POSTED: April 11, 2020

Dr. Susan Slovin On COVID-19 in NYC, April 10

Dr. Susan Slovin, MD, PhD, is a medical oncologist specializing in prostate cancer immunology at Memorial Sloan Kettering Cancer Center in New York City.

Prostatepedia spoke with her recently about the situation in NYC last week and any advice she has for prostate cancer patients.

How has the situation changed this week in New York City?

Dr. Susan Slovin: We were encouraged to work only once a week, including seeing patients and making all our teleconference visits with patients, to obviate the increased needs on nursing personnel. Any of us can be deployed to the hospital to help in the ICU or on the floor, especially nurses. Some of our outpatient nurses in oncology have expertise in critical care and have been drafted to the hospital to assist with ventilatory support.

People are getting through this. People are managing to come off vents, which is the good news. We're clarifying goals of care with our patients to determine, should they have COVID-19 infection and have respiratory distress, if they would want to be on a ventilator.

We may not have any indication that one person is at greater risk than the next person, but if the patient goes to a local hospital and ends up on a ventilator, a loved one may not be able to accompany them or speak on their behalf. Sometimes the patient is a devout Catholic who wants to go with the Lord if there's a problem.

And sometimes patients and their families don't know what they're getting into. A lot of our patients are not ready for end stage conversations. American Society of Clinical Oncology has told us in the past that we are remiss to ask patients how they would like end of life to proceed.

But I ask for clarification with every patient that I speak with, whether in person or via teleconference. So far, everybody has agreed to that clarification. It's interesting how people, even though they know they have disease, want full-court press if they feel they have something reversible.

I also clarify what would happen in the worst case situations. And I've had half a dozen patients today, both in-person and on the phone, who have thanked me for addressing it. I was shocked. My patient population is highly neurotic, aggressive, and anxious. I have never been thanked for patients being able to either talk to me via video or teleconference with me.

Most of the time, patients get irate if you go into that particular discussion. And now, they're thanking me for bringing it up. As oncologists, we approach this topic with trepidation, especially so early in the disease states where they're not at a critical point. But everybody feels that we're acting in their best interest by having some documentation expressing what they want if the worst happens.

So, the flavor of how the patients are interacting with you has changed?

Dr. Susan Slovin: Absolutely. I never would have expected that. I would expect everybody to be in mortal fear. There are some patients who have hunkered down and have not left their house in a month. There are patients who feel great and are more scared of the virus than they are of their cancer.

I never thought that would be the case, to be honest. But everybody is rising to the occasion, including the patients. That's the most important thing is how to keep our patients comfortable and looking ahead. It's working out well.

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