May 27, 2020
By Katherine H. Crawford, MA, PMP, ASCO Communications
In early spring, as the coronavirus pandemic increased in scope and the size of the population affected, ASCO leaders and staff immediately focused on how to support members and the patients they care for during the public health crisis.
“We decided to compile our COVID-19 resources in response to the questions our members were posing and the challenges they were describing,” explained ASCO CEO Clifford A. Hudis, MD, FACP, FASCO. “Our community collaborates to generate evidence and then to put it in context so that we can share optimal strategies as we care for patients with cancer. This crisis tested us because suddenly there seemed to be novel circumstances and no direct evidence to guide us. Our community turned to ASCO for guidance and our aim was to provide it quickly and accurately wherever possible.”
Beginning in March, ASCO quickly compiled (and continues to update) a compendium of resources to help oncology care team members as patient care was modified or halted and practice operations shifted to ensure the safety and health of patients and providers. Curated information addresses the dramatic and unprecedented issues facing the oncology community, including staff preparedness, telemedicine implementation, changes to government reimbursement and regulatory policy, and patient care.
“We have heard from individuals around the world who described the ways they were (and are) using our resources and the difference it was making,” said Dr. Hudis. “They also shared suggestions and more questions as the pandemic has evolved. But the greatest feedback was in the usage. There were more than 100,000 views of our content in the first month alone.”
Resources for Health Care Providers
Recognizing the lack of information available to make evidence-based care decisions and growing concerns about potential shortages of ventilators, medications, and critical care hospital beds, the ASCO Ethics Committee mobilized to provide new recommendations, published in the Journal of Clinical Oncology, for making difficult decisions about allocation of resources during the pandemic. The special article, “Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID-19 Pandemic,” was developed so that oncologists could have input into the “practical, actionable, and ethically sound policies at the health-system level for allocation of resources, especially critical care resources,” thereby ensuring that the needs of patients with cancer were represented in the global discussion.
“Our hospitals, clinics, and clinicians are being stretched more thinly than ever before in modern medical history,” said lead author Jonathan Marron, MD, MPH, chair-elect of the ASCO Ethics Committee. “Given the surge that’s already been seen in some areas and is expected soon in others, there is the distinct possibility that the demand for medical resources—particularly critical care resources, like ventilators and beds in the intensive care units—will be greater than our supply. As a result, clinicians and institutions will be forced to make incredibly difficult, if not absolutely impossible, decisions. As a result, our aim was to provide guidance in these nearly impossible circumstances. Specifically, we hope to ensure medical resources are allocated through a thoughtful process with advanced planning.”
Some of the recommendations for members of the oncology community include:
- If a policy takes preexisting life-limiting diseases into account, it should do so consistently across types of disease and should consider evidence-based information regarding life expectancies.
- All cancer diagnoses and prognoses should be considered individually with input from the treating oncologist. Cancer diagnosis alone should not be considered terminal, even for patients living with advanced or metastatic disease. Consideration of cancer as either a major or severely life-limiting comorbidity should reflect evidence-based factors, including the individual patient’s clinical status and prognosis.
- Decisions regarding allocation of scarce resources should be separated from bedside decision making. The oncologist caring for a patient should not make scarce resource allocation decisions about that patient.
- Oncologists should work with their institutions on how best to use scarce resources for care and support of patients with cancer.
ASCO’s coronavirus compendium also includes policy information comprised of updates from government authorities and payers and ASCO-developed resources where information gaps existed on topics such as financial assistance; quality, safety, and oversight; prescription drugs; and more. The page, which is updated regularly, includes information about financial assistance for providers; highlights and updates from the Centers for Medicare & Medicaid Services; and U.S. Drug Enforcement Agency and Food and Drug Administration (FDA) updates.
In May, the Society published the “ASCO Special Report: A Guide to Cancer Care Delivery During the COVID-19 Pandemic,” which provides detailed guidance to oncology practices on the immediate and short-term steps that could be taken to help protect the safety of patients and health care staff before resuming more routine care operations during the COVID-19 public health crisis. The ASCO special report also includes guidance published by the government and other medical societies. The topics covered range from infection prevention controls to telemedicine to cancer screening.
“As oncologists, we want nothing more than to provide the highest quality cancer care to each and every patient,” said 2019-2020 ASCO president Howard A. “Skip” Burris III, MD, FACP, FASCO. “The decision to dial back operations during the pandemic has not been an easy one for any oncology practice or cancer care provider. While the move to resume normal operations will be slow and steady, we hope this report gives oncology practices the guidance they need to determine when and how to return to a ‘new normal’ as the impact of the pandemic begins to ease.”
Fostering Discussion and Furthering Knowledge
Despite the pandemic, ASCO has maintained its commitment to its mission to conquer cancer through research and education. This has meant finding ways to gather members and thought leaders virtually and provide forums for discussion and information sharing. Three new events that exemplify this ability to quickly create virtual events for the community were ASCO20 Virtual, webinars, and a presscast.
ASCO20 Virtual Scientific Program
When it became clear that the 2020 ASCO Annual Meeting could not be held in person, the Society quickly transitioned to a virtual format. Since the studies presented at the Annual Meeting inform both immediate clinical practice and future research directions, ASCO was committed to delivering the latest cancer science to the global community in the same timeframe with abstracts published online and in the Journal of Clinical Oncology. The ASCO20 Virtual Scientific Program will take place on May 29-31; the ASCO20 Virtual Education Program will held on August 8-10. Registration for ASCO20 Virtual is free for members and includes access to all sessions and presentations from both the scientific and educational programs.
To bring members together across the United States and the world, ASCO created two weekly webinar series. One, co-hosted with the Oncology Nursing Society (ONS), focused on caring for people with cancer during the COVID-19 pandemic. The second, a global health series, provided a forum for oncology care team members from around the world to share their knowledge and experiences with treating patients with cancer during the coronavirus pandemic, as well as for the Society to disseminate its evidence-based guidance particularly regarding the efficient and effective use of cancer resources in this current environment.
“Every one of us, each oncology professional, is under a very high level of stress to protect patients, medical staff, and our families from COVID-19,” said webinar participant Jeeyun Lee, MD, of South Korea. “Being a speaker at a global ASCO webinar was an impressive moment to share and re-emphasize that we are not fighting the pandemic alone and there is always something to be learned from each other.”
Giuseppe Curigliano, MD, of Italy, a featured speaker at the April 14 webinar, noted of the situation in Italy, “The lessons we [took] home from our discussion were, first, that all health care workers in hospitals, nursing homes, and the community should have been tested for COVID-19, and those testing positive should have been isolated, even if they were asymptomatic, and second, an urgent and decisive state lockdown should have been implemented to contain the epidemic. This step could have reduced the number of COVID-19 cases, prevented hospitals from being overwhelmed, and potentially limited the number of deaths.”
Press Briefing for Reporters on COVID-19
In addition to supporting members, the Society also disseminated its expertise and thought leadership by hosting a press briefing—or “presscast”—that underscored ASCO’s role in providing evidence-based information and guidance during the pandemic and helped ensure that this perspective informed future media stories about the impact of COVID-19 on the cancer care delivery system. The “COVID-19 and Cancer: Addressing a Health Care System in Crisis” presscast featured a panel of experts who focused on the pandemic’s impact on the cancer care delivery system, the response by federal agencies, and steps the cancer care community has taken to mitigate the impact of coronavirus. Speakers included Dr. Burris, ASCO chief medical officer and executive vice president Richard L. Schilsky, MD, FACP, FSCT, FASCO, and a number of ASCO volunteers and guests, including Dr. Marron, ASCO Government Relations Committee chair Melissa Dillmon, MD, FASCO, Gary Lyman, MD, MPH, FACP, FRCP, FASCO, and FDA deputy commissioner for medical and scientific affairs Anand Shah, MD.
The panel provided an up-to-date overview of the situation for patients with cancer during the pandemic and ASCO’s recommendations for the future. There were more than 120 attendees at the presscast, including top-tier, national news outlets and trade press. ASCO has been featured in stories about cancer and COVID-19 in many outlets, notably The Washington Post, Chicago Daily Herald, Cancer Network, Independent, Medscape, and MedPage Today. The total outreach is estimated to be more than 5.1 million readers as of May 31.
Resources for Patients With Cancer
Another primary area in which ASCO has been an information leader is with resources for patients with cancer. Among ASCO’s resources is the “COVID-19 Patient Care Information” site, which features the popular “Coronavirus 2019: What People With Cancer Need to Know” blog post. This post is reviewed and updated daily by ASCO expert Merry Jennifer Markham, MD, FACP, FASCO, and has a Spanish-language version.
The page also contains a question-and-answer blog post, “Common Questions About Coronavirus 2019 and Cancer: Answers for Patients and Survivors,” which has a Spanish version available, as well as a compilation of organizations that can provide help with queries about financial resources. The resources for patient care have been circulated among patients, caregivers, and patient advocate groups.
Need More Help? Submit a COVID-19 Question to ASCO
The resources that ASCO has provided have proven useful to members and the public. As the COVID-19 public health situation continues to evolve around the world, anyone with a question related to COVID-19 and cancer can submit it to ASCO’s coronavirus-related questions page. The page, which opened in early March, had received nearly 200 questions by the end of April, with 94% of them answered through ASCO’s resources.