Sam Shares develops strategies to provide optimal care to elderly patients with cancer during the COVID-19 crisis

Managing elderly cancer patients during the COVID-19 pandemic, Dr. Christine Sam, said unique strategies pose a risk to this population, presenting unique challenges, reducing the risk of exposure, and limiting treatment-related immunosuppression and toxicity. They are the key to ensuring health and safety. They continue to receive treatment during this time.

Efforts such as COVID-19 and Cancer Consortium (CCC19)Sam found that older patients have certain age-specific risk factors that can affect mortality. For example, patients with poor performance or advanced cancer are at increased risk of death from COVID-19.

According to Sam, several steps can be taken to reduce the risk factors that worsen the outcome for this patient population. These preventive efforts include social distances, proper hand hygiene practices, wearing masks, and ensuring that patients are up to date on vaccination. At the organizational level, conducting more telemedicine visits than face-to-face visits is also effective in reducing unnecessary exposure to the virus.

Treatment options can also be modified to reduce the risk to this patient population, Sam said. For example, the dose can be reduced for chemotherapy in high-risk patients. In addition, hormone-based therapies can be used to delay surgery or other exposures that may increase the risk of COVID-19 if the patient has low-risk hormone-positive breast cancer.

“[Treatment modifications can include] Dose reductions, delays, and alternative strategies,” Sam said. “we [can practice] An alternative from an endocrine therapy perspective, by choosing a less immunosuppressive regimen and growth factors that stimulate white blood cell count, especially in the elderly, who are at high risk of experiencing myelosuppression with chemotherapy. We are also testing COVID-19 before we start [therapy].. “

In an interview with OncLive During the Institutional Perspectives in Cancer Program, Sam, a hematologist and oncologist and an assistant member of the Moffitt Cancer Center’s Individual Cancer Management Department/Senior Adult Oncology Program, is responsible for the prevalence of COVID-19 in geriatric patients with cancer. Emphasized strategies to prevent it. And we shared some advice on how to overcome the unique challenges we face in caring for this population.

OncLive: What do you know so far about the impact of COVID-19 on older patients with cancer?

Sam: Recent data is 2020 ASCO Virtual Science Program By COVID-19 and Cancer Consortium, we investigated various risk factors for cancer patients. Some of the factors mentioned were age 75 and older, poorly performing patients, and patients with ongoing cancer.

Researchers compared with baseline risk of death from COVID-19 [mortality] Elderly patients whose cancer is getting worse, [those who had] Performance is bad. It was at least 2-3 times bigger [in these patients].. If there was a serious risk of intubation from COVID-19, the mortality rate was above the roof compared to the baseline.

The aforementioned patient population is clearly at increased risk of developing a severe COVID-19 infection. So, if you have an older cancer patient that falls under all three [risk factors]After that, the risk of serious consequences if they become infected is quite high.

It is important to evaluate the patient’s functional status and to base it on age as well as age. Other medical comorbidities due to age [must also be considered]..

COVID-19 What are the different risks these patients face during a pandemic?

The onset of COVID-19 poses a significant risk to these patients, so physical distances are highly recommended, especially in the elderly. [Patients should be] Be at home and keep out. You must wear a mask, use hand hygiene, and avoid touching your face. Pneumonia is a very high risk in this population, which can lead to more medical exposure, so it is necessary to ensure that older patients are properly vaccinated.

Generally, older patients will see a doctor more often than younger patients. This also means improving the options for telemedicine as it exposes more healthcare. Some of these patients are new to the technique and therefore have a few double-edged swords. In the future, we need to help these patients feel more comfortable with this approach and find ways for older people to make telemedicine visits. Additional education or additional IT support may be required. But as our agency increased telemedicine, we definitely noticed [efforts]There are certainly a sub-population of patients who still want to come [into the clinic] I’m not used to using technology. [Teleheath is] One of the best ways to reduce the risk of getting COVID-19.

From a cancer perspective, the other thing we can do is if you are a high-risk patient with many comorbidities [comes into the clinic], You can start with weight loss of chemotherapy. Low-intensity chemotherapy can also be used. You can also get a good rating of [patient’s] Physical fitness by assessing the elderly. Treatment can be delayed if possible. If the patient has low-risk hormone-positive breast cancer, hormone-based therapies can be used to delay surgery and other exposures that may increase the risk of COVID-19.

There is also this evolving recommendation from the American Academy of Infectious Diseases about having a COVID-19 test before giving immunosuppressive chemotherapy. Started doing it at the Mofit Cancer Center. Before the patient’s first cycle [of chemotherapy] Inspect the patient for infections. This is especially important because the effects of giving chemotherapy to COVID-19 asymptomatic patients are unknown.

These recommendations continue to evolve. Many questions remain. For example, [test patients for infection] Only before all treatments or if you go out? We don’t know all the answers yet. However, for now, at least we’re starting with a virus test before starting chemotherapy. In addition, patients who receive very stable treatment such as trastuzumab (Herceptin) and maintenance therapy, [there is a consideration for] Reduce the frequency of direct visits.

During this time, what resources are available to care for elderly cancer patients?

Yes, many senior ratings are available. There is a laundry list for them. We have developed a short screen for the clinic because it is very difficult to evaluate for the elderly and it is important to have good resources to do it quickly. Among the first few [assessments] The CRASH (chemotherapy risk rating scale for older patients) score was developed. It is available on the Moffitt website. The other is called the CARG (Cancer Aging Research Group) score and can be done online.

Some physical assessments are also available. I like the Timed Up and Go test because it’s easy to evaluate and can be done by a medical assistant in the clinic. CRASH and CARG scores have been validated and used for a long time. The Senior Adult Supplement Screening Questionnaire (SAOP3) is what we use in our clinic.

What advice do you have regarding patient-provider discussions about COVID-19 risks?

Oncologists are often the doctors these patients see most often. It is our duty to inform patients of the risk of COVID-19. That is what can affect their treatment. It is also important to consider the trajectory of COVID-19 in the community. A few months ago, New York was far more infected than Florida, but now Florida’s trajectory is on the rise. Therefore, it is necessary to consider the trajectory of COVID-19 in each community. It affects the risk of getting a virus.

reference

Sam C. Managing the elderly population in the COVID era. Announcement: OncLive Saturday Spotlight: An Institutional Perspective on Cancer. June 27, 2020. Accessed on July 2, 2020.