Life as a medical oncologist during COVID-19

Associate Professor Lara Lipton is a medical oncologist working in Melbourne. We spoke to her about the impact of COVID-19 on cancer treatment during 2020, what has changed for patients, and what she has learned.

You are a medical oncologist living and working in Melbourne during the COVID-19 pandemic. Can you tell me about how your life has changed this year?

Initially in the year it was much the same for everyone around Australia. We were all pretty worried in February and March and were getting predictions that we wouldn’t be able to treat oncology patients with chemotherapy because there wouldn’t be enough beds in the hospital. It fairly rapidly became apparent that that was not the case. We did have set levels where we would have to reduce our chemotherapy for people who were not curative, but that never came to pass so we were able to continue giving all chemotherapy as we usually do. That’s been the case right through the pandemic. We’ve been able to deliver oncology care without any shortcuts, really.

The things that have changed in oncology are that most of our work has gone to telehealth, where it’s not vital to see and examine the patient. We’re doing most of our consultations through a mixture of telephone and video links. Probably the people coming in are the people who need to be examined, and the people who are having their treatments. In the private sector when people are coming in for treatments they’re often seeing their oncologist. In the public sector even pre-chemotherapy visits are quite often being done over the phone or via video link. We have at times had waiting times for imaging but overall it hasn’t been too bad.

I think the big things that have been problematic are that much of the time we haven’t been able to have visitors come in with patients to the hospital. That’s not just coming in for their outpatient visits or their chemotherapy, but also for hospital stays. It’s been very difficult for patients and families where they’ve been on their own during chemotherapy and on their own the whole time that they’re admitted to hospital. In the last week the hospitals have opened up a bit, and most hospitals are now allowing one visitor for one to two hours a day, so that’s been a huge relief for everybody.

The other thing that has been difficult is getting procedures done. As you may know, everyone getting a procedure done in Victoria now, even if it’s a minor procedure like draining from fluid from around the lung, needs to have a COVID test first and self-isolate until that comes back negative and have the procedure. That’s caused a few delays and some patients having multiple COVID tests.

They’re the big things that have changed in practice, but probably very importantly there’s been a sense that there have been less presentations with cancer than we would normally see. Some of that of course is down to the fact that some screening procedures such as gastroscopies and colonoscopies and cystoscopies haven’t been able to be done while there’s been limitations on elective surgery, so there may be a reduction in new diagnoses made by those procedures. Initially BreastScreen closed down. It’s open again now, but we have a feeling perhaps ladies are not presenting for BreastScreen, they’re waiting for our stage 4 restrictions to ease. We have a bit of a feeling that there may be a proportion of new diagnoses of cancer that are going to be presented later.

How have the processes in place at your medical practice changed due to COVID-19?

Everybody who enters a hospital or enters a private practice or anywhere really has to wear a mask. That became so before the general wearing of masks in Victoria was mandatory. Obviously now, wherever you go, whether it’s a shop, outside, anything, you wear a mask, but that happened in hospitals first.

In some hospitals we’re giving people a surgical mask if they only have a cloth mask. Otherwise, waiting rooms have been paired down greatly so that in a waiting room of a certain size you may only have two or three people, so other people might have to wait in their car outside to be called in. Most practices now have barriers up in front of the secretaries so that they’re separated from the patients while they’re doing their transactions. Particularly now, patients can have one person come with them into the consult room at a maximum so your family meetings are really not happening at a maximum so your family meetings are not happening.

How has treatment changed for patients?

Luckily it hasn’t changed too much in that people can access all the treatments they could pre-COVID. It does mean they’re on their own in the day oncology ward which is hard for the elderly and the non-English speaking, so we are using phone interpreters. I think if things continue on the current trajectory, people will be able to have someone with them during chemotherapy.

How have your patients responded to these changes?

Many have taken it on the chin and said, ‘We do what we have to do’. Some have found it very difficult, particularly people who grapple with anxiety or other emotional problems. Exceptions have been made for some of these people to have a person come with them to the consulting room. But on the whole, patients have coped very well.

What have been your greatest challenges this year?

Getting a haircut! Aside from that, personally I have not been too challenged. I have been able to deliver care, I have worried a bit about the lack of face to face appointments in some settings but overall I think the health service has done well in terms of continuing to deliver care where it is needed. And we’re lucky in some ways, doctors, that our lives are relatively normal, in that we can go to work, we can continue seeing patients.

It’s been more the really heartbreaking situations where somebody is actually dying in hospital and it’s just been really hard to get the family there and for people whose families are overseas and struggling to get back and see them in the final stages of their disease. Those have been the really difficult heartbreaking things.

In terms of my practice as a doctor, it’s changed the form we deliver things but it hasn’t been a major upheaval to me – apart from having to learn a lot of computer skills that we didn’t have before. A lot of us have increased our computer skills during this time to remotely access public hospitals and databases.

The other thing is that in one of my public clinics, we’re taking turns with some of us doing it at home and the next week at work, so that if some of us go out with COVID we’re not all going to go out together. A lot of units have done that – they’ve got an A team and a B team, and they don’t want the A team to really see or socialise with the B team, and they take turns doing clinics from home or from work.

What have you learned from this experience?

I’ve learned that we can do a lot more via telehealth than we thought we could do, and a lot of that is probably going to stay. The other thing which I think is probably happening all around Australia is that multidisciplinary meetings which are a core part of our business as oncologists can be done via telehealth and probably will continue to be done by telehealth in some way, shape or form, that we can have meetings of 30 participants, review pathology, review X-rays, discuss cases and we’re really not lacking very much.

One thing that I think we’ve all learned is that our hygiene practices were completely substandard before this, and that we all, even though we passed our hand hygiene module every year, we didn’t perform as well as we should perform on overall hygiene at work. I think that’s definitely going to stick now.