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Lung Cancer Trials in the Time of the Coronavirus Crisis

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Published on April 10, 2020

Key Takeaways

“Cancer is not going to take a timeout during COVID-19 and neither can we,” says leading expert Dr. Sandip Patel, from UC San Diego Health’s Moores Cancer Center.

How is the outbreak impacting lung cancer clinical trials, which represent the best treatment opportunities for some patients? Here, Dr. Patel describes the state of lung cancer care and availability of medical resources with the surge of coronavirus cases.

Dr. Patel also explains the concept of gaining herd immunity without overwhelming the healthcare system. Watch now to learn from an expert.

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Transcript | Lung Cancer Trials in the Time of the Coronavirus Crisis

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.

Andrew Schorr:
Hello from Carlsbad, California in Southern California, north of San Diego. I'm Andrew Schorr, and we're joined today for this lung cancer live webinar with a noted expert in lung cancer from where I get care actually as a cancer patient. That's the Moores Cancer Center
 at the University of California, San Diego. Dr Sandip Patel. Dr. Patel, thanks for joining us. Tell us your titles there because you've got a bunch of them, and we're going to be talking about research also related to lung cancer and I know that's a key interest of yours.

Dr. Patel:
Thanks so much. I'm an associate professor here at UC San Diego. I'm the co-leader of external therapeutics and the director of the clinical trials office and so very eager and enthusiastic to talk to you about how the current time with COVID-19 has affected our patients and what our patients can do here and nationally to deal with yet another crisis on top of everything they're having to deal with already.

Andrew Schorr:
Right. You said it. Anybody, and I'm living with two blood-related cancers, we have that anxiety going on all the time. And now in the age of lung cancer where fortunately more people are living longer based on research you and your peers have been involved in around the world, in patients participating in trials, you have that anxiety that said, "Oh no, now how does this virus put me at risk or risk of complications because of my lung cancer history?" So let's talk about that for a minute. So, many people are living longer, not enough, and we still have a ways to go for sure.

But immunotherapy, targeted therapies, combination therapies, et cetera, have helped a lot of people. And so now you have people, some people rather than living six months, living 10 years. And I know people like that. And maybe they participated in trials. Where are we with trials now when we have this overlay of the virus? And some people may have traveled at a distance to get to you in San Diego for trials you're doing. And that's not convenient to say the least.

Dr. Patel:
Absolutely. So two great questions. I think one, the overarching theme that we've really moved the needle in cancer. And cancer survival has actually improved across the board in the United States. The single greatest improvement in cancer survival actually took place in the past year. And much of that is actually driven by improvements in the care of lung cancer patients. And more interestingly, the current survival data doesn't even fully capture the improved survival we have due to immunotherapies that are currently both in clinical trials for new immunotherapies but also widely available in the stage III and stage IV settings for non-small cell lung cancer, small cell lung cancer and increasingly other thoracic malignancies. And so the point that we've really been able to bend a curve as you talk about COVID-19 but also improve survival and bend that curve in a good direction in terms of survivors for lung cancer to the point that it's affecting the overall numbers of cancer survival throughout the U.S. in a positive way can't really be understated.

And I think we're going to continue to see some improvements here as well. And that's because of as you described, the great effort that really patients I think who trust us with their care and in the context of their cancer with clinical trials that are designed to maximize their potential benefit. And so therapeutic clinical trials represent an opportunity for patients who may otherwise lack available standard of care options. So that clinical trial represents a therapeutic option for that patient. And so what we've done at UCSD and many institutions have, though it's not universal, is all our therapeutic clinical trials are continuing to run.
And for those that involve pills, we're actually trying to set up a way of having those shipped directly to the patient, and avoiding some of these unnecessary blood draws and visits doing many things by telemedicine, just like we're doing this by televisit right now by video visits, and seeing if sponsors and the FDA allow, increasingly they do. And for infusions, we're trying to make sure that patients remain safe. They're socially distanced from other patients, they have barriers between themselves and others. And that they're masked when they're here so that they minimize their risk. And so cancer is not going to take a timeout during COVID-19 and neither can we. And we believe therapeutic clinical trials for many of our patients represent some of their best opportunities. And many of these have actually become the therapies that have improved survival that we talked about earlier.

Andrew Schorr:
Now obviously the time of the virus is in overlay, we were going to have another lung specialist and researcher on with us, Thomas Marin from Mount Sinai in New York, the biggest hot spot right now as we do this program on April 8th. And he couldn't make it, because he's called all over the hospital to help with patients. And I'm sure some of them are lung patients who develop COVID. So let's talk about that. We got questions in, and if you have a question in our audience just at the Q&A button at the bottom of your screen if you haven't already sent in a question. Are lung cancer patients more likely based on having in-treatment or having had treatment for lung cancer to be more at risk of complications from the virus? What do we know? Do we know anything now?

Dr. Patel:
It's a great question. We do know patients with cancer and pre-existing lung disease have heightened risk of COVID-19, and so having lung cancer is the intersect of those two. And so the same things we do in our daily life I think in terms of social distancing are even more important for patients in particular with lung cancer, but cancer more broadly as well.

Andrew Schorr:
Okay. So, we know that the virus goes to your lungs, and I know it's kind of operating differently than a tumor that may be sited in your lungs. So having had tumors in your lungs then doesn't necessarily mean that let's say you had a—or having had a lung removed for example, does that mean you're going to have a rougher go?

Dr. Patel:
It's possible. There's not a lot of clear data on this. And a lot of this is still emerging, but many of us feel that if you've had some sort of injury to the lung, whether it be cancer, whether it be prior tuberculosis for example, COPD, asthma, there's just not as much reserve in the lung capacity if one were to have a very severe COVID-19 infection. And so universally we view patients with cancer, pre-existing lung disease and the intersect of both, which is lung cancer as patients who we need to take heightened precautions with in their care during the COVID-19 pandemic.

Andrew Schorr:
Dr. Patel, I've got to ask you the question that a lot of patients I think have been asking you, and it's all over the Internet among lung cancer patients. So you talked at the outset that people are living longer, and you've sort of been bending the curve about survival with lung cancer, but still, people are outliving what was the textbook estimation of how long somebody with advanced lung cancer would live. So if they develop COVID and they're in a place whether it's like New York or San Diego or New Orleans or Detroit, and there's a shortage of ventilators or resources, is there something tattooed on their forehead with an expiration date, advanced lung cancer patient, they are later in line for that sort of care that they would need? What's your answer about that?

Dr. Patel:
Yeah, it's a great question. I'm so glad you asked that. I've actually been asked that exact same question by my patients. And I could tell you from my own personal experience, I was just on the wards. And the way we make decisions is not based on who someone is outside of COVID-19, but where they are now in terms of their care. And there's been no rationing of ventilators here at UC San Diego or frankly even in New York from what I've heard. What they've done is they've actually repurposed sleep apnea machines, really necessity is the mother of invention. And so to my knowledge there's not been a single decision along those lines that has been made. And I don't expect those to have to be made because of our ability to adapt to the situations at hand. But one of the points I make, and this is something very true in medical ethics, is we don't judge people by these parameters, even in peacetime, let alone wartime based on where they are.

It's based on what is going on right now and what the situation is in terms of their healthcare. And are there patients who don't have cancer who may have such severe COVID-19 that continuing ventilation may not make sense? Possibly. That may also be true for cancer patients as well, but I think the key point is just because you have the diagnosis of cancer, the label of cancer in your chart or you're getting treatment, that's not some sort of stigma that you get pushed to the back of the line. But the bigger point is, right now there are no lines. And I don't see any lines developing because of all these rapid technologic innovations. One thing you may have heard about in the news is Washington and California, Washington being one of the initial places with COVID-19, we've all sent ventilators to New York.

So we're all in this together. And so New York, when they're through it, they're going to send their ventilators to whoever else needs it. And so I just want people to know that everyone's paying attention to this. We're one people. We've got this, because we're one united group of people. We're going to get through this, because we're one group of individuals. Americans are suffering with this, and we'll figure this out together, and it's a team sport. And I just don't see it going down that road. You can put two people sharing on a ventilator. There are all sorts of other things you would do before you could ever get to the point of rationing. I have not seen or heard of any rationing. I just don't expect it to happen. And even if it did, the medical history wouldn't be how those decisions would be made. It's based on how you're doing related to the COVID, not your cancer.

Andrew Schorr:
Right. And there could be somebody who is a stage IV lung cancer patient, and I have friends like this who are doing pretty well based on the therapies that have been developed, experimental or approved. Okay, Dr. Patel, let's just recap one thing about research. What you were saying at the outset is, the lung cancer research is continuing. What you're doing is continuing, and you're relaxing some of the requirements with the permission of the FDA and sponsors where you can. Okay. So that's great news, because everybody wants a cure, and we hope you'll win a Nobel Prize someday, because you'll have cured lung cancer. But as far as some people needing infused therapies, and there's one gentleman wrote in, he has actually had some complications with his lung cancer, and there are certain devices he has that have to be checked. Periodically he has to go to the hospital. So that's worrisome for people. They want to do telemedicine as much as they can, but they may be in the middle of infusions or some sort of devices that are being checked. How can they be protected? You mentioned about masks, what else?

Dr. Patel:
No, it's a great question. As much as possible, we want to shift to telemedicine and having things done close to the patient's home, but everyone who's fought with cancer on both sides knows that this is something that requires care within the health system, often IV infusions. You mentioned machines that have to be titrated within the health system. For those patients, while one of the good things is that with social distancing and trying to defer truly elective procedures that don't relate to cancer, there are resources at most health systems at the current time.

New York is in a unique scenario, and there are definitely some other hospitals that are in unique scenarios, but everything else is open as normal. And there are checkpoints. So, for example, in our institution before you come in at any door, you're screened, you get questions about fever, travel, breathing symptoms. You have a mask placed on if you're immunocompromised, right? Which most cancer patients are, and you're placed in as safe an environment as possible, probably safer than you could be at the grocery store or things like that just because of the rigorous level of screening that's happening when you come here.

And so, I think one of the key points to make is that if you have something that you need from the health system, these health systems whether it's UCSD or others, are able to provide those in a very safe way—and frankly, in a way that makes me feel as safe within these walls I'm currently here at work than I am really even at home or at the grocery store. And so rest assured that if you need something, we're still here for you. Cancer's not taking a timeout. We can't either. And we'll get it done, and we'll get it done in arguably the safest way possible.

Andrew Schorr:
Okay. So, Dr. Patel, you mentioned about different medicines people may be taking. So there are some powerful oral medicines across cancer and in lung cancer. Now, is there a reason for people to stop their medicine, have dosages reduced simply because of the virus and their immune system?

Dr. Patel:
It's a great question. I think for those patients on oral targeted therapies, there's no known data to suggest there's any interaction with the COVID-19 pandemic or the virus or enhanced risk of either contracting it or having severe symptoms from it from taking these medicines, whether it be targeted therapies, immunotherapies. I think with chemotherapy, especially for some of the chemotherapy regimens, that can result in reductions in the white blood cell count, for example, neutrophils in particular and lymphocytes, which are key in fighting infection. There is a theoretical risk, and it's worth a discussion with your doctor if chemotherapy, there may need to be some adjustments there.

Immunotherapy, in fact, is the exact opposite. It activates the immune system. But one of the questions with COVID-19 is, "Is the effect of COVID directly from the virus or mainly from a hyperactive immune response?" And so in its totality, we don't have a lot of answers about how to alter therapy with COVID-19. And so the vast majority of patients it would continue as is given that their cancer treatment likely is at a place that it can't be delayed.

Now for those patients who may have a window for delays, for example, a couple months after they have surgery, potentially before starting adjuvant therapy, maybe a couple weeks after they complete chemo radiation for stage III non-small cell lung cancer before they can continue with immunotherapy. That may be a window to take a break, but the idea that I'm not necessarily convinced that dose adjustments preventatively in the COVID-19 era will necessarily have benefit is one thing I really believe in. In my own practice, we try to continue as is, but we consider, "Hey, if we're going to take a break, maybe this is the time to do it."

Andrew Schorr:
Okay. For our audience, if you have a question right now for Dr. Sandip Patel, who is a researcher and a lung specialist at UC San Diego in the Moores Cancer Center there, just hit the Q&A button, and that'll go to our producers, and we'll ask your question. Here's one that came in, and that is related to someone who besides their lung cancer history and treatment is on a blood thinner. So people may be on other medicines like that. Is there anything where blood thinners cause more complications?

Dr. Patel:
Yeah, it's a great point, and actually if you go to the CDC guidance, they say patients with clotting disorders or on blood thinners—and to be honest, I actually looked this up myself ,and I couldn't find anything about blood thinners, whether it's warfarin (Coumadin or Jantoven), which is rarely used in cancer patients in the U.S. Enoxaparin (Lovenox), which is more commonly used, or one of the oral blood thinners of which there are at least three that can be utilized, I'm not aware of any data that suggests that blood thinners represent an enhanced risk.

Now the fact that you're on a blood thinner, especially if it's for a clot in the lung, the risk factor in terms of COVID-19 may be the fact that you have a blood clot in the lungs, what we call a pulmonary embolism. But I wouldn't do anything in terms of decreasing or stopping the dose of the blood thinner, because at least my knowledge and everything I looked up, there's not an interaction in terms of an increasing risk to COVID-19. If anything, by keeping the blood flow from resulting in clots, you're less likely to have respiratory issues that may set you up for worse COVID-19 either exposure or treatment course. And so I think continuing as is on these lifesaving medicines makes a lot of sense here, and in addition to blood thinners.

Andrew Schorr:
Okay. You're involved in research, and we've been talking about medicines for lung cancer, now just blood thinners as well. A number of the pharma companies have been applying to the FDA, to have their cancer medicine in trials to see if it can either go to work on the virus or go to work on the cytokine storm that can lead to death related to a COVID-19. So are there lung cancer medicines that you've heard about or medicines that may enter into trials like that? I know in some other areas, but I didn't know about lung cancer.

Dr. Patel:
Yeah, it's a great question. So for the lung cancer medicines more broadly, to my knowledge none of them are being tested for an anti-COVID-type effect. The drugs you're referring to for anti-COVID effect, for example, the IL-6 blocking antibodies, those are anti-inflammatory antibodies that for a rare type of blood disorder are utilized as treatment and may be repurposed for COVID-19. There are some antiviral drugs that are being investigated. And then as many people have heard, there are some rheumatoid arthritis drugs or malaria preventative medicines that are being explored as well.

And so as far as bona fide either cancer immunotherapy, cancer-targeted therapy, chemotherapy, I've not seen any of those being looked at in terms of repurposing for lung cancer. The flip side being drugs that are currently being evaluated by the FDA for treatment of cancer, including lung cancer are continuing to be evaluated. And so the FDA is open even while they're dealing with COVID-19 for continued approval of medicines through the mechanisms that exist for treatment of lung cancer. And so the show must go on from that standpoint. And the FDA should be commended for continuing to approve drugs that are cancer-related in this very difficult time.

Andrew Schorr:
So with so many of us where our life as a cancer patient is sort of full stop outside the home anyway, what you're saying is lung cancer research worldwide and here with the FDA working in collaboration with you, that's still happening.

Dr. Patel:
Absolutely.

Andrew Schorr:
Okay. All right, so now here we are in lung cancer and wondering, okay, so we're going to have telemedicine, trials, there may be accommodations for that. There's no reason necessarily to change our medicines or even stop infusions. That's an individual discussion though with you, our provider. How would you describe the concern for our lung cancer audience now in this time? How should we carry on?

Dr. Patel:
It's a great question. I think in many ways what everyone is doing regardless of if they have cancer or not, it is key for lung cancer patients maybe even more so, because they're fighting cancer, and it's a cancer that's fighting the organ that SARS-CoV-2 or COVID-19 it would actually potentially infect. And so the idea that social distancing makes a lot of sense and actually probably provides an extra benefit to patients with lung cancer, appropriate masking, wearing a bandana, homemade masks, things like that. And then I think the other point to make is some of our patients with lung cancer have a history of smoking, maybe vaping. Those are potential insults, injuries to the lung that if we're going to get COVID-19, it probably is going to be a problem. And so if you've smoked before or you vape, this is as good a time as any to quit, because we want to keep our lungs in as good a shape as possible going into what we're having to deal with.

Andrew Schorr:
Okay. Now you're here in California, I am too just up the road from you. So we've been working hard where now if you go into a supermarket, everybody who works there is required to wear a mask I believe. And most people who are going into the supermarket are wearing a mask. And we're told generally and in some cities like LA, if you go out at all, you should wear a mask. So do you feel that, that's making a difference?

Dr. Patel:
Absolutely. I think if you look at the doubling time, which is the number of days it takes for the number of people who are exposed to COVID-19, the places, the states that have incorporated social distancing early have doubling times of five or six days, as you mentioned some cities in California. The places that didn't early on, we've seen this unfortunately in Louisiana, for example, the doubling time initially was between two and three days. And one of the things we have to think about, and I think cancer patients understand this very acutely is exponential growth, right? Cancer likes to have exponential growth, so do viruses. The difference here is anything you do has an exponential benefit, right? So by socially distancing and especially doing it early on, wearing masks, things like that, there's an exponential benefit to everyone you interact with.

And so I think one of the best things we could do, even if you're in a state that hasn’t adopted social distancing, though at this point most states have and most jurisdictions have, is practice it for yourself and your loved ones. Because at least you keep your cluster as safe as possible. And a lot of what we do is social, right? When someone has the latest gadget, right, or the latest car, everyone kind of looks and thinks about that. Well, social distancing is similar in the sense that "Hey, if I'm practicing social distancing, I'm wearing a mask in my community, other people have the license to do that too, and we all protect each other."

The other point to make is there are vaccines that many of our cancer patients, including lung cancer patients take routinely. For example, influenza, pneumococcal vaccinations, things of that nature, I think those are crucially important right now for many reasons. One reason being, sometimes when you have an injury to the lung from influenza, you may be more likely to get what's called a super infection from COVID-19 or even a bacterial infection. So taking the vaccines that ideally hopefully people have already, but if they haven't, they should to protect them from other viruses, protect them from COVID-19, even though we don't have a vaccine for that just yet.

Andrew Schorr:
Okay. As a researcher, you're into data. Are you with other lung cancer specialists around the world talking to one another now and trying to document the virus related to lung cancer patients to learn more about its effect on people who are in treatment or have been treated for lung cancer?

Dr. Patel:
Absolutely. And I think one of the things that's key in this, and I mentioned earlier how we're all in this together, right? Sharing ventilators, sharing knowledge, is this key aspect in that in a very compressed amount of time we need to learn a lot. And we need to have accurate good information, so we can take care of our patients. And so, one of the key things we're doing with a lot of our collaborators is trying to better understand cancer outcomes, how we can better patients with COVID-19, because I think one of the key points to make about this is we're talking about this initial first surge, right?

What's happening right now—and probably through May—is this initial COVID-19 surge. And getting the technologies, the social distancing, the systems in place, because what's going to happen is we're probably going to have small bumps and peaks throughout the next several months is key, because this is the toughest part of the marathon. It's the incline, right? That we're climbing uphill all April and May, but we still have to run the rest of the marathon in terms of COVID-19, and also fighting cancer simultaneously, and we can do both. But having those systems there, having that knowledge base there, what's successfully preventative and what is a waste of patient's time and money and resources I think is something we need to deliver on. It's something we're actively looking at along with many institutions nationally.

Andrew Schorr:
All right, let's talk about the future a little bit. So we know that cancer patients, and certainly lung cancer patients can be immunocompromised. Could be from radiation, could be from chemo, and also they've had as you said, an insult to their lungs where the virus goes. Particularly as the after effect of radiation, let's say, let's just take that as an example. How long does that continue? So let's say that for many people, the super threat subsides or at least subsides for a while and people that have been in their home, they say, "Well, I'm a lung cancer patient. Do I still have to be afraid to go out? Am I still at risk more than other people?" Do you have any crystal ball to say when we can get out more, if you will?

Dr. Patel:
Yeah, it's a great question. I don't know if there's a time you can put on your calendar, right? That we can say, go outside, don't worry about anything, I think it's going to be something we have to re-evaluate over time. I think there are a couple things that'll really move the needle. There are some blood tests coming out that let us in a couple of minutes determine if patients had antibodies against COVID-19. And if you've developed antibodies to COVID-19 because many of the people exposed may be asymptomatic, you're protected from COVID-19 in the same way that if you got a tetanus vaccine, you're as protected as you're going to be. And so once these tests are more widely available, it really informs us that "Hey, listen, no one's 100 percent safe, but you're as safe as anybody else."
The equivalent of you're driving a car with a seatbelt and with all the air bags working, right? That kind of thing. Now for patients who may not have the antibodies available, I think that's really where we need to have these discussions. And those that are otherwise healthy and not in high-risk groups, they may choose to have things go back to normal. But those that are fighting cancer, maybe have lung disease, maybe are otherwise immunocompromised, elderly, things of that nature, if you have those risk factors, we may have to have a discussion on what makes sense.

And that's a good discussion to have with your doctor. We spend a lot of time talking about personalized medicine or precision medicine. And that's not just a fancy DNA test, right? It's creating a whole treatment plan that's unique to the individual for that time. And we're in the era of COVID-19, and we will be even when we get over this initial hump. And so creating a structure, a plan that patients can use, something that they should talk with their cancer doctors about, but I think for long and short it's an individualized decision, it's an individualized time frame. I don't think it's X days after your last radiation or Y days after your last chemo. But I do think this blood test that's coming, that's already being deployed, that tells you if you have antibodies to COVID-19 is really kind of that badge of honor, that passport that you could worry less about this and that that's what's going to lead us to have some sense of normalcy again.

Andrew Schorr:
Okay. So we're playing catch-up in the U.S. related to testing and just a lot of different things, social distancing, et cetera. And we're hopefully starting to make some progress on that. Should someone who's a cancer patient and maybe specifically a lung cancer patient, as tests become more available generally be at the head of the line to be tested or their family members who may live with them, right? And then also we have a ways to go, but when there's a vaccine, and that's going to have to roll out too, should we as cancer patients be at the head of the line?

Dr. Patel:
I think so. My expectation would be that the initial patients, once the vaccine is shown to be safe and effective will be high-risk patients, right? So everything we talked about earlier, hypertension, diabetes, cancer, pre-existing lung disease, that makes someone more susceptible to COVID-19 means they actually will be the first to get vaccinated, right? Especially as it first comes out would be my expectation. I think then in terms of more broadly, care of these patients, I think testing for us, for example, at our institution we now can do thousands of tests, where we could only do hundreds before. And initially when we're restricted to those components, it really was patients who had fever, cough, but also had high-risk factors, cancer, diabetes, high blood pressure. Now we can test more broadly, which is great, but it's a double-edged sword, right?

The very thing that makes certain susceptible patient populations, right? Those risk factors like high blood pressure, cancer, diabetes, immunosuppression and age that make people high-risk are part of the reasons those are patients who will get initial testing both for if they get a fever and cough for COVID-19 by PCR to see if they have an active infection right now. But likely these will be the patients that we along with healthcare workers initially want to test if they have immunity, because we need to figure out if they're safe to have kind of go back to regularly scheduled programming so to speak, or need to continue with the current program. And I imagine the vaccine will be treated similarly.

Andrew Schorr:
Okay. We're just going to go on a couple more minutes. If our audience has a question, just hit that Q&A button. It goes to my partner Esther Schorr, who's our producer for this program, and then she'll forward it to me. Can you explain one thing that we've been trying to understand related to immunity? There's something called herd immunity, and I'm not sure we understand that. How could that benefit let's say somebody who's immunocompromised or not perfect, where other people even have the antibodies have become immune, could you explain that?

Dr. Patel:
So great question. So herd immunity is a concept for a population, a group of people, that if enough people have been exposed to the virus that now they have immunity to it, they will be much less likely to both shed the virus to other people or whatever the infectious agent is, as well as themselves have issues with that going forward. And so there were actually a couple countries that didn't do social distancing and decided we're just going to try to get herd immunity as fast as possible. But when you do that, if a certain percentage of people get really, really sick and your health system—and this actually happened in the Netherlands, gets overwhelmed, it becomes a big problem. So one of the key points about social distancing you guys may have heard about is what's call flattening the curve. Meaning by having people exposed on different days, it means there are more resources available.

The other way of saying it is, what if every patient with cancer had to get their treatment in one hour on one day? It would overwhelm the entire system, right? Instead, what happens is some patients get their treatment and their visits on Mondays, some get them on Tuesdays, some get them on Wednesday, so on and so forth. And you load balance, right? It's like if every car hit the road at the exact same time, right? And so what social distancing does is it load balances that. And so herd immunity, one of the nice things about herd immunity and the blood tests that checks for antibodies to COVID-19 let you really figure out who has herd immunity or not, is that once enough people have immunity, the chance of them spreading it goes to zero. And it forms an effective bubble around everyone else who may not have herd immunity.

Meaning if you have a hundred people, and 99 people have herd immunity and the last one doesn't, well that one other person doesn't really have COVID-19 to cap anyone out of the catch from those other 99 people, right? Or if you have two people and 98 who don't, you're basically relying on those two people interacting while everyone else is kind of a buffer. And so the key about herd immunity is we all want to get it, but we don't want to all get it at the same time, because some fraction of us may get really sick and overwhelm the freeway, overwhelm the health system.

Andrew Schorr:
Okay. We've covered a lot of ground. So just to sum up, Dr. Patel, first of all, thank you for being with us. So lung cancer research proceeds. You're working on procedures that can accommodate people's travel issues and things like that now. That lung cancer patients you do feel have risks that we have to COVID that we have to pay attention to. That you don't believe that rationing of resources will put lung cancer patients at a disadvantage, particularly if they've been doing well on some of these therapies, right? They're not going to be dinged for being a lung cancer patient. And that the progress continues, and you're hopeful about treatments, right? In other words, there's a lot of drug development going on right now tackling this, correct?

Dr. Patel:
Absolutely. And there are a lot of resources going into this. Our engineers here at UCSD have been working on 3D printing masks and working on taking ventilators—I'm sorry, sleep apnea machines and BiPAP machines and converting them to ventilators. Currently one of the crises is that there are not a lot of people flying. So there are a lot of planes, airplanes that are just on the ground. Well, everyone remembers the part of the security actually when you're boarding, they go through kind of their security checklist and they also talk about the oxygen mask dropping. Well, that's actually a potential way of delivering oxygen. So now some of these grounded planes are being co-opted to provide oxygen, right? Ventilatory support in areas that are surging. The American people just need to be told honestly what's going on.

And then we as a group can with our resilience really just figure out ways of tackling this as a broader society. And so I think one of the key messages I really want to relay to our lung cancer community, but also just the cancer community more broadly is that we got into COVID-19 because we're linked together. We'll get out of this because we are linked together. And we'll figure out exotic ways of making sure that people don't have to worry about lines for ventilators.
We're ramping up production of masks and things like that. And I really think there's really been no challenge the American people haven't been able to handle when we've joined together. And we're seeing that. There are ventilators that are coming from Washington, California to New York. When New York's done, I know they're going to send it forward to whoever else needs it and pay it forward. And so we're going to get through this together. It's a tough time, but I want patients to know that we're all still here in the healthcare industry, taking care of you guys. And our goal is to make sure you guys are safe, both with your cancer but also during this COVID-19 pandemic. And we're there for you.

Andrew Schorr:
Well, I want to thank you so much, Dr. Patel. Here in Carlsbad up the road from you where you're in the La Jolla area, you probably can't hear us, but we've started doing something at 8 PM every night like they were doing in Colorado and almost imitating what they'd been doing where they applaud healthcare providers at 8 PM every night. We've been howling at the moon. But it's really to honor healthcare providers. So our neighbors, we roll open the windows, we howl for 30 seconds. But it's really a tribute to you guys and what you're doing for us. So first of all, on the research side, thank you for moving it forward, because certainly in lung cancer it's helped people so much already, and will continue to and maybe even lead to cures. And thank you for your devotion for people for the treatment of lung cancer.

And also you work at UCSD more generally in clinical trials and in cancer treatment at the Moores Cancer Center. Dr Sandip Patel, thank you so much for being with us today. We really appreciate it.

Dr. Patel:
Thank you for having me.

Andrew Schorr:
Okay. I'm Andrew Schorr, we'll continue to do our series on a variety of cancers and take a look at an earlier one on our webpage with Dr. Ross Camidge, who Dr. Patel knows, who's a leading lung cancer specialist. And we have others coming up. And then more broadly about living with cancer and things in relationship with your doctor, like telehealth that Dr. Patel mentioned. How do you use that successfully with your doctor to have confidence that you're getting good care? Okay, Dr. Patel, thanks so much. I'm Andrew Schorr up the road from him in San Diego County. Remember, knowledge can be the best medicine of all.

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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