A Conversation On Cancer Care During COVID-19

Drug Topics®: Hi, my name is Gabrielle Ientile with Drug Topics®, and today I’m talking to Dr Robert Brunault, a clinical pharmacy specialist of hematology and oncology at Rhode Island Hospital and Lifespan Cancer Institute. Dr Brunault, thank you so much for joining us today.

Brunault: Thanks for having me.

Drug Topics®: Today we’re going to be talking about coronavirus and how it has affected pharmacies and pharmacists, particularly how it relates to oncology pharmacy practice. We’ve heard a lot about flattening the curve and protecting those who are at heightened risk for becoming ill with coronavirus. Is there an elevated risk of contracting coronavirus for people with cancer, and is the risk different depending on the type of cancer as well?

Brunault: There’s definitely a lot consideration for a patient with cancer, specifically the type of cancer, their place in therapy, the necessity of treatment, and any of the treatment options that they need. I have a couple of examples; one being a patient who needs endocrine therapy for breast cancer, versus someone with a newly diagnosed acute leukemia. Both are cancer patients, but both in my opinion have different factors that would put them at higher or lower risk during these times where the virus is circulating. For example, that breast cancer patient, their treatment doesn’t require a lot of follow-up, so they’re actually able to have less frequent visits to our infusion center, so that promotes the social distancing that we’ve all heard about. And the treatment itself that they would be on actually doesn’t compromise their immune system. On the other hand, if you have an acute leukemia patient, their underlying disease state is compromising their immune function; their treatment, we know, is likely to impact their immune function as well, and just by the nature of their disease they’re going to need a lot of frequent follow-up here, so they’ll have more contact with people and the healthcare facility. So I think it’s kind of a loaded question, there’s a lot of things to consider. I would say yes, it definitely depends on the type of cancer and kind of where people are in their treatment, and what kind of treatment they’re going to be receiving.

Drug Topics®: Can you kind of give us an example of what happens to a patient with cancer, maybe a particular kind of cancer, if they are infected with coronavirus. How does the body respond and how is that different from a person who is not immunocompromised?

Brunault: Sure. I think it goes back to our first 2 examples – for example, the breast cancer patient, we know their treatment is not compromising their immune function, their disease state really isn’t compromising it as well, so they’re likely to respond to the virus in a very similar way that the general population would. And then if we kind of go to the opposite end of the spectrum and think of the leukemic patient who doesn’t have an existing immune system, they’re probably likely to have more of a severe course, just because at baseline they don’t have an ability to fight off the infection.

Drug Topics®: And then how should pharmacists counsel patients with cancer to avoid contracting COVID-19?

Brunault: For all the patients that I’ve encountered – my primary practice is outpatient hematology and oncology – so a big portion of my job is actually patient education regarding starting oral chemotherapy medications, and then follow-up to ensure adherence and make sure that they’re not having any adverse side effects. So for all of these patients, I’ve been recommending all of the things that the CDC has been recommending: social distancing, if possible; avoiding close contact; hand washing, especially the soap and water for 20 seconds and then if you don’t have access to soap and water, making sure to use a 60%-based alcohol hand sanitizer. These are all the things that we discuss routinely, even before the virus, hand hygiene was a big portion of what I counseled people on. These are all the things that we have previously talked to patients about, and we continue to promote. And we definitely tell people to refer to the CDC website for further guidance as well.

Drug Topics®: And what are you hearing currently from the front lines in terms of how this pandemic has impacted workflow with health care systems? For example, are pharmacists being asked to do more hours, stockpiling medications, or other changes that you heard about or experienced yourself?

Brunault: There have been a lot of changes that have happened. I would say as far as pharmacy operations, and specifically within our infusion center, we’re really trying to promote telemedicine, where possible – so trying to avoid having patients unnecessarily coming into a health care facility, where all these people that are infected are coming in as well. As far as stockpiling medications, typically we recommend not doing that, because you may be taking it from someone else’s supply – so we haven’t really implemented any stockpiling. There are plenty conversations every day regarding emergency response and refining our approach and algorithms to what to do if we contacted patients who may be infected with the virus.

Editor’s note: This interview transcription has been lightly edited for style and clarity.

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