Roswell Park physician in charge of chemotherapy infusion, leukemia services, says certain cancer populations do much worse once they’ve contracted COVID-19
By Chris Motola
Q: What does infusion mean in an oncological sense, and under what conditions would you be getting one?
A: My role at Roswell Park is chief of the clinical leukemia service. I’m also medical director of the chemotherapy infusion center. So my clinical practice is focused on patients with acute leukemia. Leukemia is a blood cancer. Blood cancers are usually acute, very aggressive or chronic. My focus is more on treating patients with the aggressive types. Patients who come into my clinic will oftentimes have blood work or a bone marrow biopsy. Acute leukemias are very fast-growing tumors, so patients usually need to initiate their chemotherapy within a few hours or days of getting a diagnosis. My clinical practice intersects with my administrative role. Our infusion services consist of our downtown location at Roswell Park as well as our satellite center in Amherst. Our main site sees up to 150 patients a day to receive any type of infusion, transfusion or chemotherapy treatment. So as medical director, I work with the nursing and scheduling staff to improve patients flow, decrease wait times and make it a smoother experience for patients, many of whom may be receiving chemotherapy for the first time.
Q: How long does a session take?
A: It can vary. The infusion center does everything from blood count checks to growth factor shots, all the way to long-term antibody infusions, which can last upward of eight hours. One of our challenges is scheduling everything so that the person coming in for a shot in the arm can get in and out quickly, and the person getting an antibody infusion can get the appropriate attention during that time, and monitoring for possible reactions or side effects.
Q: Given how time-consuming many of these processes are, how has COVID-19 affected scheduling?
A: We have an extensive screening process. Very early on, we took a large number of measures to secure the safety of our employees and patients. We have procedures in place to screen employees as well as patients when they enter our facility. They have a temperature check, a mask, they get questions asked, such as about the travel advisory. In the chemotherapy clinic the nurses have all been pre-screened. We have the ability to do same-day COVID-19 testing. We’ve made an effort to minimize visits whenever possible; obviously you can’t do that if the patient needs chemotherapy. Patients are being offered virtual visits for things like screening and some follow-ups.
Q: Are chemotherapy patients more at risk from complications related to the virus?
A: Cancer patients are at increased risk. In many studies there’s been data that patients who have recently had chemotherapy, even a few months ago, are at higher risk of contracting COVID, and certain cancer populations do much worse once they’ve contracted it. As you might guess, patients who have lung cancer, if they get infected, tend to not do very well. There’s been reports that patients with blood cancers may be at risk due to their impaired immune system. So we take the precautions I talked about earlier. In terms of treatment modalities, they’re limited overall. We’re all hoping for a vaccination, but this may not be an appropriate population to get those vaccinations.
Q: Has it been more challenging to get patients to come in for their chemotherapy?
A: That’s definitely true. There are patients who know they’re at higher risk. Many of them are older, receiving chemotherapy and maybe treatments for other diseases. They hear the media reports and they know they’re the patients who don’t do well. We’ve received — I can’t even tell you how many — phone calls telling us they’re not comfortable coming in, especially from areas outside Buffalo that may have lower infection numbers. As much as possible, we’ve tried to alter regimens. For example, we may substitute a regimen where patients come in once every three weeks instead of every week. So we’ve been trying to reassure patients we can seek out alternative ways to administer their chemo, but there have patients who have just refused to come in. I’ve had at least a few patients who were very sick who we’re finally starting to see come back. I spent 20 minutes trying to convince a patient to come in. When she came in, she actually felt much better. We were able to show her we could deliver her care under the conditions.
Q: What lessons have you and your team learned from this unusual year that you would work into your longer-term plans?
A: I think one of the lessons is when we think we know something, we may not. We’ve been completely taken aback by the emergence of a completely new disease. The last time something occurred on this level may have been in the ‘80s with HIV. I think this is an eye opener for us, and that the conventional ways we’ve been taking care of people have now been dramatically altered. We can better utilize the fact that most people have smart phones and are on the internet. I think telemedicine has been a gamechanger in helping us do our job. So I think we need to adapt and adjust, and we’ve had to do it even on a daily basis. You recently interviewed my colleague, Dr. [Igor] Puzanov [chief of melanoma services], and he talked about how we’ve repurposed some of our tools for immunological research into cancer for researching how to treat COVID. So there are great advances we can take from this time period and prioritize what’s really important when it comes to treating cancer.
Name: Eunice S. Wang, M.D.
Position: At Roswell Park Comprehensive Cancer Center: Chief, leukemia service; medical director of infusion services; assistant member of tumor immunology program. department of immunology
Hometown: Bedford, Massachusetts
Education: Keck School of Medicine, University of Southern California; completed residency training in internal medicine at Yale-New Haven Hospital, Yale University; completed a clinical hematology-oncology and research fellowship at Memorial Sloan Kettering Cancer Center
Affiliations: Roswell Park; Buffalo-area Catholic hospitals
Organizations: Children’s Oncology Group, Society of Hematologic Oncology; American Society of Hematology; American Society of Clinical Oncology; American Association of Cancer Research
Family: Husband; son (14), daughter (12)
Hobbies: Travel, reading, family activities