The new coronavirus pandemic (Covid-19) it is affecting more than ever the provision of medicines, medical care and even the very life of cancer patients. In this second installment, PROFILE continues to report the changes that patients and doctors are already facing to adapt treatments to the new context.
He National Cancer Institute (INC), which belongs to the Ministry of Health, considers the cancer patient within the Covid-19 risk group, since various treatments weaken the immune system, such as chemotherapy, extensive radiation therapy, and bone marrow transplants. This medium consulted the main oncology associations, specialized doctors, official sources, and an association that assists patients and families to answer how treatment guidelines will change; what are the keys to mobilize in quarantine; which obstacles continue to be registered; and where to get free assistance and information.
What will happen with the treatments
Oncologists are preparing for the month of May, when the pandemic is expected to reach its peak in Argentina. Still, the Argentine Association of Clinical Oncology He already talks about the lack of resources at the present time: “We are with moderately limited health resources” and this forces us to “prioritize treatments with greater potential benefits” for the patient and to postpone others.
One of the points that must be modified is the form and times of attention. In a virtual exhibition held last Thursday, the oncologist Federico Losco, from the Alexander Fleming Institute (also Argentine Association of Clinical Oncology), he explained to his colleagues that they will no longer be able to continue with their activities as they had been doing until before the arrival of the new coronavirus.
For outpatient care, Losco proposed “minimize visits, space the shifts of patients in treatment and evaluate attending more days a week to avoid contact between patients.” He also recommended “perform a pre-test on patients who will have to attend shifts, call them and detect symptoms of the coronavirus or exposure to confirmed or suspected cases.”
Regarding intravenous treatments, the Association suggests changing them to oral treatments when possible and do not harm the patient. It also recommends that subcutaneous and intramuscular applications be applied by nurses in patients’ homes. The same with blood draws.
Regarding radiotherapy, they state that there are adult patients with certain types of cancer who will not be able to see their treatments postponed, such as those suffering from digestive tumors, cervical-uterine tumors, mammary glands in positive nodes, head and neck tumors.
Although the official decision is not to postpone any oncological surgery, the medical institution advises to reprogram as many as possible, so oncologists must “decide individually each case and taking into account the potential harm of delaying the surgery.” This is because abroad, where the virus advanced earlier and faster, it was detected that “Patients who underwent surgery one month prior to becoming infected with SARS-Cov-2 (or covid-19) had an increased risk of severe events” from the infection.
As for immunotherapy, this type of treatment does not expose the patient to greater immunosuppression, as chemotherapy does. “The recommendation is that they continue to carry out the treatment but that the doctors pay special attention to respiratory symptoms,” Losco added in his presentation.
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Go into quarantine
There are patients who must do tens of kilometers to reach the health centers. PROFILE asked the Executive about the exceptions that must be claimed to be able to circulate.
Those who must move for a treatment or purchase of medicines are exempt from the single movement certificate, as they are covered by the exception “people who must deal with a situation of force majeure”Of the Decree of Need and Urgency (DNU), as reported in Government. They must carry something that proves it: medical order, hospitalization, oncologist certificate or medical institution.
Regarding family members, they must carry out an online certificate on the Remote Procedures platform, where they will find the exception for family members who must accompany or assist sick people. In urgent cases, they can also appeal to cases of “force majeure” and “assistance to relatives”.
PROFILE already mentioned that one of the problems of patients is the restriction to move. Santiago Bella, from the Argentine Association of Clinical Oncology, He explained that he has an office in Córdoba and cares for patients from other provinces who can no longer continue with their treatments, especially in Catamarca and San Luis, where the restrictions to leave and enter provincial territory are much stricter, he explains.
Given these obstacles, many oncologists are trying to relocate their patients with other doctors. These problems forced many patients to postpone their treatments for up to three weeks. Treatments that preserve their life. “We are receiving cancer patients who are wandering in front of the closure of some oncology areas because their hospitals put all their resources into the fight against Covid-19. We have to see which colleagues we refer them to, ”said a medical oncologist in off.
Where to find assistance
The Argentine Association of Clinical Oncology (AAOC) created a free service for cancer patients and their family environment to consult about covid-19 and cancer. It will be free and the entity’s doctors will respond via email to the address firstname.lastname@example.org.
Another consultation site for patients and families is www.mundocancer.org, from the Know Where to Be Foundation, which includes information to carry out ANSES, PAMI and permits during the quarantine.
Vicky Viel Temperley, founder of the entity, told PROFILE that they carried out a survey of 27 hospitals and health centers in the country. Their volunteers found that, in some cases, nursing staff who used to care for cancer patients were referred to Covid-19 treatment; Volunteers accompanying patients during chemotherapy sessions can no longer enter the wards; Nor, in some cases, can the relatives of patients who must be hospitalized for days enter.
“We are seeing that for fear of the pandemic, some doctors closed their agendas. For this reason, a network of oncologists is being set up to offer their offices in the City of Buenos Aires so that other colleagues can attend to their patients in health centers in a more protected and controlled manner, ”said Julia Ismael, a clinical oncologist, former Director of the National Cancer Institute (INC) and member of the AAOC. “We are trying to refer everything to telemedicine as possible, but some patients need personal follow-up,” Ismael added.
Last Thursday, the Ministry of Health sent a brief report (less than three pages of content) with general recommendations to oncologists and patients: the basic ones (distancing and social isolation) and some more specific ones, such as telemedicine.
However, virtual care is not for everyone. The lack of preparation of some health centers for telemedicine or virtual assistance -both public and private- is another of the weaknesses of the system that this pandemic left in evidence, the doctors consulted, patients and relatives agree.
As a consequence of this failure, in many centers, they stopped granting shifts for new treatments because the administrative and nursing staff are on leave, in preventive isolation or redirected to the areas dedicated to the pandemic, Viel Temperley said. “There are clinics where they are doing little chemo,” he explains.
At IOMA, the social work of the province of Buenos Aires, there were delays in the delivery of medication. At the institution, they told PROFILE that complaints are common. “We always claim. Thousands of cancer treatments are performed and each history of affiliations is unique ”. The institution has 2.2 million members.
Viel Temperley explained that her foundation assists patients with difficulties in accessing medications, both in Ioma and PAMI and in official drug banks. “The problem now is that no one attends them through quarantine to process claims. The windows are closed. “
ED / DS