Jul 01, 2022
On March 3, 2020, Cancer.Net published a blog post by Merry Jennifer Markham, MD, FACP, FASCO, titled “Coronavirus and COVID-19: What People With Cancer Need to Know.” In the piece, Dr. Markham provided an overview of what was known about COVID-19 and considerations for people with cancer from an evidence-based perspective. As the pandemic situation evolved rapidly, she reviewed and updated the content daily—for 650 days straight. Today, she continues to review and update the material twice weekly, ensuring that people affected by cancer have the most current, rigorously vetted information about the pandemic. ASCO and Cancer.Net are profoundly grateful to Dr. Markham for her extraordinary commitment and service to patients with cancer and the people who care for and about them.
Dr. Markham is chief of the University of Florida (UF) Division of Hematology & Oncology, a clinical professor in the UF College of Medicine, and associate director for medical affairs at the UF Health Cancer Center. She specializes in the treatment of gynecologic cancers. Dr. Markham is the Cancer.Net associate editor for gynecologic cancers and past chair of ASCO's Cancer Communications Committee. Follow her on Twitter at @DrMarkham.
In the interview that follows, Dr. Markham and ASCO chief medical officer and executive vice president Julie R. Gralow, MD, FACP, FASCO, discuss the early days of the pandemic, the importance of clear communication, and lessons for the oncology community. The conversation has been lightly edited for length and clarity.
JG: What do you remember about March 2020?
MJM: It was a really scary time, a very uncertain time. I was coming off a stint on the ASCO Cancer Communications Committee. Communications is something that I am passionate about, with patients and with colleagues. I recall being in clinic and answering questions from patients. I felt like there needed to be some broader level of communication that our patients could refer to, and also colleagues and people around the world. I remember reaching out and saying, "Hey, I wonder if ASCO should do something." I didn't intend to volunteer myself to do something, but somebody needed to jump in, and I was ready.
JG: You worked on the content [on Cancer.Net] for 650 days straight. Every single day for 650 days, you looked to make sure that what we had there was accurate. Now, you're still looking at the content a couple of times a week. How has that level of focus on COVID-19 affected your perception and experience of the pandemic?
MJM: In the very beginning, the content was really updated daily—something was changing on a daily basis. It became part of my morning habit, first thing in the morning (with a cup of coffee, if I had time for that), to read whatever was happening in the news that day and just paying attention to where we were headed, knowing that there would be changes. For example, in the beginning, there were not enough masks, so we weren't recommending that everyone go out and buy surgical masks. Then the policies changed on that as we had plenty of masks. Then, of course, vaccines. And so on and so forth.
I felt, like many people, a loss of control when the pandemic happened. So many people felt the sense of loss and the sense of uncertainty. It reminded me, actually, of what patients with cancer probably experience with a new diagnosis: the sense of loss and uncertainty for what the future holds. Like many of my patients who really want to dive in deep to the research of their own cancer and treatment course, it gave me a sense of comfort to delve deep into the facts of what we were learning on a daily basis about COVID. Having that knowledge at my fingertips and being able to put it into layman's terms really did help me, I think, not become emotionally tied up in all of the sadness of the pandemic and the loss of travel and the loss of being able to be with loved ones. It was a little bit of a coping mechanism. I didn't realize that at the time, but in hindsight, I really think it was.
JG: You were the leading authority here [at ASCO] on what everyone was recommending. Do you have any particular moments that stand out for you from those early days?
MJM: I remember being very disappointed and hurt whenever I encountered someone, whether it was a patient or a family member or an acquaintance, who didn't believe that [COVID] was a real thing. I was pouring my heart and soul into the work of providing patient education and trying to do the same in my own clinic and with my own family members. To have people brush it off was hurtful, and it was also just very disappointing as a physician and scientist.
JG: The lack of belief in evidence, or in the understanding of what is real evidence and what is misinformation, has been a very frustrating part of this whole pandemic. Were there times when you ever lost motivation or felt your work wasn't making a difference?
MJM: Not really. Eventually, I realized—and I think we all have probably come to this point of acceptance—that there are some people whose minds we will not be able to change. I just had an open conversation in my own clinic; I brought my experience in working on this content so frequently and learning as much as I did about COVID into my own clinic and created opportunities for discussion. I went from being very intent on helping to change people's minds to recognizing that it's not always possible. We just have to do the best we can with following the science, teaching about science, and having clear communications about the facts as we learn them.
For example, teaching people how science normally works: the process of doing a clinical trial, then learning the results of that as time goes on, and then only after plenty of time do we have guidelines. But with COVID, we were all doing it very backwards. We were facing a traumatic experience and having to piecemeal our knowledge in hindsight. That also made it challenging to talk to some people who felt that health policymakers kept changing their minds. And it was true—that’s what happens in science, as we gain evidence, we can change our mind. You want scientists to take new data, new evidence, and apply it. But sometimes that's challenging for people to understand.
JG: What are some lessons that the oncology community can take home from this COVID-19 pandemic? Hopefully, we've learned something.
MJM: One of the things I have learned and, I think, that many of my colleagues in oncology have learned, is that this community really does rally around each other and rally together to do what's best for patients. I think we all knew this about ourselves as physicians and scientists, but it's been a time of coming together. Even in our own individual hospital settings or practices, the unity that has come out of it from anyone involved in the health care field has been really encouraging and nice to be a part of. Again, I think we've all learned the importance of good data, following the evidence, giving time for the data to actually mature if we can, but really doing what's right for our patients and keeping that as the number one focus. Then, of course, there’s the critical importance of communicating clearly and using evidence to support our communications.
JG: You did such tremendous work for ASCO and for our patients with these regular updates. What has the experience meant to you as an ASCO member and a member of the oncology community?
MJM: I joined ASCO when I was a fellow, and I was taught the importance of our organization by my faculty members and my mentors. As soon as I realized I could, I volunteered to serve on ASCO committees and task forces. It has been one of the most rewarding parts of my career, and it's something that I encourage junior faculty and fellows to do as well. ASCO is the leading voice for oncology care globally. The opportunity to contribute something back has meant the world to me. It's been an honor to be able to do this work.