By: Ron DiGiaimo, MBA, FACHE, Dr. Michael L. Steinberg, MD, FASTRO, FACR, Ben Adams, Bri Driggers
Cancer growth and cancer care have never stopped in the world of Oncology and the COVID-19 pandemic. However, within the wider scope of healthcare, fast legislative and operation reform and comparisons to previous pandemic public reactions such as the AIDS crisis in the 1980s provide interesting takeaways to analyze. 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 with Dr. Michael L. Steinberg, MD, FASTRO, FACR, an experienced figure and influencer in radiation oncology as past leader of ASTRO, and leading future-focused cancer care as Chairman of the Department of Radiation Oncology at UCLA’s David Geffen School of Medicine. Looking at the initial response to the COVID-19 pandemic by healthcare in the United States, and the world at large, we are asking, “How did we respond?” and “What does the future hold?”
Facing Immediate Challenges: Analyzing Our Initial Response
Dr. Michael Steinberg began by reflecting on our urgency and quickness of introducing new processes to combat COVID-19’s initial spread. Frontline healthcare workers across the United States were effectively feeling around in the dark when it came to the ever-evolving safety measures and mandates, and as a result, care workers had to adapt quickly and constantly to keep patients as safe as possible. Additionally, the lack of PPE resources for physicians and staff threw many health systems into a panic during the first few months, requiring creative workarounds to move forward during difficult periods.
“At the time, we just didn’t have the necessary processes in place, as we do now,” Steinberg said, referencing the unknowns of the early pandemic. “There was a significant period of time where we didn’t know where this was coming from or how it spread.” With how much is known now, and the incredible amounts of research the world has done to get to that point, it seems incredible how little was known during the end of 2019 and the beginning of 2020.
When analyzing the virus’s scope and public reaction, Steinberg compared COVID-19’s initial wave and spread to how AIDS impacted the United States in the 1980s. “The more seasoned, grey-haired folks had seen a different version of this type of health crisis in the AIDS epidemic,” Steinberg remembered, “as there was a significant period of time where we did not know where this was coming from or how it spread.” However, the dissemination of information through the internet was a major differentiator in how the public was able to gather information and react to the spread of COVID-19 versus AIDS. While the two are drastically different viruses, comparisons can undoubtedly be drawn to its scope, public reaction, and societal impact.
Dr. Steinberg went on to state that “once we knew generally about the respiratory nature of the COVID-19 virus, we worked rapidly to prepare our facility, with our faculty working around 100 hours a week, and it resulted in everything being done and ready at UCLA in two weeks.” This rapid pace is incredible, and even more incredibly, was not just unique to UCLA’s School of Medicine, but applied to cancer centers, hospitals, and care facilities everywhere.
Rapid change management was a highlight of healthcare’s resolve against the pandemic. Healthcare workers’ efforts were combined with technological advancements that made providing care easier and safer. For example, Dr. Steinberg credited UCLA’s early adoption of ultra-hypofractionation as a gamechanger in providing care quicker when it was needed most, as the department was one of the first in the nation to popularize hypofractionation. Going all-in on future-facing treatment and faculty and instituting processes that better benefitted the patient in the past 5-10 years saved time, effort, and lives during the pandemic, as the radiation oncology team at UCLA was able to move past barriers to care and ensure safe, effective treatment when it mattered most.
To the point of continued developments in healthcare before and during the pandemic, legislation regarding telemedicine and general operations also played a huge part in healthcare’s swift adaptation to the pandemic. Brought about by the suddenness of a global emergency, we can look back on the initial wave in early 2020 with an appreciation of our frontline healthcare workers and adaptable healthcare systems getting us to where we are today; and how they will help us continue to improve into the future.
Potential Long-term Effects in Oncology: What is the 20 Year Timetable?
When asked about how Dr. Steinberg views the first two years of the pandemic in retrospect, he responded simply: “Talk to me in another six months.” He views the issues related to delayed cancer diagnoses as being the most interesting takeaway from COVID-19 for oncology and as we move through 2022, the effects will only become more visible. In the previous year, we have seen more advanced forms of cancer appearing due to widespread avoidance of medical procedures and checkups. ACRO is already observing this in cancer centers across the nation.
Additionally, what long-term effects will impact health care and oncology if we lengthen the timeline to twenty years instead of two? Considering how little is definitely known about long-term developments of COVID-19 in the body, with some reporting side effects as impactful as losing the sense of smell and taste for an indeterminable amount of time, a larger perspective on the virus’s overall impact is needed. For Dr. Steinberg, asking worrying what-ifs like “what if this disease has unknown stigmata and sequelae developing years down the road?” puts the overall impact of COVID-19 back in the dark.
For cancer care, Dr. Steinberg posits that his main indefinite concern is the development of cancer in COVID-19 survivors. “I have no evidence that a link exists or anything, but there are a whole lot of questions that are yet to be asked on this virus.” Dr Steinberg elaborates that his core concern lies in the “novel” nature of this coronavirus. There has been nothing exactly like this observed before, and as our knowledge grows, so will our questions, for the foreseeable future.
“These questions are going to pop up and hit us in the face, and in the next six months, many of them will affect what I do day-today for patients.” Steinberg concluded, bringing the focus back to the area of most importance for all health care workers.
Addressing Equity and the Disparity of Care
It would be remiss to analyze the nation’s response to COVID-19 without discussing how disparities of care were highlighted. Disadvantaged groups saw higher infection and mortality rates due to a variety of factors, including medical access and historically backed mistrust of health care institutions. First, the virus spread more rapidly in tighter communities, blue-collar careers that lack work-from-home flexibility and adequate safety procedures, and those with restricted access to healthcare. As a result, the already incredibly infectious virus was made much more serious for many.
Many of these disadvantaged groups also have lower vaccination rates for economic reasons, and an ingrained distrust in health care institutions. For example, Dr. Steinberg cites historical public health issues for African Americans, dating back all the way to Tuskegee and generations before sowing a general distrust of the health care system. “There’s always history and cultural effects intertwined in the system.”
Ensuring equity and combatting disparities was brought into focus for not just general healthcare, but on a more specific level with cancer care, as we see how the previously mentioned advanced cancer stages and diagnosis delays will disproportionately impact these ethnic and economic groups. The work that needs to be done at an organizational level is understanding why and instituting proactive measures in the event that a national or international health emergency appears again.
Similarly to how UCLA relied on future facing technology, producing health policies and practices that specifically target systemic issues like poverty and educational gaps that are represented disproportionately in different ethnic groups is the key to ensuring safety for all Americans, on the basis of equity.