Insights from Professor Stephen Clarke OAM

This week, VIVA! Communications’ Principal, Kirsten Bruce spoke with award-winning Medical Oncologist, Pharmacologist and Translational Researcher, Professor Stephen Clarke OAM, Sydney, about clinical practice during COVID-19, the impact of the virus on cancer diagnosis and treatment, and how cancer patients are faring from a mental health perspective.

Although the COVID-19 pandemic brought the entire world to a standstill, health systems bore, and continue to experience the full brunt of the virus. Meanwhile, tens of thousands of Australians living with cancer, required ongoing, life-sustaining and/or life-saving treatment and care. Because, tragically, cancer doesn’t stop.

Since the emergence of the pandemic, Prof Clarke has witnessed a dramatic upheaval to the daily machinations of his oncology department.

“Fortunately, Australia has experienced relatively few cases of coronavirus. But we were having to prepare for a scenario where there might be infection in the practice or in the hospitals in which we work.

“We worry more about our patients, because they are immunosuppressed from some of our treatments, and there have been cases elsewhere where cancer patients developed particularly serious infections from COVID-19,” said Prof Clarke.

Hospitals and treatment centres have been implementing innovative measures to minimise the risk of COVID-19 infection to their oncology patients, from the moment they set foot in hospital.

“We have been greeting patients as they enter, and immediately assessing them for any potential exposure to COVID-19, including taking their temperature. Only once they have been cleared, are they permitted to enter the treatment rooms.

“The main difference to our day-to-day has been performing telemedicine – conducting remote consultations via Zoom or over the phone, to prevent patient exposure to us, and vice versa. Patients have felt much safer doing things this way, and appreciate that the government has provided subsidies for these telehealth activities,” Prof Clarke said.

Telemedicine has enabled oncology patients living in rural and remote locations to access best-in-class medical oncology services, which they were previously denied. According to Prof Clarke, the utility of this tool will most likely extend beyond the pandemic.

“Patients living remotely will be able to consult with us from their place of residence, preventing them from needing to travel long distances to see us,” said Prof Clarke.

“Telemedicine is more efficient to clinical practice, as patients are aware their consultations are happening under different circumstances, and they come prepared to go through their list of questions, or any concerns they may have. On the other hand, it’s still clinically better to see patients in person, to better gauge whether they’re looking unwell.”

Members of the oncology department have also been working predominantly in teams, with support staff poised to cover the heavy workload, should their colleagues succumb to coronavirus.

These patient-centric measures have been implemented to help safeguard the health and wellbeing of oncology patients, enabling them to continue their essential treatment throughout the pandemic. COVID-19 has nonetheless, continued to impact the patient cancer journey, from both a diagnostic and treatment perspective.

“We’re still endeavouring to ensure our patients are diagnosed and receive the treatment they require. So we’re going to extra lengths to ensure they are socially distanced in our treatment facilities, and we’re allowing sufficient time between treatment sessions in the chemotherapy suite, for thorough disinfection.

“We have certainly seen fewer surgeries taking place during COVID, and less adjuvant therapy, so we’ve had fewer patients coming through our doors during this period, including advanced cases,” Prof Clarke said.

Clinical trials have also been impacted significantly by COVID-19, with many being suspended, to assure patient health and safety.

A diagnosis of terminal cancer, compounded by the added stress of having to weather an infectious disease pandemic, has proven due cause for concern, regarding patient quality of life. Prof Clarke further revealed COVID-19 has placed significant stress on the mental health of cancer patients.

“The isolation has been emphasising, particularly for those with incurable illnesses, that they’re missing out on some of their bucket-list plans. Cancelled travel plans, and the inability to visit family in remote places, or overseas, is definitely preying on the minds of some of our patients.”

As we emerge from lockdown, the restrictive measures faced by oncology centres are starting to lift gradually.

“We’ve started seeing patients face-to-face again this week, and we’ve returned to having a single nursing workforce, rather than teams. Should we find there is any risk to patients and staff however, we’ll be able to revisit our now well-established infection control systems, which has proven advantageous for us, for the future.

“Patients are also feeling more comfortable and safer to leave their homes, and come into our treatment rooms again,” said Prof Clarke.

With the recent easing of surgery restrictions, oncologists are anticipating an increase in patient referrals, and the re-introduction of clinical trials. Prof Clarke maintains we will gradually emerge from the pandemic, wiser than before, and with new innovations.

The pandemic has served a number of purposes. It has shone a light on the gaps in our healthcare system, including the need for further research pertaining to infection control, such as risk factors for infection transmission, and adequate personal protective equipment (PPE) for healthcare workers and the community.

“There’s also a need to rapidly assess and evaluate essential new drug treatments, or equipment safety that might be effective against COVID, or an equivalent acute illness. That’s something I hope we will take away from the pandemic,” Prof Clarke said.

The pandemic has further emphasised the high quality of medicine practised in Australia, particularly in intensive care, noting local patients have fared relatively well, in contrast to those offshore.

“Our patients can be confident in our medical and public health systems, and feel reassured that there are now fewer cases of COVID-19 around. Australia acted quickly in response to COVID-19, and we are now looking at the other side of the virus, with minimal casualties. The crisis and number of deaths in the UK and USA however, is unacceptable, in my opinion,” Prof Clarke said.

Turning to the future, Prof Clarke is hopeful the lessons learned, and innovations borne from the pandemic will serve to accelerate advances in medicine, for the benefit of all.

“We’ve been alerted to some new innovations that will further digitise medicine in the future, such as digital stethoscopes that connect via Bluetooth, to enhance our ability to treat patients remotely. We will still need a way of conducting other physical examinations, such as assessing abdomens and lymph nodes, in a remote fashion, but I am confident that will come.”