On March 11, the disease COVID-19 was declared a pandemic by the World Health Organization. As the disease caused by the novel SARS-CoV-2 virus quickly spread around the world, nearly every aspect of medicine was radically altered. Patient care was administered selectively and rapidly to patients both with and without COVID-19, while research and clinical trials deemed non-essential were put to an abrupt halt. Especially impacted by this drastic shift was patient care and research for cancer.
As the pandemic rolled into summer, more was learned about how exactly COVID-19 impacts cancer patients. A recent Northwestern Medicine study found that some patients treated for cancer and other underlying health conditions are among the most vulnerable patient populations for developing COVID-19 and complications from the disease due to a weakened immune system.
Northwestern investigators also found that COVID-19 can complicate cancer treatment for patients who have other comorbidities. According to that study, patients who are actively receiving chemotherapy or radiation therapy, and especially those who are receiving treatments such as stem cell transplants that involve drugs which suppress the immune system, have an even higher risk of infection and death from COVID-19.
The impact of COVID-19 on cancer patients has been a stark reality for many cancer centers around the world — especially in the U.S., which passed 7 million cases of COVID-19 in late September. For the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, a combination of time and immense dedication to patient care and research has resulted in a more comprehensive understanding of how the disease affects cancer patients and, in turn, the development of robust COVID-19 testing protocols to ensure the safety and health of every patient, physician and staff member.
“What has made the biggest difference is that we now understand better how COVID-19 is transmitted,” said Leonidas Platanias, MD, PhD, director of the Lurie Cancer Center and the Jesse, Sara, Andrew, Abigail, Benjamin and Elizabeth Lurie Professor of Oncology. “We know that with wearing masks and social distancing, we can really control the spread, and that’s what makes it so much more reassuring for our patients, for our staff and for our doctors.”
A Widespread Impact
COVID-19 is a threat not only to patients who currently have cancer, but also patients who may not know if they do. Since the pandemic began, the number of newly diagnosed cancer cases in the U.S. has significantly decreased, an unfortunate trend that both Platanias and the National Cancer Institute (NCI) are particularly concerned by.
“The belief is that people are not seeking medical help for symptoms due to their fear of being exposed to the virus,” Platanias said.
According to Platanias, the number of accruals to clinical trials for cancer therapies has also decreased since the beginning of the pandemic, due to nationwide stay-at-home orders in an effort to decrease the viral spread. In response, any research deemed non-essential was temporarily put on hold or modified to be done at home.
“We’re now bringing those trials back up to speed,” Platanias said.
However, some clinical trials are too important to patient health to significantly modify. For Priya Kumthekar, MD, ’11 ’12 GME, associate professor in the Ken and Ruth Davee Department of Neurology in the Division of Neuro-oncology and medical director of the cancer clinical trials office at the Lurie Cancer Center, this meant transitioning to telehealth visits and mailing medication to patients receiving treatment for brain tumors.
Kumthekar, who is the executive officer for the Alliance of Clinical Trials at the NCI, explained that her team’s experiences were informed by the guidelines released by the NCI, and speaking with other investigators helped her figure out what was best for her own trials.
“I think for the foreseeable future, we’re going to need to keep many of these policies in place,” Kumthekar said. “We have to make sure that we’re really thoughtful about everything, a balance between making sure patients are protected from COVID-19 and balancing their safety on the given clinical trial.”
Supporting Research Efforts
In response to the threat of COVID-19 on cancer, the Lurie Cancer Center has supported various COVID-19 and cancer related research efforts led by Feinberg faculty members of the center by offering multiple competitive research grants.
The center has also been involved in a joint effort with the National Cancer Institute and the National Institute of Allergy and Infectious Diseases (NIAID) to develop a COVID-19 antibody test, in which Platanias has been helping provide samples from patients with COVID-19 to help in the development and validation of antibody serological tests.
“There are many tests that have been validated and used because of this and we’re really happy that we were able to contribute to this major effort between the NCI and the NIAID,” Platanias said.
The center has also been working with Michael Ison, MD, MS, professor of Medicine in the Division of Infectious Diseases and of Surgery in the Division of Organ Transplantation, to build a COVID-19 biobank. Supported by both the Lurie Cancer Center and the Northwestern University Clinical and Translational Sciences (NUCATS) Institute, the biobank will help facilitate multi-investigator research and identify patients who have recovered from the virus with protective antibodies.
Adapting and Reactivating
Since the beginning of the pandemic, the goal of the Lurie Cancer Center has been to administer top-notch care and treatment to patients with immediate needs while also minimizing the risk of exposure to COVID-19 for every patient, physician and staff member.
This, according to Platanias, has been accomplished in part by employing telemedicine for non-urgent services, such as having patients get imaging scans and blood tests done at other Northwestern Medicine affiliate sites across Chicagoland and utilizing video chat for patient consultations and routine followups.
In response to an increased understanding and control of the virus, three months ago the center entered its reactivation phase. This has included a decline in telemedicine visits, an increase in in-person visits and the implementation of robust COVID-19 testing protocols.
For example, patients who are starting treatment must be tested for COVID-19 to minimize the risk of exposure, according to Platanias.
“When patients come here, we are prepared, and we have confidence that will create the safest possible environment for them and for everyone else who’s in the center” said Platanias.