A New Normal? For Now.

The lung cancer was the size of her fist, filling up most of her lower lung. It had been growing for some time, closing off the airway leading to that part of her lung causing chronic pneumonia.  Removing the lung cancer not only gave her the best chance of a cure, but it also cleared out the pneumonia that had no chance of resolving if the cancer wasn’t removed. The surgery was complex. She and I met each other face to face for the first time the day before. Such is the “new normal” providing care for people in the need of lung cancer surgery during the COVID-19 epidemic.

As the U.S. healthcare system rallies to fight COVID-19, we are redirecting precious hospital resources to medical wards that are helping patients struggling with the virus. Patients with lung cancer are part of the group at highest risk for experiencing severe symptoms of COVID-19 if infected.

To protect the public and prioritize resources, many hospitals have limited surgery to emergent, urgent and essential surgeries. What is an essential surgery? Surgery for larger and more aggressive lung and other types of cancers may fall into this category.

As the American Lung Association’s 2019 State of Lung Cancer report tells us, the five-year survival rate for lung cancer is 21.7%, among the lowest for all cancers. Lung cancer is more likely to be curable if the tumor is found early and can be removed through surgery at an early stage before the cancer has widely spread. Nationally, only 20.6% of patients underwent surgery as part of their first course of treatment. In addition, there are health disparities, where African Americans are more likely to die from lung cancer than Caucasian Americans. If all patients with lung cancer are delayed treatment because of the COVID-19 pandemic, this disparity will be even more pronounced.

To help lung cancer patients, surgical societies including the American College of Surgeons, American Association for Thoracic Surgery, the Society of Thoracic Surgeons and the Thoracic Surgery Outcomes Research Network have partnered to create a consensus statement to aid doctors and their patients in the shared decision-making process. These guides take a patient’s tumor characteristics, in combination with information on the local situation within the community and health systems as they relate to COVID-19, and provide guidance on which patients can likely safely wait to have their treatments and who should move forward with potentially lifesaving surgery.

If offered surgery during the pandemic, here are some of the questions patients and their families should ask, as part of their decision whether to move forward.

• What are the risks to me if I delay my cancer surgery?
• Are there alternative treatments that would that would achieve similar goals as lung cancer surgery?
• What is the local situation within the community and health systems as they relate to COVID-19? If there are a lot of patients being treated for the virus at the medical center, resources are limited, and the rate of contracting the virus in the hospital may be high. If there are modest numbers of patients being treated, then the medical center may be able to manage patients undergoing essential surgery in a safe manner.
• Do I need to come into the clinic for my initial visits? The use of telemedicine (video conferencing) has exploded. The American Medical Association has estimated that as much of 70% traditional outpatient visits can be performed via telemedicine. The patient undergoing surgery we visited earlier, lived 100 miles from our medical center. Because of the pandemic, all but one of her visits with us were performed via telemedicine, with her needed tests performed locally where she lived. Then, we met with her and her family, in person, the day before her surgery.
• Do you have COVID-19 testing? Testing for COVID-19 provides incredible information and allows us to treat the patients who have it and protect the patients who don’t. We are currently testing all patients undergoing surgery, though this varies depending on what resources are available to that hospital.
• What are my risks of catching COVID-19 in the hospital, and what happens if I do catch it? Some studies suggest that patients with COVID-19 who have surgery have worse outcomes. Understanding one’s risks are key to making smart choices.

Having lung cancer or knowing a family member with lung cancer is a difficult journey. Attempting a cure during a global pandemic is not an easy task.  But working with your care team and knowing the facts at hand will help you create the best treatment plan during this uncertain time.

Dr. David Tom Cooke is an associate professor at the University of California, Davis Medical Center, UC Davis Health. He is the section head of General Thoracic Surgery, the Task-Force chair and founder of the UC Davis Comprehensive Lung Cancer Screening Program, and program director of the UC Davis Cardiothoracic Surgery Residency. Read More.