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Breast Cancer Radiation Therapy During Coronavirus

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Published on May 22, 2020

Will receiving breast cancer radiation therapy during the coronavirus pandemic put me at a higher risk of developing COVID-19? How can I reduce my exposure? How do I talk to my doctor about my cancer treatment and potential risks?

Dr. Catherine Park, from the University of California San Francisco (UCSF), talks to Patient Power’s Rebecca Seago-Coyle about the risks associated with radiation therapy during the coronavirus pandemic. They also discuss the fear of being exposed to the virus while receiving treatment and share ways to minimize your own risk. Watch now to learn more.

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Transcript | Breast Cancer Radiation Therapy During Coronavirus

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded on April 30, 2020

Rebecca Seago-Coyle:
Hi, I'm Rebecca Seago-Coyle with Patient Power, and I'm joined here today with Dr. Catherine Park at UCSF. She is the Director of Breast Radiation. Is that correct, Dr. Park?

Dr. Park:
I'm the Chair of Radiation Oncology, and I am also an attending physician. So I treat breast cancer patients in my clinic.

Rebecca Seago-Coyle:
Wonderful. That's such an important role. As a breast cancer survivor myself, I'm very grateful for people like you to help. So, Dr. Park, why don't you tell us a little bit about your specialty?

Dr. Park:
My specialty is to treat breast cancer patients, and specifically my expertise is in radiation oncology. So I treat breast cancer patients with radiation where it's appropriate. So, that's my focus.

Rebecca Seago-Coyle:
Wonderful. So we're kind of in the midst of this global pandemic of dealing with coronavirus, or COVID-19. Can you tell us a little bit about how that's impacting your practice, and how it could impact breast cancer patients, especially those going through radiation therapy?

Dr. Park:
Yes, it certainly is a really challenging time for all of us. We're learning a lot as we go in terms of how we should best approach our cancer patients and specifically our breast cancer patients.

I'd say early on when we were preparing for a potential surge of COVID-19 here in San Francisco, we had to really rapidly think about which patients could possibly delay their treatment safely and which patients we really needed to continue to move forward for best oncologic care. So in that, we really learned, and we used our expertise to select certain patients who could, for example, who had very low-risk cancers who could have hormone therapy first, who could then have their radiation later.

We also practice something here very frequently called neoadjuvant chemotherapy. That means giving the chemotherapy first, before having surgery. So in some of these ways, we were able to continue oncologic care, but delay the portions where patients may need to actually come in to the hospital.

Rebecca Seago-Coyle:
So you mentioned delaying care. I think as most people, if they've heard the words, "you have cancer," you kind of want to either get rid of it quickly or do something about it. So if you're telling people that you're going to delay care, how do you help calm those fears and calm those nerves of what's going on?

Dr. Park:
Yes. And just to clarify, the majority of patients who need oncologic care need to proceed with their oncologic care in a timely way. So what I'm talking about in delaying certain groups of patients are where we have data from trials and experience where we really know it's oncologically safe to treat with hormone therapy or something else that would allow us to delay radiation.

Now, what I have learned and experienced through my interactions with patients are that patients are often anxious, both because of their cancer and potential delay, but they're also anxious about coronavirus and contracting COVID-19 and possibly suffering from the COVID-19 disease. Especially as a cancer patient, potentially being a little bit more susceptible to it, so I think it's even a more trying time sometimes to be a cancer patient during this pandemic, to really not know what is the risk for me to go into the hospital and to continue my treatment that I really need for my cancer when there's this other risk that is potentially there.

Rebecca Seago-Coyle:
You've talked a little bit about going into a hospital and knowing that risk. But can you talk a little bit more about, specifically more like radiation therapy? Meaning if you're—I know when you're going through chemo, you're a bit immunocompromised which could put you at a higher risk for maybe being susceptible to getting COVID. Could you talk about the radiation portion of it? I know that that makes the skin irritated, and sometimes you have sores and stuff. Does that make you also at higher risk as well?

Dr. Park:
I'd say for our breast cancer patients, most of the breast radiation really is directed at the breast and very little to internal organs. So, as you mentioned, the skin side effects are what we expect, and these are things that we can manage well. I don't expect patients to have more necessarily morbidity if they have coronavirus or COVID illness.

However, that being said, we're still learning a lot about cancer and coronavirus and where we have to be extra cautious. For example, if someone has a lot of need for long radiation, we would want to know what their risk factors are and potentially if they have coronavirus so that we'd know if they're more susceptible. But I'd say for the average breast cancer patient who needs radiation, that that is not something that we think at this point is an absolute. But we continue to learn.

Rebecca Seago-Coyle:
So that's another thing. With radiation too, you typically have to go in every day into the hospital setting. We've talked a little bit about sometimes you need to delay, but that's the conversation that you have to have with your doctor and your care team.

Can you talk a little bit about what—and we know that going into a hospital, you're doing the metrics of you're getting your temperature taken, you're being asked about your symptoms and that sort of thing. But what about the fears of just being exposed to the virus or something either in a hospital setting, especially when you're having to go so often?

Dr. Park:
That's a wonderful question. As you mentioned, our hospital, like many hospitals, have very, very strict screening. These are based on a lot of guidelines that we received from the CDC and other public health and epidemiology specialists. We really are reducing the risk of exposure here at the hospital. I'd say that you're at risk just from going to the grocery store or not doing physical distancing, and you want to reduce your risk in all aspects of your interaction.

If you're feeling uncomfortable, I would really bring that up with your provider and ask the question, "What is my risk when I come into the hospital?" I feel very confident that we have low risk here in our particular hospital setting. One, the prevalence of COVID is low here in San Francisco. But I really feel that we have now a lot of experience with screening people. We have a low threshold to screen more deeply, and people who might have risk for having the coronavirus and we can quickly test them.

So we're really mitigating risk. We screen every staff member, every doctor who comes in the hospital on a daily basis. I have had patients who feel that sort of fear of coming into the hospital for their treatment and at the same time, fear of delaying their treatment because of the cancer. I just reassure them that we are taking all these steps and that it is safe for you to come in to receive your treatment.

Rebecca Seago-Coyle:
That's good. I think always having those conversations and being very direct from both sides, from the patient's side and the provider's side or the doctor's side to help those fears. I think it's really important that we have to talk about them. It's a challenging time, whether there's a COVID pandemic going on or not, going through cancer is a challenge. It interrupts your life.

What other advice would you have to patients who might be going through breast cancer? And just talking about the radiation side of things, what they should be thinking about or asking their doctors.

Dr. Park:
I would say ask them if the pandemic situation is affecting their treatment in any way. I think we really want to minimally disrupt the best oncologic care that we can provide. We've moved to telehealth visits and those types of things that are required during this period of time. But I think for the most part, we want to assure patients that they're getting the care that they need in a timely fashion.

I’d just, again be very open and direct with your providers and ask the questions that are making you feel maybe a little bit uneasy. Because I'm sure they would have some answers for you to help you navigate and really be proactive about how to reduce your own risk. I think those are all really important things.

As you pointed out, cancer is a life-altering diagnosis in the best of times. So during these times, especially important to take care of yourself and the people around you and tune in with your providers. We're here to help. And we are continuing to really proactively learn about the impact of coronavirus and cancer in many different aspects of cancer care. And really, in whom do we be extra careful? I know many, many organizations are looking at this, including ourselves. So as we learn more, we're only going to get better. So I hope that's helpful. It's a hard time.

Rebecca Seago-Coyle:
It is. It is. And we really appreciate you taking the time and talking about this. One thing that you just said kind of piqued my interest a little bit. While I'm not a big fan of these uncertain times, I don't know that anyone is, I do see that there are some new opportunities in terms of healthcare. You brought up telehealth. Are you guys participating? Is UCSF participating more in telehealth appointments for cancer patients?

Dr. Park:
Absolutely! We dramatically and swiftly changed our format to telehealth visits wherever possible. That means when we can do—we could do consultations through telehealth. Often patients are traveling from some distance to come and see us. That has really lifted the burden of that for the patients. We still see them when we need to, for physical exams or any procedures or things that we're doing. But we have dramatically increased our number of telehealth visits and the proportion of visits that we do by telehealth.

I think as we go, we will hopefully retain our telehealth format. I think it's allowed us to have a little bit more flexibility, allowed patients to stay in the comfort of their home while receiving still live conversations that help them. Perhaps it will help them access us a little bit more directly for their care.

So all of these aspects, I think, have been tremendously positive. I'm looking forward to sustaining and looking to see where we can really keep those components even past the pandemic time period, which we will have that past point at some point. Hopefully sooner than later, we will get over this.

Rebecca Seago-Coyle:
Yes, I think we all hope that as well. I think by people staying home, it really is proving to help save lives that way and helping those also take time for themselves too.

Well, thank you again for your time today. Thank you for your expertise and your knowledge, and being able to share with our communities on some tips on dealing with breast cancer and radiation and treatments during this pandemic. So, thank you.

Dr. Park:
Thank you for the opportunity for having me here. It's been a pleasure, and I send my best to all the patients who are listening. Reach out to your providers and get the answers that you need and stay safe. We'll get through it.

Rebecca Seago-Coyle:
That's amazing advice. Thank you so much!

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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