BALANCING ACT
Hospitals weigh level of risk with a patient’s need for treatment
As cases of COVID-19 continue to increase across the state and in Berks County, doctors are having to weigh the risk of the virus against treatment plans for patients with compromised immune systems.
Every two weeks Lawrence Hensley goes to the McGlinn Family Regional Cancer Center in Reading Hospital for treatment. The 64-year-old Sinking Spring resident was surprised when he received a phone call this past week informing him his next treatment was canceled due to the coronavirus.
“When I first got the call, I was panicked,” he said. “But once I learned more about why, I understood.”
During a phone call the following day, Hensley learned the reasoning behind the decision was the threat of the coronavirus was more dangerous to his health than missing his treatments.
Hensley is receiving immunotherapy treatments for what began as tonsil cancer in 2009 before spreading to his lungs. At this time, his cancer is controlled.
“If it had to be anyone (to be delayed), it’s better that it’s me,” he said. “They are all wonderful people (at the hospital), and it must have been very difficult for them to make this decision.”
Hensley credits the center’s team with making it possible for him to still be here today, living a relatively normal life.
Reducing the risk
Dr. Erik J. Rupard, chief of section of hematology/oncology at Reading Hospital, said the hospital is following national guidelines in how best to protect its patients who are in more danger of severe symptoms with the virus due to their compromised immune systems and its staff.
“We want to reduce the risk and have patients only come in if it is absolutely necessary,” Rupard said.
Other hospitals, including Penn State Health St. Joseph, are also following these guidelines.
“Patients with normal routine followups are being contacted to either reschedule or to have what is called a virtual checkin,” said Dr. Marc Rovito, chief of oncology/hematology at Penn State Health St. Joseph. “This is a phone call between the doctor and the patient that allows for the patient’s ongoing care, questions, medication refills, and other issues that can be handled over the phone.
“During these conversations if we determine that a patient requires a visit, then a visit is set up within the guidelines set for all office visits during this unique time.”
Some patients, like Hensley, have their cancer controlled to a point of little to no detection and not causing the patient any pain.
“It’s kind of like chemotherapy holidays in which if a patient is doing well and the cancer is not causing any problems, it is safe for the patient to skip a treatment,” Rupard said.
In other cases, the treatment can be done in pill form at home instead of in the hospital. Those who absolutely need to receive treatment at the center will continue to do so.
“About half of the patients can do their appointments over the phone,” Rupard said. “Most of the patients were very happy about this change because they were worried about the risk. They were relieved.”
Every case and patient is different so Rupard and his team are working to accommodate every patient to the best of their ability with the current situation.
Conferences are done daily, virtually and while practicing social distancing, to discuss new pathways in delivering treatment. In some cases, Rupard believes these new pathways may be better in the long run.
Rovito and his team are also using a teleconference platform for multidisciplinary clinics and tumor board discussion to coordinate the required care in oncology and to ensure it’s uninterrupted.
Health screenings
To ensure patients and medical providers are as safe as possible, both hospitals have health screenings before the visits.
At Reading Hospital, patients are screened three times before entering the center. They are first screened by phone the day before their treatment. At that time they are asked questions including recent travel, any known exposure to someone who has the virus, if they have a fever and if they are experiencing shortness of breath among other similar questions.
Once they pass the first screening, they are screened at the hospital entrances and again at the entrance to the center. If the patient has a temperature of 100 degrees or more, or a pulse oximeter reading of 90% or lower (blood oxygen level), the appointment is canceled and they are transferred by staff to the necessary department such as the emergency department.
“We are keeping patients as safe as possible, and we are doing everything we can to make sure everyone is safe,” Rupard said.
In an effort to protect not only the patients but the center as well, half of the health care providers in the center work from home, while the other half work in the center. They then switch places each week. This ensures that if the virus does present in the center and there is a need for health care providers to be quarantined, at least half of them will be able to continue to work at the center for patients who require in-person treatments.
“We are reducing the risk in the case of a worst case scenario,” Rupard said.
Penn State Health St. Joseph is also doing screenings before people enter the building. The hospital has increased patient access to triage nursing and physicians. Patients exhibiting side effects from treatments will continue to be redirected from going to the emergency room to the cancer center office to receive short-term supportive care.
“This is our usual practice. We’re just reinforcing this,” Rovito said on asking patients to avoid the emergency room. “This will hopefully continue to reduce the flow of patients into the ER should St. Joseph need to address a COVID surge. We also have a process for patients who come to the office and who are exhibiting COVID-related symptoms to be immediately redirected to a screening station.”
Rupard and Rovito continue to stay in touch with each other. The two hospitals are working together and ready to step in to help the other should there be a situation involving the coronavirus at either hospital’s oncology department.