Impact of the Covid-19 pandemic onmedical oncology utilization at a busy urban academicmedical center

ABSTRACT

Background: The unprecedented global pandemic of Covid-19 caused major shifts in medical care throughout theworld. Because chemotherapy delays have been shown to lead to worse outcomes, one of the foremost challengesfor health care systems during this crisis was maintaining uninterrupted care for patients with cancer. Methods: The Division of Hematology-Oncology at UCLA Health has 56 medical oncologists working at 17community practices. Using scheduling data stored within our electronic medical record, we defined three distinctperiods related to the intensity of precautions related to the COVID-19 pandemic in LA county;2/3/20-3/15/20 wasbefore stay-at-home orders were announced (baseline), 3/16/20-5/8/20 was during a period of the strict stay-at-home order, and 5/9/20-6/5/20 was during a period of reopening in the new COVID era. Results: In the baseline period, UCLA Health had an average of 4,555 total patient encounters per week, 0% ofwhich were telemedicine encounters (TE). During the strict stay-at-home period, visits dropped to 3,728 per week(an 18% absolute decrease) and an average of 472 (13%) were TE each week. Since reopening was initiated, visitshave increased to an average of 4,433 patient encounters per week (97% of baseline), with 516 (14%) TE per week.In the baseline period, UCLA Health had an average of 115 infusion cancellations per day with 51% being patientinitiated, 35% physician initiated, and 14% for other reasons (i.e., patient hospitalizations, treatment plan changes, or deaths). During the period of strict stay-at-home orders, cancellations increased from 115 to 133 per day (16%increase), with 47% being patient initiated, 41% being physician initiated, and 12% for other reasons. Sincereopening began, UCLA Health has had an average of 98 infusion cancellations per day with 47% being patientinitiated, 37% being physician initiated, and 16% for other reasons. Conclusion: The Covid-19 pandemic led to a significant decrease in patient encounter volume and an uptick inchemotherapy infusion cancellations. Future study will be needed to examine the effect of this on patient outcomes.Compared to national statistics of changes in patient encounter volume, oncology fared better than most otherspecialties, particularly procedural specialties. Upon reopening, there appears to be a rapid return to baselinepatient encounter volumes and fewer chemotherapy cancellations per day. The pandemic appears to have spurredan increase in the use of telemedicine in medical oncology, previously not utilized by medical oncologists at UCLAHealth, as an important adaptation to maintain continuity of care. This trend has continued even after reopening.Alternative visit models, such as telemedicine, hold promise for ensuring patient-centered continuity care in thiscritical patient population.