Implementing At-Home Care

The pandemic also opened the door to patients receiving certain cancer therapies at home, particularly injectable drugs.

Penn Medicine increased its use of at-home cancer treatment during the pandemic via its “Cancer Care at Home” program.2 The program initially launched in November 2019, but the pandemic accelerated it. Over a 7-week period in spring 2020, there was a 700% increase in home infusion referrals for cancer patients.

The Sidney Kimmel Cancer Center also transitioned some cancer patients to at-home treatment, according to Dr Handley. Patients receiving hormone therapies, for example, began to administer those treatments themselves at home.


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Still, Dr Handley said the implementation of at-home cancer treatment has not been as widespread as he once hoped. Both before and during the pandemic, at-home cancer care has been hindered by provider hesitancy and billing issues.2

“I really thought that [the pandemic] was going to be a huge catalyst for a much more aggressive move to home-based care, and that hasn’t totally materialized,” Dr Handley said. “I think there’s a lot of interest in it … but I thought, over a 2-year period of time, there would be robust systems. So that’s a little bit surprising and a little bit disappointing.”

Impact of Omicron, Other Variants

The emergence of the more transmissible omicron variant has brought with it renewed concerns for cancer patients. However, it remains unclear how this and newer variants will impact cancer care long-term.

Recent data suggest that a third COVID-19 vaccination may provide additional protection against omicron for some cancer patients, but others, particularly those with hematologic malignancies, remain at higher risk of infection.6

A study conducted before omicron emerged suggested that vaccinated cancer patients with a breakthrough SARS-CoV-2 infection had a 65% hospitalization rate and a 30-day mortality rate of 13%.7 It’s not yet clear how cancer patients fare when infected with the omicron variant.

Despite the risk of breakthrough infection, COVID-19 vaccination remains an important tool in cancer care, according to Dimitrios Farmakiotis, MD, of Brown University and Rhode Island Hospital in Providence.

Aside from recommending vaccination, cancer centers can help prevent patients from developing COVID-19 by educating patients via active outreach and written prompts and getting formal input from infectious disease specialists, Dr Farmakiotis said. 

“Patients with cancer may benefit from antiviral medications against COVID-19, which were not all available during earlier surges,” he added.  

Disclosures: Dr Farmakiotis disclosed receiving a grant from Merck to study COVID-19 in immunocompromised patients. Dr Handley and Dr Kubal reported having no conflicts of interest. 

References

  1. Sugalski JM, Franco T, Shulman LN, et al. COVID-19 and cancer center operations: Lessons learned from the NCCN Best Practices Committee. J Natl Compr Cancer Network. Published online January 6, 2022. doi:10.6004/jnccn.2021.7102
  2. Laughlin AI, Begley M, Delaney T, et al. Accelerating the delivery of cancer care at home during the Covid-19 pandemic. NEJM Catal. 2020 doi:10.1056/CAT.20.0258
  3. American Association for Cancer Research. AACR report on the impact of COVID-19 on cancer research and patient care. Published February 9, 2022. Accessed February 15, 2022.
  4. Shumaker L. U.S. reports 1.35 million COVID-19 cases in a day, shattering global record. Reuters. Published January 11, 2022. Accessed February 15, 2022.
  5. Tevaawerk A, Chandereng T, Osterman T, et al. Oncologist perspectives on telemedicine for patients with cancer: A National Comprehensive Cancer Network survey. JCO Oncol Pract. 2021;17(9):e1318-e1326. doi:10.1200/OP.21.00195
  6. Fendler A, Shepherd STC, Au L, et al. Omicron neutralizing antibodies after third COVID-19 vaccine dose in patients with cancer. Lancet. Published online January 25, 2022. doi:10.1016/S0140-6736(22)00147-7
  7. Schmidt AL, Labaki C, Hsu C-Y, et al. Covid-19 vaccination and breakthrough infections in patients with cancer. Annals Oncol. 2021;Dec 24:S0923-7534(21)04880-8. doi:10.1016/j.annonc.2021.12.00

This article originally appeared on Cancer Therapy Advisor