Being an oncologist in New York, having recovered from the trauma of flooding from Hurricane Sandy and the aftermath that ensued when hospitals were flooded in 2012, my anxieties are now heightened again over the global threat and uncertainties surrounding the novel coronavirus. Daily emails from administrators at my institution seek to both reassure as well as prepare us on the front line of health care to deal with the specter of hospitals being at capacity with critically ill patients. In times like this, I worry even more so about my patients who are immunocompromised as a result of their cancer and their treatment regimen. Many of my patients with hematologic malignancies have altered adaptive immunity, and not uncommonly encounter pneumonias during the course of their treatment. Some patients have even asked me whether they should delay their treatment. As the coronavirus seems to affect older patients more severely, presumably due to their naturally decreased immune function compared to younger individuals, it is reasonable to assume that immunocompromised cancer patients are also at risk of having a more severe illness related to COVID-19. To discuss the current climate surrounding coronavirus, I recently met with a colleague for dinner in a local diner that was strangely quiet. Usually at that time, chatter is loud, and waiters are hustling around with loaded trays, but this time was different. We lamented about how much virology we forgot and agreed that maybe this would be a good time for a refresher. As we continued our discussion about how we are dealing with the current situation in our respective practices, I looked around at the usually empty diner. In a sense, it was reassuring that people, particularly seniors, were heeding advice from authorities to limit community exposure and stay home. We both wondered how long this new reality would last. Cancer patients know what it is like to face an unclear future. I have seen remarkable strength in my patients at times of vulnerability and uncertainty when living through a life-threatening and often unpredictable illness like cancer. This same optimistic outlook can be applied to the emotional challenges of a pandemic. Several of my patients have asked me about general precautions, advice on travel, and whether to allow guests into their homes. I first try to ease their concerns by being lighthearted. I walk into the exam room and “elbow bump” to greet my patients and break the ice, I quip about this being the last thing any of us need right now, and sometimes we reminisce about our past travels to countries currently affected by COVID-19. Similar to when I speak about difficult topics like cancer prognosis and relapse, my approach to discussing coronavirus has been to address it head-on as a part of my visit checklist. Most of my advice is similar to what I would normally give to my patients about avoiding infections while on chemotherapy, though perhaps telling patients to be even more obsessive about things like contact precautions and hand hygiene. The reality is that every day we are learning more about the ways that the virus can affect people, as well as more about the means to prevent its spread and severity. This is public health in real-time, and nowhere on the battleground is it more important to provide critical information than to those individuals who lack the capacity to mount a robust anti-viral immune response. Likewise, as vaccines and anti-viral agents become available, we have to educate our patients about the importance of clinical studies to prove the safety and efficacy of untested treatment. We all hope for this pandemic to cease, but I have not had to look farther than my exam rooms to find extraordinary faith and resilience from my patients who are cautiously optimistic. I believe the same strength that allows cancer patients to go on with their lives in times of crisis can be applied to how we can face the current threat surrounding the coronavirus pandemic. Uncertainties exist, but we must persevere. Marc Braunstein is a hematologist-oncologist and can be reached on Twitter @docbraunstein Source
