“When someone tells you that you have cancer, and then COVID, your life puts the brakes on pretty hard,” says Fidel Goodnight, who discovered he was COVID-19 positive while awaiting surgery for lung cancer.
Like many COVID-positive patients at Atrium Health, Fidel received at-home care through Atrium Health Hospital at Home (AH-HaH), which allowed him to receive care at home through daily calls and virtual visits by providers. But as someone dealing with both COVID-19 and cancer – a combination that can increase the risk of serious illness – Fidel needed an extra level of care.
“Early on, we were reviewing data coming from China that showed that patients with cancer were doing a lot worse with COVID-19,” says Brittany Ragon, MD, who specializes in hematology at Levine Cancer Institute. “They had a higher chance of contracting COVID and a higher likelihood of dying from it. We were worried for our patients and needed a way to mitigate some of those risks for them.”
Dr. Ragon says that Levine Cancer Institute, with its excellent nurse navigators in the lead, acted immediately to incorporate the cancer hospital into the virtual hospital to do just that.
Adding cancer care to the virtual COVID-19 hospital
Cancer patients with the highest risk for COVID-19 complications – those with malignant tumors within five years of treatment – would get care from Levine Cancer Institute as part of their AH-HaH treatment. In recent months, more than 900 Levine Cancer Institute patients who were COVID-positive received this dual treatment.
“Patients told us they were very thankful that we were checking on them. Many people said that they were much more comfortable knowing that Levine Cancer Institute was aware of their day-to-day health, in addition to the virtual hospital team,” says Kris Blackley, RN, the director of nurse navigation at Levine Cancer Institute. “They were happy to know that we were following up with them from an oncology perspective.”
Meeting the January surge
In January, numbers of COVID-19 patients surged. As the AH-HaH team cared for thousands of patients, oncology doctors and nurses could relieve some of the pressure by caring for the cancer patients in the virtual hospital. Levine Cancer Institute providers coordinated with AH-HaH providers to ensure and coordinate timely care for all patients, even during the surge.
Audrey Cody spent a week in the hospital with COVID-19 pneumonia in early January. She’s been a patient with Levine Cancer Institute for six years, first with chronic lymphocytic leukemia and now with breast cancer. When Audrey’s COVID stabilized, her doctors gave her the opportunity to transfer her care to the virtual hospital, and she enthusiastically took that option.
“I looked forward to going home,” Audrey says. “I had a good support system at home with my daughter and my husband, and a nurse was just a phone call away. That’s all I had to do. If I needed anything, I’d call them. If I had a problem, I’d call them. And they were always calling me, too. Even though I had my family, I looked forward to talking to those nurses, too.”
Audrey spent about six weeks in the virtual hospital, and she believes that the unique combination it provided – giving her the comfort of home and regular communication with providers – helped her heal better. She said Deborah Bradley, MD encouraged her to go to the hospital initially, supported her throughout her bout with COVID-19, and then gave her peace of mind about the health of her lungs after she finished treatment. Audrey also expressed gratitude for the nurses in the virtual hospital and at Levine Cancer Institute for the day-to-day care and quick accessibility.
“Everyone was so concerned. I could tell the empathy [the nurses] had for me as an individual,” she says.
The reassurance of virtual visits and in-home care
AH-HaH and Levine Cancer Institute teams coordinated with providers within and beyond hospital walls. Paramedicine teams offered in-person treatments and administered lab tests to patients at home. If a patient’s sickness became serious, virtual hospital providers would quickly begin the process to admit them to the hospital. In addition, providers offered regular conversation and reassurance for cancer patients during a time of fear and isolation.
“Many patients expressed their fears, especially having both COVID-19 and cancer, but they felt much more comfortable having Levine Cancer Institute involved,” Blackley says. “A lot of patients just wanted to talk! They were isolated, anxious. We provided an extra layer of comfort and filled a gap that we couldn’t expect others to fill.”
Fidel was sick with COVID-19 for about five days, and each day, a nurse navigator from Levine Cancer Institute checked on him. Fidel says he felt lucky to have had just a mild case, but that the daily check-ins from Levine Cancer Institute, where he already knew so many members of the team, “absolutely made a difference.”
“It was reassuring,” Fidel says. “I did exactly what they said – stayed home, bundled up, didn’t expose anyone. They were very professional and did a good job. Levine [Cancer Institute] has some of the best staff in the world.”
