COVID-19 Impacting GU Cancer Care in New Orleans at Tulane Cancer Center - A. Oliver Sartor
March 19, 2020
Oliver Sartor joins Alicia Morgans sharing his perspective of the novel coronavirus 2019 (COVID-19) and the current disruption in healthcare. Dr. Sartor discusses variables his institution is experiencing with personnel resources, the importance of staying in close communication with patients and considerations of their care in this challenging time. Drs. Sartor and Morgans also discuss treatment decisions that they are weighing for their GU cancer patients since there is no data.
A. Oliver Sartor, MD, Professor of Medicine and Medical Director, Tulane Cancer Center; C. E. and Bernadine Laborde Professor of Cancer Research, New Orleans, Louisiana
Alicia Morgans, MD, MPH Associate Professor of Medicine in the Division of Hematology/Oncology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.
View: COVID-19 and Genitourinary Cancers Videos
Alicia Morgans: Hi, this is Alicia Morgans, Associate Professor of Medicine and GU Medical Oncologist at Northwestern University and I am so excited to have here with me today, Dr. Oliver Sartor, who is a Professor of Medicine GU Medical Oncologist at Tulane. Thank you so much for joining me today, Oliver.
Oliver Sartor: Yeah, glad to be here on this rather unusual day.
Alicia Morgans: Absolutely. Oliver, we're trying to hear voices of folks who are affected by COVID and let's be honest, that's the whole world. And I'd love to hear your take as a senior member of your cancer center and of your university. Tell me what's going on at Tulane.
Oliver Sartor: Sure. Well, first of all, I'm the Medical Director of the Tulane Cancer Center, so I'm really in the thick of it right now. What we're trying to do are several things and it really does take a village to be able to respond appropriately here. First of all, all the schools in Louisiana have released children from classes, meaning that childcare responsibilities are taking priority for many of our staff.
We're attempting to organize, at the school level, additional support for those who have children and are giving vouchers immediately to those who have needs that are full-time school employees. And so the childcare responsibilities impact patient care responsibilities. That's part of the mix. Of course, all the patients are undergoing screening with a questionnaire and a temperature check prior to entry into the clinics. As you well know, we have many immunocompromised patients on chemotherapy and of course in our cancer center, it's not just prostate cancer but things like [inaudible] as well. And so we're being very, very careful to screen patients prior to entry. That's another element we're doing.
Another issue directly related to prostate cancer is many patients do have choices with regards to whether or not they undergo chemotherapy, which is obviously immunosuppressive. And we're taking steps right now in order to minimize chemotherapy.
Now, another thing I should say, we're prioritizing our active patients. Active patients who are coming into clinics. Active treatments are being administered. Nobody is being turned away. But, for those issues that are less acute, a routine PSA monitoring, a follow-up check for those who are well, we're deferring those visits until we get a better handle on the current situation. Alicia, that's a quick synopsis of what we're doing here at Tulane.
Alicia Morgans: And I think that that's certainly what we're trying to do as well. But just on a practical point, how are you going through patient visits and actually saying, "Okay, this is a well PSA check and this is more an active", I mean this has to be a day to day kind of a thing? Do you have advice for folks who have very busy clinical practices, how to make that actually happen?
Oliver Sartor: Well, we are meticulous about collecting cell phones and we've been doing that ever since Katrina. We lived through a true disruption of healthcare during the Katrina crisis. At that time I started collecting cell phones, and even prior to that time, every patient has my cell phone and I have every patient's cell phone. Now there may be an exception to that, but that's kind of where we are.
Communication via text, which may be a HIPPA issue is the way we prefer to communicate because that's a lot easier than cell phones. The majority although, not all of our patients are tech-savvy. Remember our patient populations are often older so they're not accustomed to the newer technologies such as text, but I'm going through patients on an individual basis and texting them in order to either stay away or not stay away.
And many patients have concerns that are being texted into me. I also have a superb secretary and a nurse practitioner and a nurse and a clinic manager that are helping to coordinate these issues. I think for patient care it has to be case by case, but the real communication issues are via text and cell phone.
Alicia Morgans: Absolutely. It's just that important that we need to go through our patient list, pull out those patients who do not need to come in right now because frankly, it's actually in their best interest and their health is paramount here, that we need to push them to maybe see them later in the summer if it is just a PSA check or just a routine check-in and that's going to be a critical part of caring for their health.
Oliver Sartor: I agree completely and we're on it.
Alicia Morgans: Absolutely. You mentioned a little bit about treatment choice and treatment decisions and certainly, I think we all advocate for using every available option for our patients. We want to give them exposure to every life-prolonging therapy over time. But this may not be the best time for us to really be pushing for cytotoxic chemotherapy if we have a choice. At least that's how I'm thinking of it. And it's not that I don't think that chemotherapy is effective or that I wouldn't use it because I absolutely do, and regularly. But I think that when we have a choice, we may shift the lineup such that we don't necessarily increase the risk of our patients to be in an immunocompromised state during the pandemic. What are your thoughts?
Oliver Sartor: I agree completely and I mean there are some pretty obvious choices. For instance, those with newly diagnosed metastatic castrate-sensitive disease where the use of docetaxel is certainly guideline-driven and a very appropriate choice. But now we also have enzalutamide, apalutamide, abiraterone, that's able to be used in that setting. That's our kind of obvious choice right there.
But there are other choices in the castrate-resistant setting. And that also is playing out in our clinics. And quite frankly, there might be an individual with a relatively slow PSA rise and maybe in the past, we would have had a chemotherapy discussion, but that's certainly as being deferred right now. Clearly there are indications for chemotherapy and we're not averse to using it in patients whom we think that it is not only appropriate but the only appropriate option. But every option, as you pointed out, needs to be considered. And right now we're deferring chemotherapy unless we deem it absolutely necessary.
Alicia Morgans: Okay. Well, do you have any other advice for those who are trying to make their practices function care for patients when they're really facing some of the challenges that, although you faced these kinds of ... something similar at least in the past with the stresses that were put on your practice from Katrina, many of us have not faced this. What are your recommendations for the rest of us?
Oliver Sartor: Well, I think we're all struggling here and I'm not sure that my advice would be any different than yours, but I think what we're trying to do is to make sure that patients understand that we're there for them and that the patients are not being abandoned. What patients fear, particularly cancer patients fear, is that they'll be left alone and somehow abandoned. We're trying to make sure that patients know that they're not being abandoned, but we're trying to make sure that the deferral of the non-urgent practice patients takes the priority.
For us, the reassurance of patients we're there, we're making sure that they know how to contact us and we are available for contact. We're just switching over into a more remote mode. And I think that's what we all should do. I'm sitting right now, not in the office, but I'm doing my work from home and I'm able to do a great deal through the combination of cell phones, emails, texting, and communicational conference calls. And I think that's the way we need to evolve as a nation right now because we need to protect our healthcare providers as well. Our healthcare providers are absolutely critical to get us through this crisis.
Alicia Morgans: Absolutely. And I am, of course, in my home as well. And the early part of this interview was almost interrupted by my two boys who ran in trying to take a break from their e-learning, which, of course, is happening. There are strains and struggles that are happening to all of us, but I think your message is clear. We can come together, though remotely, to support each other through this. We will get out on the other side, but we just need to be smart about it. And we are taking strides already to make sure that we keep our patients safe, keep our healthcare providers safe, and that we make it to the other side as a stronger community and hopefully a very well and healthy one. Thank you so much for your time today.
Oliver Sartor: Well, thank you, Alicia. It's a really critical time and thanks for the opportunity to discuss these important issues.