Pancreatic Cancer Care in the Age of Physical Distancing

By Ali Schofield

 

The advent of physical distancing measures has led to many questions from our pancreatic cancer community – from whether you can still get a second opinion to whether patients should continue with their treatment plans. We spoke with Pancreatic Cancer Canada’s research liaison, Anna Dodd, who is also the Program Manager, Hepato-Pancreato-Biliary Oncology Research at Princess Margaret Cancer Centre, about how pancreatic cancer healthcare teams are providing patient care during this uncertain time.

Access to Standard of Care Treatments

“Diagnosing and treating patients safely is still the most important function of cancer centres across Canada amidst the pandemic,” Dodd said. “Standard of care treatments like chemotherapy and radiation are happening as usual at most centres although, potentially a long term silver lining of the pandemic, many visits once requiring patients to go into the hospital have gone virtual.  Rather than coming into the hospital for short follow-up visits, many doctors are now able to provide virtual care to patients at home. We’re hearing that many patients appreciate this, particularly those who commute long distances to cancer centres.”

When patients do need to go to the hospital for treatment it’s important to be aware of the procedures each centre has in place to ensure patient safety. This can vary from centre to centre and may include being asked screening questions at the hospital entry, being provided a mask and exhaustively reminded to sanitize hands.  Some hospitals are also restricting loved ones visiting inpatients or accompanying patients to their appointments.  This is particularly tough on patients and their loved ones when receiving complex information, bad news or treatment for the first time. Remember to harness technology as best as you can – healthcare providers are sensitive to how difficult this restriction is and are happy for there to be an audio-visual component to visits so that loved ones can participate.  Patients are encouraged to consult their hospital’s website for any special steps to take before going in for treatment or appointments.

 

Surgeries

When it comes to pancreatic cancer surgeries, there are many factors doctors need to consider, so the landscape for doing these procedures has been a moving target throughout the pandemic. As with other oncologists, a surgeon’s first concern is providing patients with the best care within safe timelines to set up patients for success.

“Of the centres that do pancreas cancer surgery, all of those surgeons are in contact with each other given their tight community. From the beginning of the pandemic, they have been working together to come up with plan A, B and C to ensure they are poised to perform operations and when possible, help each other to make sure they’re getting patients into the operating room as soon as possible” Dodd said. She shared that it’s important to remember that doctors are making these decisions by keeping patient outcomes as their first consideration. She explained that because any surgery for pancreatic cancer is a major surgery with potential for complications that may lead to longer than planned hospital admissions, doctors have to weigh the risk of exposure to the virus and impact to hospital resources against providing the best cancer care that will lead to the best patient outcomes. Most centres are working hard to ensure surgeries aren’t delayed and are of course, following governmental guidelines.

 

Second Opinions and Tumour Genetic Sequencing

One area where patients can expect varying processes at different centres is in second opinions. With resources stretched at cancer centres and hospitals across the country, second opinions are not being done at some hospitals at the moment. There are always exceptions to the rule and as the landscape of COVID19 changes daily, it is best to ask your doctor their thoughts about a second opinion.

Likewise, some clinical trials that focus of genetic sequencing of pancreatic cancer tumours have been paused. “For instance, COMPASS (a clinical trial that conducts genetic sequencing of pancreatic cancer tumours at Princess Margaret Cancer Centre and other centres across Canada) has been paused,” Dodd said. “This study requires about 40 people to process each patient’s tumour. Many of those folks are considered ‘non-essential’ staff and have been working from home since mid-March.  Many research labs also had to close in the first months of the pandemic. As restrictions are lifted across the country, doctors and investigators are eager to get these studies back up and running in a thoughtful and safe manner.” There may be other options for tumour sequencing using a recent tumour sample. Ask your doctor about these options.

 

The Status of Clinical Trials and Ongoing Research

While most clinical trials have been paused, Dodd explained the good news is that doctors and research teams are now working on reopening and expect that existing and new studies will be opening soon.

Research teams are also finding other ways to keep the momentum going on their projects. “Our translational research team focusing on pancreas, biliary and liver cancer are working full time from home. There is a tremendous amount of data collected across our program and the pandemic has not slowed us down. In fact, some projects and global collaborations have been accelerated given we have the time to dig in.  Investigators are busy analysing data and writing long awaited papers to be published in peer reviewed journals”

Researchers are also working behind the scenes to set up their next projects. “For some of us, our timelines are – thankfully, we think – very modestly impacted. We are preparing to open new studies as soon as we are able,” Dodd shared. One of those studies Dodd is currently preparing is a North American collaborative research initiative funded by PCC. “Our research is still chugging along,” Dodd said. “And we are getting ready to reactivate paused studies.”

 

All hands on deck

When the full force of COVID-19 was first being felt, Dodd joined other research staffers in going to the hospital a couple days a week to help in the effort to keep hospitals as safe as possible. The team continues to go in shifts to help screen patients and staff for symptoms, and work in the respite centre that provides a calming area for hospital staff to rest, recuperate and manage the anxiety of being a frontline healthcare provider.

Other times they are “runners”, taking the things family members drop off for their loved ones to those patients in hospital, helping to provide as much compassionate care as possible to cancer patients in a situation that can be extremely lonely.

“University Health Network is very lucky in that there is this massive research community the hospital can count on to help the clinical staff where we can,” Dodd explained. “Research staff have felt really grateful to be able to help patients and frontline workers in some small way during this very tough time.” In this way, the researcher’s role of innovating care for patients takes on new meaning.

 

Final Thoughts and Advice

Above all else, Dodd wants to assure patients and their families that they are not alone.

“I can’t emphasize this enough,” Dodd said. “No one has forgotten about pancreatic cancer patients. Everyone is still working in the fight against this disease. There is a lot to navigate right now but the healthcare community truly has the patient’s best interests at heart.”

And her biggest piece of advice while we wait for things to return to normal? “If you have concerns about your health don’t just wait and see – talk to your doctor, talk to your nurse – they have answers for you, just keep the lines of communication open.”