publication date: Sep. 4, 2020
Delivering a cancer-free frontier during COVID-19
Mary Beckerle, PhD
Jon M. Huntsman Presidential Professor
CEO, Huntsman Cancer Institute
Distinguished Professor of Biology, University of Utah
This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage is available here.
As the only National Cancer Institute-designated Comprehensive Cancer Center in the Mountain West—a region that includes Utah, Idaho, Montana, Nevada, and Wyoming, covering 17% of the landmass of the continental United States—Huntsman Cancer Institute (HCI) at the University of Utah (U of U) has a longstanding focus on improving cancer research, prevention, and treatment strategies for our patients and communities.
Utah alone has a footprint of more than 80,000 square miles, and vast tracts of this geography are sparsely populated—more than 96% of Utah is classified as rural (<100 people/square mile) or frontier (<7 people/square mile). Rural/frontier residence is known to contribute to differences in cancer health disparities across screening and risk behaviors, treatment, and access to clinical trials, among others. And HCI is committed to addressing these challenges through a variety of comprehensive programs and interventions.
Like all cancer centers, the COVID-19 pandemic has presented extraordinary challenges to our efforts to serve our patients and communities. And like other centers, we found that our unique focus and commitment to the region served as a critical compass to guide our work to make an impact during this unprecedented time.
Here in Utah, some of our experiences during the COVID-19 pandemic have been particularly remarkable. I think each of us remembers March 11—for me, this day came in the midst of some intense weeks of planning at HCI to ensure our critical staff, infrastructure, and supplies were in place should a worst-case scenario with COVID-19 emerge.
This extraordinary evening began with an Oval Office address on the pandemic from the president. Later that evening, the NBA season announced that it was suspending the season as two local players from the Utah Jazz tested positive for COVID-19 shortly before a scheduled game. The following day, Utah Governor Gary Herbert closed public schools and HCI began working on major adjustments to shift most of our faculty and staff to remote work operations.
Our resiliency was further tested just a few days later on March 18, when a 5.7 magnitude earthquake with an epicenter just west of our flagship location in Salt Lake City further rattled us in the early morning hours. Our patients and staff were still adjusting to a reduced visitor policy at this point, but I was so heartened to hear that our nursing team sprang into immediate action and personally visited each patient in our hospital to provide reassurance and comfort.
These experiences, and countless others, demonstrated to me the extraordinary resolve of our community and how a steadfast commitment to our vision and principles has been our guide during this time.
There are two projects I want to highlight that display how our cancer center infrastructure has proven to be invaluable during the pandemic, including both managing community spread and tracking of COVID-19 and addressing the cancer burden in new and innovative ways.
Members of the Huntsman at Home team include clinical care professionals from Huntsman Cancer Institute and Community Nursing Services.
Shifting gears: How HCI’s cancer screening and education bus helped with COVID-19 testing
In fall 2019, I joined colleagues and community partners at the Urban Indian Center of Salt Lake to debut an incredible new community resource: a state-of-the-art, 45-foot mobile cancer screening and education bus. The bus was designed in collaboration with our Community Advisory Board to support a variety of cancer screening mechanisms. It began with mammography, a critical area as Utah ranks 46th in the nation for adherence to breast cancer screening, regardless of insurance coverage.
Through a robust network of partners, our team was able to bring HCI’s expertise and the latest screening technology to urban and rural residents, including those who live in distant areas. In just the first six months of operation, more than 1,100 women in 14 of Utah’s 29 counties were screened, many of whom had never previously had a screening mammogram.
When non-emergent patient care visits were curtailed to prevent community spread of the coronavirus, we quickly realized that this incredible community resource would also have to be temporarily halted, a decision that was heart wrenching for us and our community partners.
Meanwhile, as COVID-19 cases increased in Utah, University of Utah Health (U of U Health) began an ambitious new project called the Utah Health and Economic Recovery Outreach (HERO) Project. This program set out to test 10,000 Utahns for the presence of coronavirus and coronavirus antibodies, which show probable past infection with the virus, to better understand the rate of infection in Utah and which groups were being affected most. Utilizing our bus for Utah HERO made perfect sense.
HCI’s Cancer Screening and Education Bus joined U of U Health’s Wellness Bus to bring pop-up testing sites to designated neighborhoods throughout several Utah counties. The bus served as a command station, supplying Wi-Fi, power, refrigerators, and centrifuges. HCI staff, who usually assist patients with mammography screening, were temporarily redeployed to assist the Utah HERO team.
HCI’s Cancer Screening and Education Bus team as they were redeployed to provide ‘pop-up’ COVID testing sites in Utah communities earlier this year.
Health care workers drew blood and collected nasal swabs from patients in tents set up outside the bus. The samples delivered to the bus, where they were documented and processed by HCI staff. Staff then prepared the samples to be taken to ARUP Laboratories, the lab that processes specimens for HCI and U of U Health.
During May and June 2020, HCI’s Cancer Screening and Education Bus helped support no-cost COVID-19 and antibody testing for more than 7,500 people. As COVID-9 testing has become more readily accessible in our region, the HCI bus has resumed mammography screening, with many new health precautions in place to keep our patients and providers safe.
HCI announces next major expansion: Cancer care coming to patient homes in rural Utah
During the COVID-19 era, we have found that our rural health strategy has been critical to delivering world-class cancer care.
In 2018, HCI launched Huntsman at Home with the goal to provide cancer care for patients who live far from HCI in Salt Lake City, by partnering with patients and their caregivers, communities, and medical teams to deliver many aspects of cancer care in a patient’s own home as an alternative to hospital visits at a medical center or emergency room.
This service has been incredibly popular with our patients. And the data have shown the benefits as well, as outlined by our team at the 2020 American Society of Clinical Oncology annual meeting.
Selected for a major presentation, the senior author of the study, Kathleen Mooney, PhD, distinguished professor of nursing and co-leader of our cancer control and population sciences program, reported that Huntsman at Home patients had improved outcomes and reduced medical costs compared to a control group of cancer patients who did not participate in Huntsman at Home.
Thanks to a recent $4.5 million gift from the Huntsman family through the Huntsman Foundation, we are now able to scale this model to serve even more patients across Utah and bring a cancer hospital-at-home model to three rural Utah counties. For cancer patients in these counties, HCI is the only dedicated cancer specialty hospital in the region, which means that a five-hour drive each way for clinical appointments was routine prior to the arrival of Huntsman at Home.
Community Nursing Services is a partner in this effort, bringing extensive networks through the state to serve even more patients in the comfort of their own homes and communities.
A map shows the current Huntsman at Home service area in blue, and the new rural expansion of Huntsman at Home in yellow.
While this project was not designed in response to COVID-19, in these times I have reflected on how this innovative approach to serve rural patients can be a best-practice model for informing larger scale health strategies.
Both of these examples underscore to me how critical it is to partner and be nimble as we address cancer and other major health challenges. We are all in this together—donors, patients and families, home health organizations, community partners, and our fellow NCI-designated cancer centers.
Whether for cancer or COVID-19, we look forward to continuing our work together to face these unprecedented challenges and deliver the best outcomes and evidence-based strategies for our patients and communities.