What happens when COVID and cancer treatment collide?

For 73 year-old Bonna Nelson, 2020’s unpredictability took her from a routine annual mammogram to sitting in a breast cancer surgeon’s office within days.

Receiving her diagnosis in June, Nelson initially sought care at another University of Maryland Medical System affiliate before transitioning 90 minutes away across the Chesapeake Bay for further treatment. Now in radiation therapy at the University of Maryland Greenebaum Comprehensive Cancer Center, Nelson chose to fast-track her treatment because of the pandemic, not in spite of it.

“Who knows what the future may bring,” she says. “I wanted to undergo treatment while the doctors and facilities were available and open to treat.”

A few months earlier, LaVera Davis, a patient at the NorthShore Kellogg Cancer Center in Illinois, had a mastectomy nearly 18 years after her first bout of cancer.

Speaking about her experiences handling both the pandemic and her treatment, she says “it’s a strange experience to constantly wonder – even sitting in a waiting room — if the chair had been cleaned and if I had done what I needed to do before arriving in order to protect others.”

When everything comes under scrutiny

With a cancer diagnosis, there’s always an added sense of caution when looking at actions once thought as normal.“It changes you. It changes the way you think forever,” says 50 year-old breast cancer patient Lisa Taylor.

Under current conditions combined with the risk of being immunocompromised, uncertainty becomes amplified a thousand times over.

The inability to control your surroundings when you leave the house is one thing. In any other time, seeing loved ones would’ve helped comfort patients, but not this year.

Taylor, diagnosed at the beginning of September, went to visit her teenager at university before starting radiation therapy. When she returned, she got a call saying she might have come into contact with COVID-19 on the visit, putting the schedule of her treatment plan up in the air.

Easing the burden on anxious patients

The pandemic has seen second and third waves in the U.S. But, as more time passes, we’re normalizing rather than cracking down. As a result, 67 percent of respondents in a survey from The American Cancer Society Cancer Action Network felt added amounts of anxiety towards keeping themselves safe as some social distancing measures were relaxed.

In that sense, telehealth has helped health systems give cancer patients another option for care. “It’s the best PPE out there!” says Dr. Jeff Metts, COVID-19 Incident Commander for Cancer Treatment Centers of America and Chief of Medicine for the Atlanta branch.

As opposed to in-person treatment, where stricter visitor regulations have been set, telehealth has also allowed patients to feel supported during visits.
“The stress of cancer treatment can cause someone to forget the conversation you had only moments before” says Metts. Because of this, Nelson says, “it was important to prepare for those appointments as I do for in-office visits. I prepared questions in advance and had my husband join me as a second set of ears and to take notes.”

Delays in care

Elective surgery delays have caused huge backlogs as OR volume dropped close to 35 percent from March to June. When Davis’ mastectomy date was pushed from March to April, she notes her doctor advocating for her to get the date she did as something that helped reassure her during this process.

Early detection

Had Lisa Taylor been scheduled for her annual mammogram earlier in the pandemic, she would’ve strongly considered delaying it, citing her almost-canceled annual physical in May. Her past mammograms had all been clean. How likely was it that this year would be any different?

Thankfully, she went in on time for her mammogram scheduled for July. A 6 millimeter mass was found, biopsied, and later confirmed to be early stage breast cancer. The tumor had an Oncotype DX test score of 0, meaning skipping chemotherapy was actually the safer option. Her friend, who happens to be a breast cancer surgeon, called her “a poster child for early detection.”

The shadow curve

Then, there’s the opposite scenario. The pandemic caused screening rates and appointment volumes to plummet across specialties. Metts believes this is where the “shadow curve” comes into play.

Coined by CTCA President and CEO Pat Basu, the term describes the results of undiagnosed and untreated diseases due to missed preventive care. “This means more cancers going undetected and more that will become fatal,” says Metts.

According to the same survey as above by the ACS CAN, nearly 80 percent of patients receiving active treatment said they experienced delays in their health care. Whether they know it or not, their cancer could return or progress, with 20 percent of respondents sharing this concern.

Getting used to new protocols

A breast cancer diagnosis is already difficult in its own right, but during a pandemic? An even greater challenge to contend with amidst all the changes to treatment protocols.

Taylor mentions confusion caused by new pricing schemes for telehealth services, as well as misunderstandings between her and hospital staff about whether her husband could wait with her before and in-between appointments.

Sometimes, Nelson says it’s as simple as not being able to hear and understand conversations when wearing masks.

Other times, it’s the mundanity of “answering the same questions every single time about being tested, travel, contact,” says Davis.

Speaking of tests, in comes the infamous COVID-19 nasal swab test to top off all the other cancer-related ones. “I can’t ever have that done again,” Taylor says vehemently.

The social aspect of cancer treatment

Empathy and human connection have long been shown to positively impact healing.

Despite Nelson, Davis, and Taylor all taking a breast cancer diagnosis in stride, all also discussed how the lack of an in-person social network has challenged them throughout the course of their respective treatments.

In any other situation, they would be able to go out with friends to a movie and get their mind off things for sometime. They would’ve had visitors at their bedsides, holding their hands.

“My chemotherapy was different this time around,” says Davis. “Because of social distancing, I communicated less with other patients than during the last time I went through this when we talked more…and hugged.” ♥

Reassure patients with touchless patient intake



Health system revenue recovery hinges on changes to the conventional patient intake process.

In late March, medical appointment cancellations reached up to 80 percent. Now, months after the first lockdown orders, more than half of US health systems are still under 75 percent of pre-pandemic patient volume, finds an MGMA Stat poll. 

Health systems need a new approach to recover even some of the over $200 billion dollars and counting in lost revenue from COVID-19

Patients continue to delay care

Patients fear contracting and transmitting COVID-19 while waiting in a waiting room or elsewhere in the healthcare facility.  

Just 31 percent of patients feel comfortable about the idea of going back to the doctor, finds a survey conducted by the Alliance of Community Health Plans. In addition, nearly 40 percent of respondents planned to delay future care as of May 2020. 

Unfortunately, delaying care results in disastrous outcomes. On the population level, preventive care measures — think vaccines, screenings, and annual physicals — dropped by as much as 94 percent in some specialties. The burden of this could be catastrophic as more cancers get diagnosed later and measles cases surpass normal levels. 

Touchless patient intake

In order to ensure social distancing guidelines are met, many health systems have asked patients to wait outside for their appointments. But without a system for managing patient intake, this creates operational inefficiencies as nurses and receptionists have to run in and out to just to keep the patient intake process going. 

But waiting outside the waiting room has potential. “If we can allow people to remain in their vehicles instead of congregating in waiting rooms, we can adhere to that social distancing to help decrease the community spread,” says Jane Arnold, Senior Vice President of Hospital Operations at UnityPoint Health

It simply requires automated patient communication. 

Virtual waiting room to facilitate touchless patient intake

What health systems need right now is a platform built to streamline the process of patients waiting outside of the waiting room when they arrive for appointments. WELL’s virtual waiting room feature is designed to do just that. 

“That is a huge benefit of WELL,”  says Dr. Cibu Panicker, a family medicine practitioner at Vista Community Clinic. “Because that’s really the only way we’re going to be able to treat patients while reducing the actual contact with other people.” 

The virtual waiting room allows patients to text their provider upon arrival and then wait safely in their car until the provider is ready to see them. It also accommodates digital patient intake forms and touchless payment options.

How it works

  • An hour before the appointment, the patient receives a reminder message with instructions to wear a mask and to text when they arrive. 
  • When the patient arrives at the provider location, they send a text indicating they have arrived. 
  • The provider sends an automated confirmation response, along with a link to patient intake forms if needed. 
  • Co-pays and balances can also be settled via text message through electronic payment options
  • The patient waits in their car until they receive a text message indicating that a room is ready.

At WELL, we make it our mission to help you help your patients

With a touchless patient intake process, health systems can progress with revenue recovery efforts while also ensuring patients are as safe as possible. 

Kids need the vaccines we already have

On a lazy summer afternoon while pushing my son on the swing outside, I thought of the coming school year.

I ran through the list of things to get done before school started. Suddenly it dawned on me, “We didn’t do his seven-year-old well child visit this year!”

Both my children get their well child visits in April. But with the COVID shutdown, parents and providers cancelled appointments in record numbers. They were never rescheduled.

Why hasn’t my provider contacted me?

I could have been distracted by making dinner, work, and the thousands of other things that are currently occupying my mind. But because of my background in healthcare, I realized this is a problem. A big problem.

Vaccination rates down due to COVID-19

Across the country, vaccination rates plummeted with the COVID-19 pandemic, especially among children over the age of two. Data gathered in the Vaccines for Children Program showed vaccinations fell below 50 percent of pre-pandemic levels in March and April compared to the previous year averages in several states. Washington, D.C, Texas, Maryland, and Pennsylvania were hardest hit.

And from mid-March to mid-April, doctors in the program ordered 2.5 million fewer doses of vaccines and 250,000 fewer doses of measles-containing vaccines as compared with the same period in 2019.

Consequences of delayed vaccines

While my children aren’t due for immunizations, thousands of others are. And when those immunizations are missed, it could mean severe consequences.

Stanford College of Medicine and Baylor College of Medicine published a study in 2017 indicating that a five percent drop in the number of children ages 2 to 11 who received the MMR vaccine would triple the number of annual measles cases in this age group. The MMR vaccine is an inoculation against measles, mumps and rubella.

“We have a tenuous handle on measles disease now. It’s all dependent on very small increments of vaccination,” said Yvonne Maldonado, MD, professor of pediatric infectious diseases at Stanford and an expert on vaccination.

As we anxiously await a vaccine for COVID, perhaps our primary concern should be obtaining the vaccines already available — vaccines for diseases that once ravaged the United States.

HHS expands access to vaccines

The U.S. Department of Health and Human Services (HHS) issued a ruling August 19, 2020 designed to increase access to vaccines and decrease the risk of vaccine-preventable disease outbreaks. The amendment authorizes state-licensed pharmacists to order and administer vaccines to children ages three through 18 years.

“As a pediatric critical care physician who has treated critically ill children suffering from vaccine preventable diseases, I know first-hand the devastation to the child – and to the family and community – of a death or severe brain damage that could have been avoided by a safe and effective vaccine,” HHS Assistant Secretary for Health Brett P. Giroir, M.D.  said, calling vaccines the “cornerstone of public health.”

Patient outreach could improve vaccination rates

When I consider the impending outbreaks of diseases we once had under control, I want to think the problem is temporary. As children return to school in the next few weeks, they will necessarily reschedule those missed visits and catch up on their vaccine schedule. Immunization levels will return to normal, especially with the HHS ruling making access easier.

But, as an increasing number parents are loath to discover, many schools are staying closed.

So I wonder again, why haven’t I heard from my doctor? Even a simple text message could prompt me to schedule an appointment.

A 2019 vaccination campaign launched among 11 WELL clients reached a total of 115,992 patients, and 5,731 responded to ask questions or make appointments. Many providers are in regions imminently at risk for a measles outbreak.

Today this kind of outreach could have measurable effects in preventing new outbreaks on top of our current pandemic.

I’m not waiting for the text message. But for everyone who is, let them know, “Hey, our office is clean, you can wait in your car and not run into any other patients. And your kids really need to get those shots!” ♥

COVID-19 showed us the power of healthcare communication tools

The COVID-19 crisis forced healthcare (along with the rest of the world) to go remote.

Effective communication between healthcare professionals and patients has always been important, but global shutdowns created a wave of new pressures. As a result, healthcare communication tools came to the fore. Many people witnessed the power of innovative communication tools used in healthcare. Consequently, these communication tools are here to stay and will continue to reshape patient expectations into the future.

How COVID-19 has changed patient behavior

The COVID-19 pandemic had a twofold effect. One, it made people wary of visiting their healthcare providers or going to the hospital, for fear of contracting the disease. During the pandemic, both ER and outpatient visits have experienced a steep drop. The National Syndromic Surveillance Program (NSSP) reported a 42 percent dip in ER visits between March 29 and April 25. Outpatient visits dropped to 37 percent from March 14 to June 20, according to the Commonwealth Fund.

The flip side of this decline, however, produced the second big effect of the pandemic: the adoption and utilization of telehealth. As an example, a data report by WELL Health found that between February and April 2020, some health systems reported as high as 50x increases in telehealth visits.

There is also an uptick in the number of patients using telehealth to avail medical services, according to another study. Patients seeking primary care through telehealth rose from 80 percent in May to 85 percent in June 2020. Those seeking specialty care through telehealth also increased from 53 percent to 78 percent in the same period.

Patients want innovation

The upswing in the popularity of telehealth mirrors the rise of other sophisticated healthcare technologies. A good example is AI-driven healthcare. Providers may, in the future, be able to use predictive analytics to anticipate patient concerns. Machine learning researchers believe that AI could potentially outperform human surgeons by 2053. Moreover, IBM Watson Health has announced progress in cancer-care treatment through AI.

Most patients are excited by technological innovations that improve the delivery of healthcare. And now that the COVID-19 crisis has revealed the power of healthcare communication tools that facilitate effective telehealth, patients will expect these innovations to stay in place. From here on out, patients will be keen to see that their healthcare providers have optimized their remote operations.

We should expect patients to be unforgiving with these new expectations. According to research, poor lines of communication in healthcare make up about 53 percent of healthcare complaints. Being stuck on hold accounted for a majority of these complaints. After COVID-19, patients are likely to become even less tolerant of sub-par communication standards. Healthcare organizations expect the pandemic to persist for months, even years. Because of this, medical practitioners need to respond to the new patient expectations by providing effective communication for healthcare.

Healthcare communication tools are the future

During the COVID-19 crisis, many WELL users experienced firsthand how the platform facilitates effective communication between healthcare professionals and patients. WELL’s centralized patient communication and information platform helped providers reach patients through any channel—email, text, phone, or live chat. This allowed for seamless, real-time communication throughout the healthcare journey, despite the turbulent times.

In March and April, WELL clients processed over 18 million messages, providing patients with critical information about the coronavirus crisis. At the height of the crisis, WELL users reported a 78 percent rise in cancelled and rescheduled outpatient appointments and saw a 15-fold increase in virtual appointments.

Cedars-Sinai Hospital in Los Angeles experienced firsthand the value of digital lines of communication in healthcare that come with a platform like WELL. Rescheduling 15,000 personal visits to virtual appointments seems impossible. But with WELL, the hospital successfully managed the impossible. Cedars-Sinai managed to reschedule all these appointments without adding extra manpower.

Now that both providers and patients have seen how healthcare communication tools can improve the patient experience, and make the entire process more efficient on both sides, there will be no going back.

Providers need to adapt

During the COVID-19 crisis, communication tools used in healthcare have come to the fore. Without them, some providers would have been incapable of coping with the demands of the pandemic. As patients have experienced the efficiency and efficacy of new telehealth solutions, it is crucial that providers stay competitive by adjusting to these new expectations. If they don’t, patients who have seen how effective tools like WELL are will abandon them for another provider.

Contact WELL Health today to see how a full-solution communication for healthcare can help you and your patients. ♥

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