions and continue to provide exceptional cancer care for our patients.

COVID-19 has given me new appreciation for MD Anderson’s experts

I’m proud to be part of an organization and a Leukemia department whose leaders have handled this pandemic with such transparency. It’s comforting to know that our leaders, including MD Anderson President Peter WT Pisters, M.D., and Leukemia chair Hagop Kantarjian, M.D., are focused on keeping our patients, as well as our employees and our families, safe and healthy during this difficult time. The ability to care for patients with aggressive and often rare blood cancers remains a core focus of the entire Leukemia team, no matter what.

I already had high respect for our Infectious Disease and Infection Control teams, but I appreciate them even more now. While infection control has always been important at MD Anderson, this situation has brought the type of stringent infection control concepts that we practice in the post-transplant setting to the forefront for solid tumor patients and cancer survivors as well. I also have so much admiration for the advanced practice providers and inpatient nurses who are working many hours to provide unparalleled bedside care. 

Looking forward, I expect epidemiology and emergency preparedness will be emphasized in future medical training. In the research world, new opportunities are already arising to study contagions and pathogens, not just at a theoretical level, but at a very practical level. This includes influencing the way we think about novel targeted drug development, the risks and benefits of repurposing older drugs, and streamlining the process of clinical trial development and design. We’re taking this threat seriously and will be even more prepared if and/or when the next pandemic occurs.

Compassion shines despite added stress of COVID-19

As I’ve been rounding on the inpatient Leukemia service, I’ve been absolutely blown away by the compassion from every single team member. I see colleagues checking in on the psychosocial health of their teams and families in a way that folks were too busy to fully do before the pandemic. Everyone is taking the time to ask each other, “How are you doing?” and truly listen to the answer. Throughout the hospital, I see people showing they care about each other’s mental and physical health and well-being like never before – to each other and to our patients, who remain at the heart of everything we do and every decision we make here at MD Anderson.

Even the myChart inbox has become an unexpected source of joy. I’ve received note after note of love and prayers from patients wishing me and my team health and safety.

We’re all being pushed to the extreme and tested by this historic pandemic. When it’s all over, I know I’ll look back and mourn the lives lost, but also continue to be inspired by the unprecedented courage and compassion shown during COVID-19. We’re all in this together.

Naveen Pemmaraju, M.D., is a hematologist-oncologist at MD Anderson.

Learn more about MD Anderson’s COVID-19 response.