The ABCs of Community Oncology Are Adaptability, Communication, and Flexibility

Day 1 of this year’s virtual Community Oncology Conference opened with the panel discussion, “Learnings From COVID-19: How Cancer Care Has Innovated & Evolved,” that touched on all things related to the pandemic, with leaders presenting a unified front on how they were able to adapt their practices, keep the lines of communication open, and remain flexible over the past 15 months.

Led by Barry Russo, MBA, CEO of The Center for Cancer & Blood Disorders and OneOncology, the elephant in the room was immediately acknowledged: how the pandemic has affected your practices and what lessons you will carry going forward.

Joining Russo to discuss how they reacted and remained resilient over this trying past year when it came to vaccine rollout, physical changes to office space, employees, telemedicine, cancer screenings, and patient safety and volume were:

• Jennifer Pichoske, MS, AONCP, FNP, chief clinical officer, Hematology-Oncology Associates of Central New York
• James Perry, MD, chief medical officer, Alliance Cancer Specialists (ACS)
• Lucio N. Gordan, MD, managing physician and president, Florida Cancer Specialists & Research Institute (FCS)

Vaccines were up first, and Russo asked the gathered experts how they responded to vaccine availability and dealt with a seemingly uneven distribution of the 3 approved vaccines. For example:

• Pichoske’s practice did not receive any vaccines for patients until last week, despite initiating vaccination among staff in late December.
• Perry highlighted how slow rollout was in Pennsylvania, where ACS is based, and that his organization is “kind of lower down in the queue to actually get vaccines” but staff vaccinations and community vaccination of patients were still accomplished.
• Gordan expressed concern over the asymmetric nature of vaccine supplies and the need for clear communication regarding rollout.

A chief concern noted by the panelists was hesitancy toward vaccine acceptance, based on how fast the vaccines were formulated. Their solution: clear communication.

“The most common objection that I heard was a concern about how quickly the vaccine was formulated,” Perry stated. “There was a little suspicion there and I was able to discuss that with them. And I saw that the more clinical training one had, the more they were accepting of the vaccines.”

A passion for keeping everyone safe—staff, patients, and their families and caretakers—permeated the discussion, as did the fact that vaccine education and distribution to the most vulnerable patients was a joint effort. Russo himself noted, “That’s the pitch we sort of made to the county and the state: cancer patients are the group of folks that are most vulnerable.”

Following the conference’s opening address by cochair Jeffrey Vacirca, MD, FACP, CEO of New York Cancer & Blood Specialists and director of OneOncology—in which he noted that screenings in breast cancer and colon cancer alone dropped by 85% and 75%, respectively—the remainder of the discussion focused on these precipitous drops in cancer screenings over the past year, what the panelists needed to do to continue care as uninterrupted as possible for their patients, and what they believe the principal consequences will be.

How were they able to tackle this challenge head on, and most important, what did they do to ensure ongoing patient safety? By physically altering and adapting their spaces to introduce distancing measures, by instituting cleaning protocols and following CDC guidelines, by using telemedicine, by communicating and offering constant guidance, and by coming together as a team, they said.

“We've spoke openly and candidly and been transparent through the whole COVID process,” Pichoske noted. “Most individuals that work in oncology really have such a passion for patients and families and want to be part of keeping them safe. It's been a joint effort.”

During these times, patient prioritization often intertwined with telemedicine.

“We had to reach out to the patients and sort of decide which patients really needed to come to the office,” Perry stated. “We focused on those patients who are on active treatment and toward anyone who really needed to come. We did move to telemedicine very early as everyone else did.”

Of course, none of this was easy, with temporary office closures and lack of necessary equipment in the beginning, but productivity seemingly never faltered, despite patient volume ebbing and flowing with the spikes in virus numbers.

For Gordan and FCS, it was all about camaraderie, cooperation, and delivering the best care possible at all times. “People came together to help each other out. I think all of us were able to retain focus on patient care and delivering the best care possible—despite the adversities.”

“Normal” may not have been the norm in the beginning of the pandemic, but the panelists continuously emphasized how they did all they could to normalize operations, with Pichoske and Perry noting they have resumed normal operations and Gordan noting that FCS will start migrating to this beginning May 1.

And although telemedicine is seemingly here to stay, it is now the exception, as Gordan summarized, “There’s a role for telehealth, and I think that should continue to be available and can exist. But it’s quite impressive that there's a significant desire to have that connection, that in-person examination, that human touch.”

What lessons will they carry forward from all of this, Russo asked at the discussion’s conclusion, with there being a high likelihood of a surge in late-stage cancer diagnoses and mortality, as well as a devastating impact that could last for years?

“We need reliable sources of information, because the media distorts everything,” Perry stated. “Everything that we do is based on reliable information.”

“We need continual communication, to always stay strategically ahead of the ‘what-ifs,’” Pichoske answered.

“We need resource management, to get the right information that is properly vetted and data driven to the communities, our patients, and our team members,” Gordan stressed.

And most of all, there always needs to be that focus on patient care at the community oncology level, they agreed.