publication date: Jun. 12, 2020
Impact of COVID-19 on Georgia’s community providers: a snapshot from Georgia NCORP
Guilherme Cantuaria, MD, PhD
Principal investigator, Georgia NCORP,
Chair, Gynecologic Oncology Steering Committee, Northside Hospital Cancer Program
This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage, as well as the latest meeting cancellations, is available here.
As we approach the middle of June, Georgia appears to have come to the other side of its COVID-19 curve. Available information from the Georgia Department of Health reveals Georgia has nearly 54,000 confirmed COVID-19 cases, with the heaviest concentration of cases in the metro Atlanta area (as a result of population size, not density).
The Georgia NCORP Community Site, established in 2014, serves a broad population of Georgia’s cancer community and represents a collaboration between the largest community oncology clinical trial programs in Georgia—Northside Hospital Cancer Institute (NHCI) in Atlanta, the Nancy N. and J.C. Lewis Cancer & Research Pavilion (LCRP) at St. Joseph’s/Candler in Savannah, and the Georgia Center for Oncology Research and Education in Atlanta. Georgia CORE provides network affiliation for four actively accruing healthcare organizations across the state: Northeast Georgia Medical Center (Gainesville), Navicent Health (Macon), John B. Amos Cancer Center (Columbus), and Harbin Clinic (Rome).
We surveyed our GA NCORP partners and affiliates to ascertain the impact of the COVID-19 pandemic and the shelter in place orders on daily practice and trial participation. Areas addressed in the survey included the use of telemedicine, surgery, ambulatory cancer care and testing, personal protective equipment, the impact on clinical research, and staffing.
Telemedicine has become widely incorporated into GA NCORP sites during the COVID-19 pandemic, as high-risk cancer patients are reluctant to risk visiting healthcare facilities for in-person appointments.
Our providers agree that while telemedicine has its utility and patients currently seem to enjoy it, its practice interferes with productivity and consumes more time than in-person visits. Insurance reimbursement will likely dictate the continued use of telemedicine in the long-term. While there will certainly be a role for telemedicine post-pandemic, it will likely be to a much lesser extent.
At least three of our providers, who comprise 98% of the GA NCORP accruals (NHCI, LCRP, and NGMC), adhered to the American College of Surgeon’s COVID-19 Recommendations for Management of Elective Surgical Procedures, which were released mid-March. Elective surgical volumes at these sites dropped to as low as approximately 20%.
As the curve of COVID-19 infection plateaued and began to flatten, surgical procedures were phased in to approximately half their pre–COVID-19 volume. With Georgia’s reopening phase now in full swing, most sites continue to build back surgical volume by resuming all elective surgeries (though not at pre-pandemic levels yet).
Significantly, surgery was not rescheduled in cancer cases where the delay of the surgical procedure could affect outcome.
For the most part, ambulatory cancer treatment was not impacted by the COVID-19 pandemic. Chemotherapy infusions were still administered, with minimal change in volume; however, strict policies were implemented to protect patients and staff.
The changes included appointment check-in from the patient’s vehicle, temperature check and screening prior all visits, a strict no family or visitors policy, social distancing, and the universal mandatory use of face masks.
Pre-chemotherapy testing for COVID-19 was not instituted at any sites prior to treatment infusions, unless it was warranted based on clinical screening. Of interest, one site saw an apparent increase in new lung cancer diagnoses stemming from individuals seeking medical care for suspected COVID-19, which turned out to be cancer.
All members had strong concerns about the availability of PPE, especially N95 masks (which became scarce at a few sites); therefore, measures were put into place very early to preserve equipment. Fortunately, availability of PPE and preservation measures (e.g., strict inventory control, re-use, decontamination of masks) prevented the manifestation of a dire situation.
Clinical trial accrual took a nosedive among our sites from March and April (see table). With the exception of a treatment trial that presented the best option for a patient, all research (including screening, CCDR, cancer prevention, and cancer control) was put on hold. Screening trials have been the first to be phased back in, with all research resuming and trials reopening in mid-May. We are working through extensive plans to safely re-engage research.
|Accruals / Activity||Month||2019||2020|
(excludes DCP, TMIST & CCDR)
Lastly, GA NCORP was fortunate to have avoided any significant furloughs or mandatory redeployment. Some nurses and staff were voluntarily placed in different functions, but we are in the process of resuming normal staffing operations.
Our Community Site has learned a lot about managing patients with cancer during a pandemic in a short time, but we have all risen to the challenge and have put systems in place to continue our important research in a safe manner moving forward.