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Planning for post-pandemic cancer care delivery: Recovery or opportunity for redesign? ​

Literature Information ​

DOI10.3322/caac.21644
PMID32997807
JournalCA: a cancer journal for clinicians
Impact Factor232.4
JCR QuartileQ1
Publication Year2021
Times Cited10
Keywordscancer care delivery, coronavirus disease 2019 (COVID-19), health care delivery, pandemics
Literature TypeJournal Article
ISSN0007-9235
Pages34-46
Issue71(1)
AuthorsPelin Cinar, Richard Bold, Bryn A Bosslet, Daniela A Bota, Debra Burgess, Helen K Chew, Joshua G Cohen, Emad Elquza, Kathryn A Gold, Emi Kamiya, Beth Y Karlan, Rana R McKay, Sandip P Patel, Kimberly Ternavan, Jeanna Welborn, Maki Yamamoto, Hope S Rugo

TL;DR ​

The COVID-19 pandemic significantly disrupted cancer care delivery, prompting the University of California Cancer Consortium to adapt its management strategies amid varying regional impacts. This review highlights their interventions and recovery planning, suggesting that lessons learned during the pandemic can inform improved cancer care delivery models in the future.

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cancer care delivery · coronavirus disease 2019 (COVID-19) · health care delivery · pandemics

Abstract ​

The delivery of cancer care has never changed as rapidly and dramatically as we have seen with the coronavirus disease 2019 (COVID-19) pandemic. During the early phase of the pandemic, recommendations for the management of oncology patients issued by various professional societies and government agencies did not recognize the significant regional differences in the impact of the pandemic. California initially experienced lower than expected numbers of cases, and the health care system did not experience the same degree of the burden that had been the case in other parts of the country. In light of promising trends in COVID-19 infections and mortality in California, by late April 2020, discussions were initiated for a phased recovery of full-scale cancer services. However, by July 2020, a surge of cases was reported across the nation, including in California. In this review, the authors share the response and recovery planning experience of the University of California (UC) Cancer Consortium in an effort to provide guidance to oncology practices. The UC Cancer Consortium was established in 2017 to bring together 5 UC Comprehensive Cancer Centers: UC Davis Comprehensive Cancer Center, UC Los Angeles Jonsson Comprehensive Cancer Center, UC Irvine Chao Family Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and the UC San Francisco Helen Diller Family Comprehensive Cancer Center. The interventions implemented in each of these cancer centers are highlighted, with a focus on opportunities for a redesign in care delivery models. The authors propose that their experiences gained during this pandemic will enhance pre-pandemic cancer care delivery.

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Primary Questions Addressed ​

  1. What specific redesign strategies were identified by the UC Cancer Consortium to improve cancer care delivery post-pandemic?
  2. How did the varying impacts of the COVID-19 pandemic across different regions influence the planning for cancer care recovery?
  3. What lessons learned from the pandemic can be applied to future public health emergencies in cancer care delivery?
  4. In what ways can technology and telehealth be integrated into the redesigned cancer care models post-pandemic?
  5. How can patient feedback and experiences during the pandemic inform the future approaches to cancer care delivery?

Key Findings ​

Research Background and Objectives ​

The COVID-19 pandemic has dramatically transformed cancer care delivery, prompting a need for innovative approaches in oncology practices. This paper discusses the experiences of the University of California Cancer Consortium (UCCC) in adapting to these changes, emphasizing the importance of redesigning care delivery models rather than merely returning to pre-pandemic practices.

Main Methods/Materials/Experimental Design ​

The study outlines a phased approach to recovery planning across the UCCC, which comprises five comprehensive cancer centers. The methods include:

  1. Communication and Transparency: Engaging patients and staff about safety measures and recovery plans through multiple communication channels.
  2. Testing Protocols: Implementing increased testing for asymptomatic patients and high-risk groups, and developing partnerships with community hospitals for accessibility.
  3. Prescreening and Screening: Utilizing automated systems for symptom screening in patients, visitors, and staff.
  4. Telehealth Integration: Expanding telehealth services to maintain patient access while reducing exposure risk.
  5. Visitor Policies: Adjusting visitor restrictions based on patient needs and safety considerations.
  6. Treatment Modifications: Adapting therapy schedules and considering home-based care options.
  7. Clinical Trials Management: Adjusting trial protocols to accommodate remote monitoring and patient safety.
Mermaid diagram

Key Results and Findings ​

  • Patient Engagement: Increased communication led to higher patient confidence in returning for care.
  • Testing Accessibility: Partnerships improved testing availability, with significant engagement from high-risk communities.
  • Telehealth Adoption: There was a notable rise in telehealth visits, facilitating ongoing care while maintaining safety.
  • Visitor Policy Adjustments: Flexible visitor policies improved patient experiences without compromising safety.
  • Clinical Trials: Despite challenges, some trials continued, adapting to remote monitoring, which proved efficient.

Main Conclusions/Significance/Innovation ​

The UCCC's response to the COVID-19 pandemic highlighted the necessity of adaptability in healthcare delivery. The experiences gained have the potential to enhance cancer care beyond the pandemic, emphasizing the importance of addressing health disparities and ensuring equitable access to care. The innovative approaches adopted during this period may serve as a model for future healthcare challenges.

Research Limitations and Future Directions ​

The study acknowledges limitations such as:

  • Unequal access to telehealth among vulnerable populations.
  • Ongoing uncertainties regarding the long-term impact of COVID-19 on cancer care delivery.
  • Financial challenges faced by healthcare institutions.

Future directions include:

  • Continued assessment of care delivery models.
  • Addressing healthcare disparities exacerbated by the pandemic.
  • Further integration of technology in patient care and clinical trials to enhance accessibility and efficiency.

References ​

  1. Promoting health equity in the era of COVID-19. - John H Farley;Jeffrey Hines;Nita K Lee;Sandra E Brooks;Navya Nair;Carol L Brown;Kemi M Doll;Ellen J Sullivan;Eloise Chapman-Davis - Gynecologic oncology (2020)
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  7. Planning for post-pandemic cancer care delivery: Recovery or opportunity for redesign? - Pelin Cinar;Richard Bold;Bryn A Bosslet;Daniela A Bota;Debra Burgess;Helen K Chew;Joshua G Cohen;Emad Elquza;Kathryn A Gold;Emi Kamiya;Beth Y Karlan;Rana R McKay;Sandip P Patel;Kimberly Ternavan;Jeanna Welborn;Maki Yamamoto;Hope S Rugo - CA: a cancer journal for clinicians (2021)
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Literatures Citing This Work ​

  1. Planning for post-pandemic cancer care delivery: Recovery or opportunity for redesign? - Pelin Cinar;Richard Bold;Bryn A Bosslet;Daniela A Bota;Debra Burgess;Helen K Chew;Joshua G Cohen;Emad Elquza;Kathryn A Gold;Emi Kamiya;Beth Y Karlan;Rana R McKay;Sandip P Patel;Kimberly Ternavan;Jeanna Welborn;Maki Yamamoto;Hope S Rugo - CA: a cancer journal for clinicians (2021)
  2. Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada-Colorectal Cancer Canada; 2021. - Eliya Farah;Maria El Bizri;Radmila Day;Lavina Matai;Fred Horne;Timothy P Hanna;David Armstrong;Susan Marlin;Olivier Jérôme;Darren R Brenner;Winson Cheung;Laszlo Radvanyi;Eva Villalba;Natalie Leon;Chana Cohen;Karine Chalifour;Ronald Burkes;Sharlene Gill;Scott Berry;Brandon S Sheffield;Pamela Fralick;Barry D Stein; On Behalf Of Ready For The Next Round Patient Panelists - Current oncology (Toronto, Ont.) (2022)
  3. Experience of a National Cancer Institute-Designated Community Outreach and Engagement Program in Supporting Communities During the COVID-19 Pandemic. - Jessica D Austin;Kimberly Burke;Erica J Lee Argov;Grace C Hillyer;Karen M Schmitt;Jasmine McDonald;Rachel C Shelton;Mary Beth Terry;Parisa Tehranifar - Journal of community health (2022)
  4. Construction and experimental validation of a B cell senescence-related gene signature to evaluate prognosis and immunotherapeutic sensitivity in bladder cancer. - Ranran Zhou;Jiawei Zhou;Bahaerguli Muhuitijiang;Wanlong Tan - Functional & integrative genomics (2022)
  5. Fit for Duty: Lessons Learned from Outpatient and Homebound Hematopoietic Cell Transplantation to Prepare Family Caregivers for Home-Based Care. - A J Applebaum;T Sannes;H R Mitchell;N S McAndrew;L Wiener;J M Knight;A J Nelson;T F Gray;P M Fank;S C Lahijani;C Pozo-Kaderman;M Rueda-Lara;D M Miran;H Landau;H L Amonoo - Transplantation and cellular therapy (2023)
  6. Impact of the COVID-19 pandemic on cancer healthcare utilization in southwestern China on March 2021. - Peiyi Li;Yajuan Zhu;Yaqiang Wang;Xiaoyu Liu;Xiang Fang;Yuanxin Hou;Rujun Zheng;Junying Li;Bo Zhang;Zhuo Chen;Chengdi Wang;Tao Zhu;Weimin Li;Xuesong Han - Cancer medicine (2023)
  7. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Family Caregivers. - Allison J Applebaum;Erin E Kent;Lee Ellington;Grace Campbell;Heidi Donovan;Ranak Trivedi;Courtney Van Houtven;Tamryn F Gray;Rebecca R Gebert;William E Rosa;J Nicholas Odom - Journal of palliative medicine (2024)
  8. The impact of the California state lockdown during the COVID-19 pandemic on management of patients with pancreatic ductal adenocarcinoma. - Parisa Oviedo;Shohei Burns;Wen-Pin Chen;Hanna K Mandl;Claudia Rosso;Niloofar Radgoudarzi;Anna Crosetti;Steven Zamora;Lauren M Perry;Richard J Bold;Amanda N Labora;Timothy R Donahue;Ajay Maker;Jennifer B Valerin;Jason A Zell;Rebekah R White - Journal of surgical oncology (2024)
  9. National Cancer Institute-funded grants focused on synchronous telehealth cancer care delivery: a portfolio analysis. - Roxanne E Jensen;Rachelle Brick;Joshua Medel;Priyanga Tuovinen;Paul B Jacobsen;Rebecca Hardesty;Robin C Vanderpool - Journal of the National Cancer Institute. Monographs (2024)
  10. Global determinants of gynecologic cancer incidence and mortality: A cluster-based analysis with predictive insights. - Mauricio A Cuello;Fernán Gomez-Valenzuela;Ignacio Wichmann;Alexander B Olawaiye - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (2025)

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