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Melanie Cole: Welcome to Back to Health, your source for the latest in health, wellness, and medical care. Keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and today we're discussing COVID-19 and patients with thoracic conditions. Joining me is Dr. Jeffrey Port. He's a Daryl and Steven Roth Professor of Cardiothoracic Surgery at Weill Cornell Medicine and an Attending Cardiothoracic surgeon at New York Presbyterian Weill Cornell Medical Center. Dr. Port, it's a pleasure to have you join us today. Have you been treating patients throughout COVID-19 and how are you and your patients handling these circumstances both physically and emotionally?

Dr. Port: Yes, we've been trying to treat our cancer patients out, thoracic patients throughout this pandemic at Weill Cornell. In terms of how they're handling it both emotionally and physically, our patient population, as you can imagine, often gets the diagnosis of cancer, which it creates a lot of anxiety on its own. Combine that now with the background of COVID-19 in the pandemic and you can see how this is amplified in our patient population.

Host: So define for us because I think a lot of patients and listeners want to know what essential care means and the difference between essential care for these patients versus routine care check-ins for instance. Have they still been able to receive procedures, MRIs, other things. Tell us a little bit about what essential care means.

Dr. Port: Well, essential care means patients who cannot afford to have their care delayed for an excessive period of time. And so it has to be measured, it has to be assessed actively during the actual pandemic in your area. Essential may vary based on where you're at in terms of the pandemic curve. So for example, we don't want patients who are going to have cancer diagnosis being delayed 90 days if that's going to impact their chance of being cured and treated. And so throughout the pandemic we've been open for business trying to take on those cases that we feel cannot be delayed. And so in lung cancer for example, if someone gets a recent diagnosis, it's something that maybe doubling over time over the last, since the last imaging study, someone who is at high risk for waiting. That would be an essential care patient that has to be treated. It can't be delayed. If it's somebody who presents with something that may have been on a cat scan in the past, it's a nodule. It hasn't been diagnosed as cancer remains fairly stable. That may be a patient that you can wait until resources become more available at your institution. In terms of getting the test that they need, we've been open the pandemic for non COVID patients, obviously at a reduced rate and so we prioritize patients. And those with the most significant cancer diagnosis obviously still can get in and get their cat scans, their MRIs and even their surgical treatment throughout this.

Host: What a great point that you're making Dr. Port, what reassurances can you provide your patients who are coming in for these procedures and treatments that you're discussing? What are you doing to protect patients? What's your protocol and protecting healthcare workers as well?

Dr. Port: Well as you can imagine, the pandemic has really made us be very thoughtful about how to Institute appropriate hygiene. So we're practicing all the safety measures that you might on the outside and then we've further amplified that and created incredible hygiene here. And so there's not only industrial cleaning, there's not only mask wearing by all staff, there's testing of anybody who may be symptomatic, but there's also courting off of areas that are for non-covered patients. And so there are units to treat these patients. There are waiting rooms for non-covered patients and ultimately we make sure that there's limited contact with anyone who might be at risk for the patient.

Host: That's very reassuring. And Dr. Port, tell us how you're utilizing telehealth to help people with heart and lung conditions and what you want them to know if they have to come in versus what they can do via video visits?

Dr. Port: We've really now relied heavily on the video visits and they've really been exceptionally important to our patients. And so we understand that if we're hitting the height of a pandemic in New York City and people are reluctant to come into the City where televisit videovisit, it really may help the patient. Number one know that we're here, two is to help guide them through the early diagnosis and staging, and ultimately to let them know how to prioritize their care. And so the televisits have been really exceptionally great. So I can't imagine going backwards. These are really going to be implemented I think moving forward because the City can be a challenge in general, even when it's not a pandemic. And so we can first identify a patient who's appropriate for us to treat. So it's the right Doctor and the right appointment. Two is that they have all their information to make an actual onsite visit worthwhile. And a lot of the testing, the diagnostics can actually be done remotely if necessary. So the televisit has really been an important tool during this time.

Host: Doctor, then let's talk about patients with these preexisting conditions. If their surgery is delayed, are they able to start on neoadjuvant therapy? Are you still able to do things like immunotherapy during this pandemic? Tell us a little bit about when it comes to things like chemotherapy and radiation, immunotherapy, any of these other types of things that they really have to come in for, what you want them to know about that?

Dr. Port: Yeah, so it's really important that a patient obviously understand that they're each unique and they're individuals that have to sit down with the treating physicians and establish what the priorities are. Just because we have a COCID infection doesn't mean that everyone should just basically stop their therapy and there should be cessation of all treatment for non COVID patients. That's not practical. It's not, it's not appropriate. And so depending on the severity of your disease, how symptomatic you are, you may benefit from continuing therapy without disruption. And so here at Weill Cornell we're prepared to treat patients with chemotherapy, with immunotherapy, with radiation therapy for the appropriate patient. So if they're a high priority with symptoms, with advanced disease, they must sit down and have a discussion with their treating physician, surgeon, oncologists, radiation oncologist, to determine the necessity of the therapy. And if it's a necessity, if it's urgent and they're under the guidelines of the essential patient, they will be treated.

Host: Okay. So and that's really very important as you say, but if they're on immunocompromised therapies, does this put them more risk of contracting COVID-19? What advice would you like to give your patients about keeping themselves safe at this time?

Dr. Port: Right. So there are certain therapies that intuitively we might think put patients at higher risk and those therapies have to either be continue to stop based on the recommendation for that particular patient's disorder. So I would say uniformly nobody's suggesting that everyone come off of their therapy because of the increased risk because the consequences may be more severe than the risk of the COVID disease. And so again, it's a discussion that must take place with your treating physician. We do know that even though risks may be elevated for COVID, the risk of having a delay in diagnosis or delay in treatment could equally be as bad if not higher risk. And so it has to be assessed individually for each patient. So if a patient's on immunotherapy and they're high risk patients, we're continue that therapy. If the patient, for example, is considering starting on a chemotherapy protocol but can be delayed safely, then we might consider a delay of a week or two or more if we can do it safely. So we're individualizing people's therapy, custom tailoring it to their diagnosis and their staging, but not in vertically stopping therapy for an endless period of time during this pandemic, which we don't know how long it's actually going to go on for. So it's very important that you take the advice of your treating physicians and understand it has to be customized for your particular stage of disease.

Host: That's truly great advice. And what advice are you giving your patients when it comes to chest pains, other symptoms that they might be feeling that could be due to their preexisting conditions? Are you advising them to look at virtual urgent care, call their physician, or go right to the emergency room? What symptoms would trigger this response from you?

Dr. Port: Again, patients often will have overlapping comorbidities that put them at risk for lung cancer that put them at risk for COVID, put them at risk for emphysema. So it's not surprising. We're seeing a lot of these complaints among our patients and we're trying to parse out how to best treat these patients. Clearly telling everyone there's one size that fits all and if you have symptoms run to the emergency room is not practical. The emergency room in many locations during the peak of the pandemic was really being stressed and so the optimal treatment is really to first contact your internal medicine doctor, your internist. Then if they're under our treatment, they'll give us a call and we go over their symptoms and clearly if they're a severe and they're having shortness of breath, they may require an in person visit, but some of these things can actually be sorted out through their virtual urgent care visit. Some local testing can be done, even x-ray and lab testing. And again, we can sometimes help patients stay closer to home and not have to come in and stress the system and stress themselves with the virtual televisits. But as you can imagine, we are seeing a lot of these complaints because many of our patients have overlapping comorbidities and symptoms. Really it's about their cancer diagnosis and potentially even COVID.

Host: What about the stress that we're all feeling, I mean there seems to be a worldwide feeling of anxiety, but for cancer patients, heart and lung patients, it's amplified as you were saying. So can you put this into perspective for us and help manage the emotional challenges during this pandemic and what do you want listeners to know about taking care of themselves that self care, relaxation, things they need to do, the continuum of care that is so important at this time?

Dr. Port: Yeah, really good points. I mean the cancer diagnosis is overwhelming. It's anxiety provoking on its own, in this time. It's just amplified by the further concerns for their own health and exposure to COVID. And so the first thing it starts with is patients usually feel much more reassured knowing there's an actual treating physician on the other side that's looking after them. So getting a plan in place, putting together a stepwise management plan that makes sense and obviously allows a patient to feel like they're being cared for during this pandemic. Even if there's a delay, knowing who they can call, understanding their staging, understanding the next steps. It's really critically important to know that they have a plan and someone on the other phone to reach out to if there's any issues in terms of helping to allay some of their concerns and anxiety. You know normally you would surround yourself with family members and bring lots of folks with you.

Speaker 2:

It's really not practical coming into the hospital during this time where you're limited in terms of your visits. And so if you are going to basically be in your home and often sequestered in place and domiciling in place, often identifying one person who can be with you, who is going to be helpful in your care may also be a stress reducer. And so some of our patients will get operated on, go home and normally they would have lots of visitors, they would have their children, their grandchildren. And obviously that's not recommended. And so identifying sometimes one caregiver who can remain with you in place and be quarantined in place can also be very helpful relieving the stress, but it really starts with knowing that there's a plan, there's a treating team that's open and taking care of you and then ultimately perhaps having someone with you who can be quarantined in place with you.

Host: As we wrap up, this is such an important episode and such a great topic, Dr. Port, do you have any final thoughts that you'd like to leave the listeners with about COVID-19 during this pandemic and the resources available and what you're doing for them at Weill Cornell Medical Center?

Dr. Port: Yeah, I think that patients have to understand that we're open obviously for treating patients. We've been open throughout this pandemic and even though we may be reduced in our capacity, we're here for patients and obviously prioritizing those patients who have essential issues. As we are now on the down swing in terms of the pandemic and services are becoming more freely available. Safety zones throughout the hospital have been established where you can rest assured that a COVID patient and a non COVID patients are not interacting and so you're limited exposure, so there shouldn't be apprehension necessarily if your doctor recommends that you need to come in for a visit. In any circumstance where we can do things through a telemedicine through either virtual urgent care or virtual visits. We've really been relying on these heavily and they've been very effective. And so you can get a lot of information from your doctor, from your treating physician just by the televisit.

And it can establish even a not only a diagnosis of stage and sometimes even a treatment plan that allows you to even delay things until even more services online and perhaps you're more comfortable coming into the City. But if you have to come into the hospital, rest assured that we're doing everything in our capacity to make it a clean, friendly and receptive environment that really puts you at limited risk for contracting disease. As we scale up and offering more and more operations, chemotherapy and radiation therapy, delaying just because of anxiety or fear without talking to your physician is not recommended. You really need to discuss your treatment plan with your physician and customize that based on the not only the environment we live in, but your own stage of your own disease.

Host: Wow, that was so well said, Dr. Port, thank you so much for coming on today and sharing your incredible expertise on this topic. Thank you again. For more information on how to manage the emotional challenges of this pandemic, please visit Weillcornell.org/news. You'll also learn about how Weill Cornell Medicine is taking extra precautions to prioritize your patient experience in office and offering more resources via digital health on Weillcornell.org/digital-health-services. That concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review Back to Health on Apple podcast, Spotify, Google, play music. For more health tips, go to Weillcornell.org and search podcasts. Parents, don't forget to check out Kids Health Cast. I'm Melanie call.

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