Managing Cancer Care in Hawaii During the COVID-19 Pandemic

By: Ron DiGiaimo, MBA, FACHE, Darlena Chadwick, MSN, MBA, FACHE, & Ben Adams

Cancer growth and cancer care have never stopped in the world of oncology and the COVID-19 pandemic. Hospitals and cancer centers faced unique challenges and were forced to adapt quickly to ensure the safety of cancer patients, at heightened risk for COVID-19. Across the nation, we saw oncologists, healthcare workers, and patients come together to overcome the challenges and produce incredible solutions that may be with us for years post-pandemic. We sat down to obtain lessons learned and information that can be shared with Darlena Chadwick, MSN, MBA, FACHE, Vice President of Patient Care at The Queens Medical Center based in Honolulu, Hawaii with affiliates on the surrounding islands; it is easily the largest trauma center in the Pacific. 

We cover the processes that she oversaw to “protect the castle,” while leading her oncology operations to permanent change for radiation and medical oncology. We also wanted to learn about Chadwick as a person and leader, delving into her interesting and inspiring path through health care.

Chadwick & Her Personal Journey to the Pacific

Picture of Darlena Chadwick,, VP of Patient Care at The Queens Medical Center
Darlena Chadwick, VP of Patient Care at The Queens Medical Center

Chadwick’s journey began serving in the Air Force, serving and traveling while also getting her education, doing 12 years of active duty, and 23 years overall. Her 5-year-old daughter’s cancer diagnosis pushed Chadwick towards medical oncology. Being incredibly overwhelming news for the young family, she used her military training to combine empathy and immense concern for her daughter and family to a goal of curing her daughter.  

She knew she had to save her daughter or try everything within her power to have any hope for normalcy in her life. “That diagnosis changed everything in my life,” Chadwick said, “including my career path.” She was impressed by the care and compassion the young parents received from nurses, and after her daughter recovered (and is now a young, successful professional herself), Chadwick immediately went to nursing school.

Chadwick was accepted at the Medical University of South Carolina, where her daughter was treated, then moved to Hawaii due to her active-duty husband being transferred. She launched herself into the oncology world without hesitation, finding a career at Kuakini, a hospital catering to the Japanese culture and spending her first four years rising into leadership role after leadership role.  She eventually was given responsibility over the GI department and imaging lab before getting her Master’s in nursing. She then spent two years at Hawaii Pacific Health as the executive over oncology for the four hospital system.

The Queen’s Medical Center then reached out to Chadwick with an offer she could not refuse– building a cancer center. She immediately got to work opening the cancer center, managing the oncology program, creating a brand-new colon cancer screening program, and starting the system’s first hospital-based navigation and survivorship programs. She is currently the Vice President of Patient Care after 15 ½ years at Queen’s, with service lines that touch every part of The QMC system.  Chadwick is well known in the oncology community and strives to bring all providers together whenever possible for the good of the Hawaiian people and the Legacy of Queen Emma and King Kamehameha IV.

Unique COVID Complications that Faced Hawaii & the Essential Use of Telemedicine

Image of the Queens Medical Center
A Look at Queens Medical Center in Hawaii

The Queen’s Medical Center is the largest private hospital in the state of Hawaii. Queen’s serves as the states’ major referral center for cancer, heart disease, neuroscience, orthopedics, surgery, emergency medicine and behavioral health, operating the only organ transplantation program in Hawaii as well as the state’s Level I trauma center and teaching hospital. 

The Queen’s Medical Center is the largest private hospital in the state of Hawaii. Queen’s serves as the states’ major referral center for cancer, heart disease, neuroscience, orthopedics, surgery, emergency medicine and behavioral health, operating the only organ transplantation program in Hawaii as well as the state’s Level I trauma center and teaching hospital.

Transportation for some cancer patients to health services ranged from inconvenient to impossible, meaning Chadwick and her team had to adapt quickly to ensure patients were safe and cared for. “We never stopped, and we never said no. We will take care of patients,” Chadwick recalled, “That’s what I’m most proud of my team for.” Even at the pandemic’s peak, their cancer care team never hesitated in doing what needed to be done. They all recognized that cancer patients still had to be treated, and fast adaptation had to be made to allow for that as it was quite literally a matter of life or death.

The enormous benefit of telemedicine in cancer care and the use of MyChart were essential due to The Queen’s Medical Center’s primary and secondary markets and locations around the Pacific Ocean. Connecting with patients and providing screenings and information helped initially in cross-island care and expanded throughout the year. It ultimately reached a point where a Telehealth Medical Director was hired to lead both Queens and the rest of our catchment area in taking full advantage of telemedicine services.

The pandemic also helped Chadwick’s team appreciate the functions of “MyChart”, a free service offered to patients that provides secure online access to portions of their medical records, allowing access to Queens remote incorporation of pre-chemo education, pre-inpatient admission teaching, and clinic updates in the future to vastly improve patient communication. The positive feedback and ability to re-read multiple times as well as allow family members to read the education components have proven so beneficial, they will likely maintain this option for the foreseeable future.

When Queen’s did arrange transportation for patients to visit one of their hospitals, a practice known as “Protecting the Castle” included screening patients, visitors and staff to decrease the risk of infection in their clinic. Fear of hospitals by patients, especially those with cancer, rose dramatically with the risk of COVID, and it was the hospital’s job to protect both patient and facility to alleviate or reduce this risk.

In addition to the unique challenge of transportation to island communities, providing care to the Pacific Islanders required a modified approach. Chadwick praised the people and Queen’s cooperation, “You have to really ingrain yourself in the culture and this community, and Queen’s has done a really good job of getting out there and doing outreach in community education.” Disadvantaged groups throughout the world were hit hard by COVID-19, with cancer care at the forefront.

They have instituted virtual support groups, education, and community outreach programs in addition to easily accessible health care services. The virtual Healing through Art program, offered by Queen’s has skyrocketed with participants, offering a fun outlet for cancer patients to heal, connect and have a touch of normalcy with others safely.

Recovering with a Focus on Mental Health

“Cancer care never stops, and neither did our team.” The pandemic created challenges for both our patients and providers; social deprivation takes a toll. They answered that challenge with extended hours and stressed infection control to ensure safety, and help to reduce general anxiety, thereby opening the door for leaders to spotlight mental health care in cancer care.

Social deprivation of patients who were coming for care and being treated alone caused a lot of emotional distress. “We have seen an increase in the number of patients sharing their need to talk to someone and to be heard” Chadwick stated. Mental health resources, talking to them about their personal frustrations and fears, along with the patient’s regularly measured distress thermometer were integral enhancements to psychosocial assessments and therapies. Measuring stress and immediately reporting upticks provided positive effects to patients, especially in a year with the highest stress thermometer readings in the recorded history of Queen’s.

Portion of the Stress Thermometer Used by Cancer Care Centers

For caregivers, pandemic-related stress was universal, with health care at the front lines. The risk and associated danger of COVID-19 on weakened immune systems dramatically increased. While providing enhanced safety measures and maintaining a secure area for patients was necessary and provided positive results, the toll on staff understandably increased. To help ease these burdens, work from home flexibility was a major assistant in relieving stress without burning PTO. It was encouraged for caregivers to periodically work from home for a few days and “take the time to take a breath.”

In addition, the Hawaiian community stepped up and showed their support to Queen’s expressing the Hawaiian term, “Ohana”, synonymous with “family”, in an extended sense of the term, including family of an adoptive nature. The locals came together in a time of need to provide food and thanks to our health care workers, bringing together the many communities across the islands and cultures. 

The unique nature of inhabitants and pacific communities provides worldwide benefits with regard to cancer care and health research used around the world. Queen’s and the Hawaiian Islands are one of the most beautiful and unique locations and cultures in the world. Chadwick and her team have spent years giving back and building strong connections with the community fulfilling the intent of Queen Emma and King Kamehameha IV of providing into perpetuity quality health care services that improve the well-being of Native Hawaiians and all of the people of Hawaii.

Evaluating the Present & Changing the Future

In regard to mental health going forward, psychosocial assessments and therapies will remain in the spotlight for cancer care, and as the programs grow and evolve, patients and caregivers are at the center of the system ensuring the best possible care is given, no matter what.

Chadwick stated that the greatest thing to come out of the pandemic is the opportunity to evaluate processes and to implement permanent improved practice changes to keep our clinics safe and maintain a science/data-based approach. In addition, the growth of telemedicine opened opportunities for personalized care to the patient and their situation. 

For the island network of Hawaii, using telemedicine for checkups and information will eliminate the need for frequent and sometimes cost limiting inter-island travel. However, it will never replace in-person visits, where doctors can see, touch, and interact directly with patients. That is where the increased safety procedures and workflows that ASCO and CDC guidelines cemented will assist in ensuring that cancer care centers always remain a secure area for patients.