EHA 2020: Dr. Matthew Davids on how COVID-19 is affecting clinical care for patients with chronic lymphocytic leukemia (CLL)

The global COVID-19 pandemic had disrupted all our lives, and it has altered how we interact with healthcare professionals and the healthcare system. The normal routines around cancer treatment have been upended, and patients and doctors have had to figure out new ways of working together. How do we see our healthcare providers? How do we get blood work done? How do we get scans done? Will this affect my treatment plan? And how do we do all these things safely?   

At the annual meeting of the European Hematology Association (EHA) 2020, our own Dr. Brian Koffman interviewed Dr. Matthew Davids, Associate Director of the Center for Chronic Lymphocytic Leukemia (CLL) at Dana-Farber Cancer Institute in Boston, MA. They discussed how COVID-19 is affecting clinical care for patients with CLL. 

Takeaways: 

• Most patients have transitioned to telemedicine appointments and meet with their healthcare provider either by video or phone. 
• Getting labs and scans done is a bit more challenging, but usually arrangements can be made to have them done at a location near the patient’s home area. 
• Many patients with CLL are on active surveillance, so telemedicine appointments work well for them. 

• The highest priority for in-person appointments are patients undergoing active treatment and those who need staging evaluations. 
• Does the pandemic affect decisions about when to start treatment or when to change treatment?  

• Starting treatment or changing treatments are situations where closer monitoring may be needed. 
• If it is clear that a patient needs to start treatment, they will get treatment.  
• However, if a patient doesn’t necessarily need treatment right away, doctors may suggest continuing with active surveillance for a few weeks and seeing how things progress. 

• Has the pandemic affected what types of treatments are being offered or used? 

• Clinical trials are still available, and researchers have tried to be flexible since patients are concerned about coming into clinic. In some circumstances, trials have pivoted to shipping drugs to patients’ homes and altered the study visit schedule to reduce in person contact. 
• With current treatments, there has been continuation of the trend to move away from chemoimmunotherapy because of its immunosuppressive effects. 
• The most frequently discussed frontline therapies are a BTK inhibitor taken orally or the combination of venetoclax and obinutuzimab which requires infusions. 
• During the pandemic, more patients have been opting for a BTK inhibitor due to ease of starting and less frequent visits needed. 

Conclusions: 

Thus far, telemedicine seems to work very well in the short term by allowing patients to see their healthcare providers from the safety of their own homes. However, continuing with telemedicine over the long term might be more challenging, especially for patients who have not met their doctor in person or who need more intensive monitoring and care. Overall, anyone who needs care will still be able to receive care, and healthcare providers are working to ensure that their patients get the necessary care in a safe manner. 

Please enjoy this interview with Dr. Davids from June 2020 at the EHA virtual conference. 

Take care of yourself first. 

Ann Liu, PhD