Virtual visits may provide a solution to a very real problem in oncology during the COVID-19 pandemic, when safety measures to contain the infection spread involve a reduction in the number of cancer patients visiting hospitals and outpatient clinics. To ensure continuity of cancer services and assistance to their patients, oncology teams in different countries are currently implementing or improving telemedicine services, to be integrated into daily routines to ensure the continuum of cancer care. Dr Rafal Dziadziuszko from the Medical University of Gdansk, Poland, shares his direct experience in using digital technologies to interact with his patients.
The adoption of safety measures to prevent COVID-19 infection and contingency plans in healthcare is impacting daily routines of medical oncologists. How does the current situation affect the doctor-patient relationship?
Both doctors and patients are stressed by the current situation and the pandemic is drastically impacting on the typical management of cancer patients. Although we aim to continue the care as planned whenever it is possible, we are also making fast-track important changes in the workflow to keep on providing quality cancer treatments while reducing the possibility of environment contamination due to the coronavirus. Currently, there are not high numbers of confirmed cases in Poland, but we have already worked very hard to increase opportunities for managing patients remotely and get prepared to face the pandemic.
All outpatients clinics are now shifting toward telemedicine. So far, we have received very positive feedback from patients who also want to maximise their safety by minimising physical contact. Earlier today, I have done about 20 outpatients visits by telemedicine. I have access to all the examinations, radiological scans and tests of the patients, and I am quite surprised by the amount of things that I can do with this approach. However, it is also important to note that physician-patient interactions may be challenging when managed remotely, especially during first visits. The oncologist has built a positive relationship with the patient, something which is not possible to do remotely, and this will pay later, especially at difficult times as those we are living now.
Which tools do you use to interact with your patients?
At the moment, I use telephone or Skype but a new digital platform is being implemented in my institute. It will soon enable us to have a virtual room for visiting patients, with potential benefits that hopefully will exceed the pandemic, such as less frequent visits for patients who live far away. From the psychological perspective, virtual visits require to put into practice the same principles that play a key role in face-to-face visits such as being careful when speaking with patients, listening to their concerns and understanding the amount of knowledge they may need and want.
The psychological impact of the COVID-19 pandemic may be particularly high on cancer patients who are vulnerable and at higher risk of infections. What are the key messages that medical oncologists should give to their patients to help them to deal with the COVID-19 pandemic?
The strongest message to give to our patients is ‘Please, don’t panic’. The situation is very difficult in many countries, but oncologists are doing their best to ensure a continuum of care and create safe environments for their patients. Patients should understand that if they are asked to undergo treatments in medical oncology outpatient clinics or radiation oncology facilities in the next weeks, they should be compliant to treatments. It may happen to see some patients who do not want to show up in the clinics because they are afraid of anything that may happen there, including the risk of being exposed to infections. Oncology teams should stress that for most of our patients the benefits of undergoing cancer treatments far outweight the risks associated to a potential COVID-19 infection.
What is the optimal approach to cancer patients for whom a change in regimen schedule is recommended?
It is a matter of finding enough time – although it may be sometimes difficult in this situation – to speak honestly to the patient on what the real risk is versus benefit calculation of deferring treatment. For instance, a patient with early prostate cancer who is already on hormonal treatment and must undergo radical radiation treatment should be carefully informed that the chances of being cured from that disease will not significantly vary in 3 to 6 months from now, so any treatment can be safely postponed. The use of leaflets and other informative materials may also help patients to quietly process the information, giving them time to adapt to a new clinical scenario. We, as oncologists, should not forget that cancer patients are not only bothered by their disease but also by coping with uncertainties related to the pandemic.