Patient Perspective: COVID Vaccine and Cancer

March 15, 2021

Information

March 14, 2021

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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00:00Support for Yale Cancer Answers
00:02comes from AstraZeneca, dedicated
00:05to advancing options and providing
00:07hope for people living with cancer.
00:10More information at astrazeneca-us.com.
00:14Welcome to Yale Cancer Answers with
00:16your host doctor Anees Chagpar.
00:19Yale Cancer Answers features the
00:20latest information on cancer care by
00:23welcoming oncologists and specialists
00:24who are on the forefront of the
00:27battle to fight cancer. This week
00:28it's a patient perspective on cancer
00:30treatment during the pandemic with
00:32Christina Allen and Doctor Tara Sanft.
00:34Christina is a cancer survivor and doctor
00:37Sanft is an associate professor of
00:39medicine and medical oncology at the
00:42Yale School of Medicine where Doctor Chagpar
00:44is a professor of surgical oncology.
00:48Let's start with you
00:50Christina, tell us a little
00:53bit about your story.
00:55Sure, thanks so I was 38 years old at
00:58the time of my diagnosis and I have a
01:03diagnosis of locally advanced breast cancer.
01:07I was not experiencing any symptoms prior
01:11to my diagnosis and like so many other
01:15people I did not have a family history
01:19of breast cancer either.
01:21So the cancer was found after
01:24I felt a small lump,
01:26which I initially thought was a bug bite.
01:29It was over the summer,
01:32this past July I had been swimming and
01:35really thought not much of it until the
01:39following morning when I woke up
01:42and it was still there and felt almost
01:46like a little pebble under the surface.
01:50And at that point it was
01:55a bit of a freeze moment, OK
01:57do I do something about this?
01:59What do I do?
02:02So I reached out and was able to
02:06see my OBGYN within a day or two.
02:11At which point she had referred
02:14me for further imaging,
02:16and that's when I became connected to Smilow.
02:20I think another important thing
02:22to mention is that throughout
02:25my treatment and my illness,
02:28I have continued working and I
02:30am a licensed clinical social
02:33worker in healthcare and have been
02:36working in hospital systems for a
02:39little over 12 years now.
02:44So Christina you were diagnosed,
02:45I mean this really happened
02:48this past July, July of 2020,
02:50right in the middle of this pandemic.
02:53Talk to us a little bit about,
02:56you kind of mentioned this,
02:59Oh my gosh, what am I going to do moment,
03:02I can only imagine that that was
03:05even heightened with what am I
03:08going to do in the midst of Covid?
03:10Is my doctors office open?
03:12Do I do a virtual visit?
03:15Do I go into the office?
03:17How does that work?
03:18Tell us a little bit about that
03:20thought process and whether
03:22you ended up seeing
03:24your doctor using telemedicine,
03:26or whether you went into their
03:28office and whether you had
03:30any challenges with that.
03:35That's a great question.
03:37Almost right from the beginning,
03:40covid sort of felt like this parallel
03:47opponent in my treatment and in my
03:50illness it was always a consideration,
03:53always a factor in the decisions that
03:56I was making and the decisions that
04:00my treatment team has been making.
04:02I knew that getting in for a clinical
04:07breast exam was going to be the
04:10next step after I felt that lump,
04:14so I was pretty specific and persistent
04:17with asking for an in person visit with
04:21my OBGYN and I really love the flexibility
04:24that has come out of covid and the
04:28increased availability of telemedicine,
04:30but you know some things just
04:34have to be done
04:35in person and I knew that I
04:38wouldn't feel comfortable at that
04:40point using a telemedicine visit,
04:43so I was able to get the in person visit
04:47and then there was a bit of a struggle
04:51and delay with trying to get imaging
04:55going because my understanding is that
04:57a lot of imaging centers had decreased
05:00capacity or maybe even temporarily closed.
05:03So I did have to
05:05advocate for myself to get that imaging
05:08done and to be very clear that this was not
05:12routine screening, although that should not
05:15be deferred either,
05:17but rather that this imaging
05:20was diagnostic and those days
05:24I mean I can remember the seconds, minutes,
05:29hours and days between visiting my OBGYN and
05:34getting confirmation that yes,
05:36this is cancer.
05:38That was a really,
05:40really difficult time.
05:42Tara maybe I'll bring you in here,
05:47you know, during the pandemic
05:49talk a little bit about how as a
05:53health care provider and as
05:56a chief patient quality officer,
05:59patient experience Officer,
06:01things kind of shifted during the pandemic.
06:04What were the approaches in terms
06:08of clinic visits in terms of imaging?
06:12How did facilities shift and what
06:16ramifications do you think that had?
06:20Thanks Anees,
06:22I feel like in recalling and listening
06:25to Christina's story, it brings me back.
06:28I'm also a breast cancer oncologist,
06:31so I treat patients with breast cancer,
06:34and I vividly remember the process
06:36of going through a national shutdown
06:39and talking to many institutions
06:41on how they're handling it.
06:43And then I remember the Yale
06:46response and I have to say that
06:50with the guidance of the CDC,
06:52we did everything we could
06:54to keep our patients safe.
06:56It was very disorienting.
06:58As a provider, I was in clinic,
07:012 1/2 days a week,
07:04most weeks,
07:05and then we went through a complete
07:08shutdown where we really minimized
07:10in person visits because of the
07:13virus and really tried to focus on
07:16the patients who were receiving
07:18in person IV chemotherapy.
07:20And so you know,
07:22patients like Christina coming through,
07:24we really stressed over what to
07:27do about patients with suspicious
07:29findings or needing diagnostic imaging
07:32that fortunately at Yale,
07:35I think, that never stopped.
07:37There were many routine imaging
07:40that was deferred.
07:42And we're still feeling the effects of that.
07:45Yale is a system that I have to say I thought,
07:50did a really wonderful job
07:53especially in communicating,
07:54because this was the first time for
07:57any of us to go through a pandemic
07:59and so really understanding the
08:00protocols and how things are changing
08:03everyday was paramount in our response,
08:05and as a provider I felt very well
08:08informed and I was able to convey
08:10those messages to my patients.
08:14So Christina ultimately, you
08:16were able to advocate for yourself,
08:18which I think is such a strong
08:21message for patients at large,
08:23whether there is a pandemic or no pandemic,
08:26but particularly during these times,
08:28to advocate for yourself to get
08:30the in person visit with your OBGYN
08:33to get the diagnostic imaging,
08:35and it sounds like ultimately to
08:37get the biopsy and the diagnosis.
08:40And so then what happened?
08:45After the diagnosis was confirmed,
08:48I was referred to a medical oncologist
08:52and a breast cancer surgeon,
08:55and then shortly afterwards,
08:58my radiation oncologist,
08:59so I started to have that treatment
09:03team built up around me and
09:07I have an awesome treatment team.
09:10Doctor Tristen Park,
09:12my breast cancer surgeon, Doctor Knowlton
09:15my radiation oncologist and doctor
09:18Kanowitz, my medical oncologist.
09:21They've all been wonderful,
09:23so it may sound a little strange, but
09:30once the diagnosis was confirmed,
09:32I had this team,
09:33we started putting plans in place,
09:36it was a little bit less of the unknown.
09:39I'm somebody who likes to have a plan.
09:42OK, this is what we're going to do.
09:46This is how we're going to approach this.
09:49These are the people you can contact
09:52with questions or when you need help,
09:55so getting that ball rolling felt
09:57like a bit of a relief to me.
10:03And were those visits that you
10:06had with those providers in
10:08person as well?
10:11Some were and some weren't, and now I'm
10:15recalling some things from earlier on,
10:18I do recall that initially when I was
10:22scheduled with my breast cancer surgeon,
10:25it was set up as a telemedicine
10:28visit and I didn't quite understand
10:31the rationale behind that,
10:33and was sort of wondering,
10:35is this best to meet her for
10:38the first time over Tele Medicine
10:42when she's somebody who is
10:43going to be operating on me so I actually
10:47reached out to Doctor Park directly
10:50and asked her if she felt that that
10:53was the best thing to do clinically to
10:56meet for the first time over Tele Medicine,
10:59or if she thought it would be more beneficial
11:03to come into the office in person.
11:06She was extremely responsive,
11:07and gracious and said no,
11:10I would prefer
11:12to see you in person so
11:14she switched the visit from Tele Medicine
11:18to in person and I really appreciated
11:21that flexibility and input from her
11:24because this is not my area of expertise,
11:28I don't know sometimes is
11:31it better to see somebody
11:34in person versus telemedicine.
11:36The risks versus benefits there.
11:38So I really had to depend a lot
11:41on the team and let them tell
11:44me what's the better way to go.
11:47But for example,
11:48my first meeting with Doctor Knowlton that
11:51was telemedicine and that was more
11:54or less to establish a relationship
11:56with her and for her to hear a
11:59little bit more about my history,
12:01knowing that the radiation
12:03was going to be at the
12:05tail end of my treatment
12:11and that even allowed me to
12:14work almost a full day
12:15and just take
12:18an hour out to go somewhere quiet
12:20and private and do the telemedicine
12:22visit and then get back to work.
12:26So certainly, I mean,
12:28it seems like the pandemic which
12:31caused this versioning of Tele health
12:34visits might actually have been a little
12:37bit more convenient for some visits.
12:44How did you kind of think about
12:47which visit should be Tele medicine,
12:50which visit should be in person.
12:53And going forward, do you think that
12:56Tele Medicine might play an increasing role,
12:59particularly when you hear
13:00stories like Christina's
13:01where
13:03you can work the whole day and just take
13:06an hour off for the visit instead of
13:09having to take half a day off,
13:13find parking,
13:14and go through the whole rigmarole
13:16for what might be the same visit.
13:21Yeah, when the pandemic first started,
13:23we often didn't have a choice.
13:26Many of our visits were converted
13:28to Tele medicine again in the hopes
13:30that we weren't exposing patients
13:32to a contagious virus in person.
13:34So a lot of our new patient visits
13:37where we would normally see them in the
13:39office were done on Tele medicine in
13:42retrospect some of that was good.
13:45It was very disorienting.
13:46You know, we're all learning new
13:48ways to take care of patients,
13:51and I think as time goes forward,
13:53the most important thing will
13:55be what Christina mentioned,
13:56which is a shared decision.
13:58Are you comfortable doing this
14:00on Tele medicine?
14:01Do you feel there is a good reason
14:04to be seen and examined in person?
14:06And I think providers are learning
14:08the value of listening to those
14:10patient preferences in order
14:12to accommodate and honor
14:13what is preferred and
14:15probably what's necessary,
14:16so patients know inside it's
14:18OK to just do this one on video and
14:21next time in person or they know
14:24I think I need an exam and we
14:25need to really pay attention to
14:27those preferences and honor that.
14:29We're going to take a short
14:32break for medical minute and then come
14:34back to learn more about Christina's
14:36experience with cancer and the Covid
14:38vaccine right after this short break.
14:40Please stay tuned.
14:42Support for Yale Cancer Answers
14:44comes from AstraZeneca, working to
14:47eliminate cancer as a cause of death.
14:50Learn more at astrazeneca-us.com.
14:54This is a medical minute about Melanoma.
14:57While Melanoma accounts for only
14:58about 4% of skin cancer cases,
15:01it causes the most skin cancer
15:03deaths and when detected early
15:05Melanoma is easily
15:06treated and highly curable. Clinical
15:08trials are currently underway to test
15:11innovative new treatments for Melanoma.
15:13The goal of the specialized programs
15:15of research excellence in skin cancer
15:18or SPORE grant is to better understand
15:20the biology of skin cancer with a focus
15:24on discovering targets that will lead
15:26to improved diagnosis and treatment.
15:28More information is available
15:30at yalecancercenter.org.
15:31You're listening to Connecticut Public Radio.
15:36Welcome
15:36back to Yale Cancer Answers.
15:37This is Doctor Anees Chagpar and
15:40I'm joined tonight by my guests
15:42Christina Allen and Doctor Tara Sanft
15:44and we're talking about Christina's
15:46journey with cancer through Covid,
15:49and ultimately to the Covid vaccine.
15:52So Christina right before the break
15:55you were telling us how you were
15:58diagnosed right during the pandemic
16:00and you ended up having some of
16:04your visits virtually some of your
16:06visits in person tell us a little bit
16:09more about how the decision-making
16:12went in terms of your treatment strategy.
16:18Sure. At the beginning everything
16:21was so overwhelming for me and I
16:25really didn't realize just how many
16:28decisions there are to make about
16:31the treatment and about the strategy.
16:34And then what the options are.
16:39I did my best to educate myself and
16:43then of course I have to heavily rely
16:48on my treatment providers and really
16:52deeply trust them because they are
16:56the experts at treating breast cancer.
17:00I was worried all throughout that
17:04Covid would possibly delay or
17:08defer parts of my treatment,
17:11although that did not turn
17:14out to be the case,
17:17so I was starting chemotherapy
17:23about a month after we had
17:26confirmed the cancer diagnosis,
17:29I did make a decision to receive my
17:33chemotherapy at one of the outpatient
17:37clinics for Smilow in North Haven,
17:41which was extremely convenient
17:43for me, closer to my home,
17:47and also much easier to park,
17:51to get in and out of and also just less
17:56congestion and traffic then Smilow proper.
18:01So it was really,
18:03really great to have that option
18:07to use the North Haven location
18:11for my chemotherapy visits.
18:14And I felt very
18:16safe there the entire time.
18:23Tara, NOTE Confidence: 0.8432569
18:25did you find that in your
18:28management of breast cancer patients
18:31that you may have switched
18:34therapies or the sequencing of
18:37therapies or the location of therapies
18:40given considerations of the pandemic?
18:44Yes, we did all of those things.
18:48So fortunately we have a robust cancer network
18:51here with locations all over the state.
18:54And just as Christina got
18:56her care in North Haven,
18:59I frequently recommended my patients
19:01be treated close to home rather than
19:04coming down to the main hospital
19:07for some period of time.
19:09And even during that time,
19:12some listeners may remember that
19:15the cancer care was temporarily moved outside
19:18of Smilow Cancer Hospital for some time,
19:20and so I even practiced at a location in
19:24Guilford for awhile while we were again
19:28minimizing people coming into the hospital.
19:31We also made modifications to the timing of
19:35some therapies and that was consensus driven,
19:38so we really spent some time listening to our
19:42leaders and colleagues across the nation.
19:46And I remember logging into many webinars
19:49where there were conversations about
19:51how to best care for patients without
19:54compromising their curative treatments,
19:57but minimizing their risk of exposure.
20:01And I think that we made the best
20:03decisions we could make at the
20:05time and it was collective.
20:07Oncology tends to work really well
20:09together for the good of the patients,
20:11and I felt that coming through
20:13during the pandemic.
20:15Yeah, and so Christina you ended
20:18up getting your chemotherapy
20:201st and then what happened?
20:23How long after that did
20:25you embark on surgery?
20:30I recall asking Doctor Park how soon
20:35after chemotherapy can I have
20:39my surgery and her response was
20:42four weeks would be the minimum and I
20:46think my surgery was like 4 weeks to
20:51the day that I ended chemotherapy.
20:54I was ready for the next step
20:58so there really wasn't any disruption.
21:02The planning went pretty smoothly.
21:05I was extremely fortunate that I
21:08did not experience any delays
21:12in my chemotherapy,
21:13I was able to have the treatments
21:16as scheduled.
21:17Of course, there were side effects,
21:19but they didn't sideline me
21:22so I finished as expected and
21:25then exactly like 30 days later
21:28I went in for surgery.
21:31And so what was that experience like?
21:34I mean you come into surgery.
21:36Were you able to bring your family?
21:39Did you have to wear a mask?
21:45when you talked about Covid being like
21:48this parallel line with your your cancer,
21:51tell us how that kind of
21:53influenced the surgical management.
21:56Sure, so masks of course at
22:00that point they were so commonplace,
22:03and familiar that it's
22:06just what what we do, right?
22:09What was a little trickier was figuring out
22:12who can be with me?
22:15Can my husband be with me if he can?
22:19Can he stay? What does he need to do?
22:23What do I bring to the hospital
22:27with me if he can't stay?
22:32So that was a little trickier than
22:35even right up to the day that I
22:39was being admitted for surgery it
22:41still wasn't clear which portions
22:44he was going to be able to be there for
22:48and how long he might be able to stay for,
22:52so I think you get
22:53more comfortable,
22:55sort of living in gray areas and with
22:58the unknown when you have cancer,
23:00so that was just another something
23:02that we sort of had to roll with.
23:07It was more of, this is the bag I'm going to take
23:10if you can't come with me.
23:12If you can come with me,
23:14I have this bigger bag that you're
23:16going to take in with you and then there
23:19will be another backup plan if needed.
23:22So just trying to be flexible.
23:25But he was able to stay with
23:27me right up until I went
23:31over to the operating room.
23:34Tara, you know we
23:36talk about cancer so often,
23:38we talk about having a support
23:41system and how important family is
23:43and you know clearly the pandemic
23:46kind of threw a wrench into familial
23:49support where patients often
23:51will have their entire families
23:53with them at clinic visits or in
23:56the hospital room or in the waiting
23:59area for their surgeries and so on.
24:02Tell us about how that that changed
24:04with the pandemic and what adjustments,
24:07if any, were made to compensate for that?
24:12Yeah, thanks for bringing this up.
24:15I think this is one of the most
24:18painful changes that came with the
24:20pandemic because of the risks,
24:22the decision was made to
24:25limit or restrict visitors.
24:26And as you mentioned,
24:28especially in cancer care,
24:30those visitors, those loved ones are
24:33so important to every step of the way.
24:37And I think that that
24:39decision was very difficult.
24:41It was painful for everyone involved,
24:43especially the patients and their loved ones.
24:46You know, many efforts were made to
24:49try to improve the communication.
24:51Once a patient was hospitalized,
24:53for instance,
24:54we did a lot to try to ensure
24:56communication with the family member
24:59through all different types of media,
25:02including face timing on rounds,
25:06lending iPads to each room and then
25:08we even had a system where there were
25:11volunteers who called with updates every day.
25:14I'm not sure that we did
25:16that for every patient.
25:17I know there were many patients
25:19who felt that the communication
25:21could have been better.
25:23And I think that we
25:25need to look at our processes and
25:28going forward figure out all the
25:30different ways that patients prefer
25:32to be communicated with and then try
25:35to do everything we can to spend that time
25:39doing that communication,
25:41in addition to all of this,
25:43we were avoiding going into
25:45rooms for the risk of exposing the
25:48patient and I know that was also
25:50a very isolating experience for
25:53patients hospitalized during that time.
25:55So it's something that
25:58in retrospect,
25:58we will analyze and understand
26:01how we can do better,
26:03and we continue every day to try
26:05to maximize the chances that
26:07patients and their loved ones feel
26:10informed and cared for and heard.
26:14And so then Christina,
26:16you have your surgery and presumably
26:20you get out of the hospital.
26:24Then what happened?
26:28So I was doing well enough that
26:32I was able to leave the hospital
26:36that evening and that was a
26:40decision that was definitely
26:44brought on by me and partially
26:46because I wasn't able to have
26:49family with me during that time.
26:52I knew as long as my doctor felt
26:56that it was safe for me to go,
26:59I knew that it was going to be better
27:03for my healing and recovery to be
27:07around family and to be back home.
27:10So I went in that morning and I was home
27:16by like 8:00 PM that evening,
27:18but my team, Doctor Park was
27:21texting me that evening, the next day
27:24checking in on me so I still felt
27:27like I had a lot of support but had
27:30the luxury of being back home where
27:34I was going to get the best rest and
27:38have the most help from family so
27:41everything went pretty smoothly
27:43once I got home.
27:46Did you worry about potential covid
27:49risk that your family could bring in?
27:52That would affect you, particularly?
27:55You know, not even after your surgery,
27:58but even during your chemotherapy.
28:02Was that concerning for you
28:04in living with your family,
28:06who you know presumably
28:08were out in the real world?
28:11Potentially exposed to the virus and getting
28:15infected yourself?
28:20Yes, I live with my husband and he
28:22had to make a lot of sacrifices.
28:28And think very carefully about who he
28:31was around and where did he absolutely
28:35have to go versus maybe want to go?
28:39And I really didn't see much other family,
28:42especially prior to getting vaccinated
28:44myself and I also didn't bring my husband
28:48into my chemotherapy treatment, even at
28:50times when it was better under control.
28:53And they said I could bring one person,
28:57and I was worried about what he could
28:59potentially be bringing into other
29:02people receiving treatment as well.
29:04So yeah, that was a worry.
29:07I mean, it's still a worry.
29:09Now, even after being vaccinated,
29:11but less so.
29:14So in our last minute just tell us
29:17about your decision to get
29:20vaccinated, when you got vaccinated and
29:23how that went.
29:26I was extremely fortunate that I'm
29:28working in a hospital environment.
29:30I work in an emergency room.
29:34And my hospital did an amazing
29:36job of rolling out the vaccine
29:38to staff as soon as possible.
29:42It was something I had been thinking about.
29:45As soon as we started
29:48hearing about a vaccine.
29:49And of course I talked it over
29:52with my medical oncologist before
29:54moving forward with the vaccine.
29:57But knowing the potential.
29:59devastating effects of covid
30:01and seeing what it did,
30:04it really seemed like an easy
30:06choice and the right choice for me.
30:09Christina Allen
30:09is a cancer survivor and Doctor Tara
30:12Sanft is an associate professor
30:14of medicine in medical oncology
30:16at the Yale School of Medicine.
30:18If you have questions,
30:20the address is canceranswers@yale.edu
30:21and past editions of the program
30:23are available in audio and written
30:25form at yalecancercenter.org.
30:27We hope you'll join us next week to learn
30:30more about the fight against cancer.
30:33Here on Connecticut public radio.