key: cord-0890848-0b1o21rc
authors: Nierengarten, Mary Beth
title: Q&A with Ishwaria M. Subbiah, MD, MS: Palliative care and COVID‐19
date: 2022-01-06
journal: Cancer
DOI: 10.1002/cncr.34070
sha: d7a59e920baacdfd2b6641975e8299e555114c9a
doc_id: 890848
cord_uid: 0b1o21rc

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I n March 2020, oncology centers, like health care delivery in general, had to adjust to the unfolding COVID-19 pandemic by imposing safety measures to restrict the spread of the SARS-CoV-2 virus among both patients with cancer and medical staff. For patients with cancer, the pandemic has contributed to an already high level of uncertainty about what their futures hold.

In this brief, Ishwaria M. Subbiah, MD, MS, assistant professor of palliative, rehabilitation, and integrative medicine at the University of Texas MD Anderson Cancer Center, talks about how she has seen COVID-19 affect her oncology patients.

A: For patients, one of the most notable changes early on was the restrictions on allowing a support person to accompany them to their clinical appointments. This added to the pressure on the patient to find ways to make sure their loved one was included in their care. In addition, there was the added worry about the infectious nature of SARS-CoV-2 and acquiring an infection in an already immunocompromised state.

Q: How has the pandemic affected palliative cancer care? A: One of the true silver linings of the pandemic has been the increased use of telehealth. Telehealth has given us more ways for patients to access care and has allowed us to engage with them in their home with family nearby or even in other parts of the country. Q: Are you hearing different questions or about different issues from patients during the pandemic than those that you received from patients prior to the pandemic? A: In the context of the pandemic, the level of general worry has been perceptively higher in patients as well as an uncertainty about the future. That was particularly true prior to a timeline for a vaccine.

Q: Do you think that providers are talking with their patients in a different way during the pandemic? A: I think oncologists are going through the uncertainty along with their patients. There are elements about COVID-19 that oncologists themselves may not be sure about, but we can counter uncertainty with as much information as we have.

A: At the outset of the pandemic, and really during the first year, there was quite a bit of uncertainty about what the future would hold. Now, with a vaccine available and a high uptake of that vaccine among health care providers and patients, we have a layer of protection for our patients, their families, and for ourselves. The uncertainty of the future is still with us, but the unifying message for us is to openly acknowledge this uncertainty, discuss it with our patients, and stay up to date with the data so that our decision-making with our patients is driven by the data. DOI: 10.1002/cncr.34070 cirrhosis awaiting liver transplantation or in patients with cirrhosis after cerebrovascular disease treated with aspirin or APT. 2, 3 As to what these findings mean for clinical practice, they emphasize that further study is needed. "The meta-analysis does not provide enough evidence to be prescriptive about with which populations and when aspirin should be used as a chemopreventive, or what the overall risks would be," they wrote in the editorial response. They underscore the difficulty of conducting such a randomized trial because of the funding challenges (for example, the low incentive for drug companies to fund this research given the low cost of NSAIDs) and the need for a large patient population to statistically determine efficacy and safety questions.

Despite these challenges, Dr. Danta says that he thinks the meta-analysis supports such a randomized trial because of the potential for the availability of a cheap chemopreventive agent accessible to patients, particularly those at high risk of developing HCC with less access to care.

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