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  1. Opinion

I’m a doctor with Stage 4 cancer during a pandemic | Column

I've seen firsthand how the coronavirus affects care for my patients -- and for me, writes the doctor.

I have advanced cancer. Stage 4 lung cancer, to be exact, even though I have never smoked, and I am only 48 years old. Cancer is scary enough, but now I am in a real unknown, with so many others like me: dealing with advanced cancer in a pandemic.

Dr. Sarah Hallberg is the medical director at Virta Health and an adjunct professor at Indiana University School of Medicine. [ Courtesy of Dr. Sarah Hallberg ]

Don’t get me wrong. For me personally, the pandemic has not been all bad. For a mother with terminal cancer, the lockdown has given me time I could never imagine having with my busy kids. A hidden gift in the madness.

Although cancer will end my life, I still have some time, and dammit, I want it. And that means not getting infected. The studies so far indicate that cancer, especially lung cancer, puts patients at exceptionally high risk for poor outcomes from COVID-19.

Protecting my health therefore means staying home, even as states begin to lift their shelter-in-place orders. Since the outbreak began, I’ve canceled all but my most essential medical appointments. I still worry each time I head to the infusion center. I am not alone with this worry. An alarming number of patients are avoiding emergency rooms and doctor’s offices, even when they urgently need care.

If patients continue to miss treatments and screenings, our healthcare system could easily see another wave of emergencies when the coronavirus crisis begins to wane. In the New York City Health+Hospitals system, emergency room visits dropped by 50 percent when the pandemic began. The problem has gotten so bad that public health officials have to remind people to call 911 or go to the ER if they’re suffering a heart attack. In the Mass General Brigham health system, cardiovascular hospitalizations dropped by over 40 percent from March 2019 to March 2020, and in-hospital mortality was up -- indicating that patients who were admitted had more severe disease.

The pandemic has also taken a severe toll on cancer treatments. Nearly 80 percent of cancer patients in active treatment have reported delays in their care, according to a survey from the American Cancer Society. One of my medications that I need and could obtain from compassionate use has been held up by the FDA for weeks now, due to COVID-19.

Additionally, many new cancer cases will go undetected. In March, preventive screenings for breast, colon and cervical cancers dropped by up to 94 percent compared to the previous year. The number of visits from new oncology patients dropped by about 40 percent between February and April. The IQVIA Institute for Human Data Science recently estimated that over 80,000 cancer diagnoses might be missed or delayed as a result of COVID-19.

Delayed care will quickly become emergent care, creating a dangerous strain on our healthcare system if we don’t act quickly. It has happened before. Researchers from Taiwan and Johns Hopkins found that hospital utilization for diabetes decreased during the SARS epidemic, only to soar after it was over. Cancer incidence in Hong Kong dropped in 2003, the year of the SARS outbreak, only to rebound significantly the following year. Researchers in Hong Kong are already calling on preparation for a transnational cancer crisis from COVID-19.

We need to prepare for that second wave. That’s why, right now, physicians must begin urging those who need medical treatment to receive the care they need, whether virtually or in-person.I understand how this delay of care can be as deadly as COVID-19 itself. In addition to being a cancer patient, I am also a practicing physician. Even before COVID-19, I treated my patients virtually. That made a huge difference when the pandemic hit. My patients all have diabetes or prediabetes, conditions that put them at a high risk of COVID-19 complications -- just like me. Connecting with them virtually meant that their care was never delayed.

Virtual care during the pandemic has ramped up at a speed that would have been unbelievable in almost any other circumstances. But it is not enough, and progress is still threatened. Often, virtual care is still very “clunky,” and there are some people it can’t reach. Additionally, much of the eased regulations surrounding virtual care were only temporary. We need to expand remote monitoring, help everyone gain access, and ensure that regulations that block progress don’t get reinstated.

Of course, doctors can’t do everything virtually. But by keeping many patients out of clinics and hospitals, virtual care reduces risk for those who need chemotherapy, infusions, and other in-person procedures.

Health care needs many radical changes, and expanded virtual care is one of them. Let’s keep moving forward with the technology that can keep people like me, and my patients, safe both during the pandemic and after.

Dr. Sarah Hallberg is the medical director at Virta Health and an adjunct professor at Indiana University School of Medicine.

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