*For medical professionals only
Protecting cancer patients is the original intention of every oncologist
Written by | Wang Hang
Source | "Medical Community" public account
Under the epidemic situation, The specialist outpatient and elective surgery of Professor Huang Chen, director of the Gastrointestinal Surgery Department of the First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Shanghai First People's Hospital), has been affected to a certain extent, but his phone calls have increased.
Most of the patients on the other end of the phone who want to come to the operation or cancer patients who have done surgery for a long time follow him, due to the epidemic, patients with travel and hospital visits are limited, stomach cancer, colorectal cancer and other gastrointestinal tumor patients and their families, most of them report to him on the progress of the disease or inquire about the treatment method through online means.
Professor Huang Chen
He can only calm the emotions of patients who cannot come to the hospital for follow-up, while giving patients as detailed treatment plans and precautions as possible. For patients from other places, it is also recommended that patients go to the local hospital for nearby diagnosis and treatment. But the reality is that anti-cancer treatment needs regular follow-up to evaluate the treatment effect, and patients cannot be left behind in each treatment course, otherwise they will face the risk of progression, but now between home and hospital, it has become the most difficult road, and the epidemic has become an insurmountable gap.
Professor Huang Chen is fully aware of these points, in addition to the telephone, his online consultation window, mailbox, doctor team and other channels are always open. He wants to do everything he can to take care of every cancer patient he can. However, medical judgment requires comprehensive and detailed information, some information cannot be obtained from online communication, and patients and doctors are in a relatively anxious and helpless situation.
Since the outbreak in March, as of April 21, the total number of people infected in this round of local epidemic in Shanghai has exceeded 400,000. In order to achieve social clearance as soon as possible, Shanghai has divided three areas of "sealing, control and prevention" and adopted a combination of "antigen + nucleic acid" screening strategy, and the epidemic prevention and control has achieved initial results, but the current epidemic prevention vigilance has not been relaxed.
In addition to Shanghai, Xi'an, Wuhu, Zhengzhou and other places have pressed a certain pause button to varying degrees due to the needs of epidemic prevention and control. Under the continuous situation of the epidemic, medical staff must not only do their own work, but also pull out their strength to support the frontline fight against the epidemic. Professor Huang Chen introduced that public hospitals not only have to send medical nurses to the frontline to support the fight against the epidemic, but also shoulder the local anti-epidemic and daily medical work, which to a certain extent brings great pressure to the normal operation of hospitals and departments.
"Many doctors and nurses have to go to the frontline of the fight against the epidemic to provide support, resulting in a relatively small number of medical staff in the hospital, and some patients who have undergone nucleic acid testing and admission to the hospital will suddenly turn positive due to the incubation period of the virus, bringing pressure to the hospital's epidemic prevention work."
Due to the current shortage of manpower in the hospital, Professor Huang Chen said that the hospital will open enough ordinary outpatient clinics to ensure medical needs, but the expert door is limited, and most of the emergency patients are in critical condition and cannot wait for the nucleic acid test results, at this time, they also need to take a greater risk for emergency treatment.
For cancer patients, from following the treatment of a certain specialist to now only being available in ordinary outpatient clinics, it has undoubtedly weakened the trust of patients. Professor Huang Chen said that according to the different disease conditions, the impact of delayed treatment cannot be generalized, and for some patients with stable disease period, chemotherapy or surgery delayed by 1-2 weeks will not have much impact on the condition. However, for patients with more critical diseases or in the backline, the cost of delayed treatment is immeasurable.
How to manage cancer during the pandemic?
As the epidemic continues, Professor Huang Chen believes that this may affect the routine physical examination of the masses, which in turn will affect the early diagnosis and intervention of cancer, and for patients who are receiving anti-tumor treatment, cancer management in special periods is crucial.
According to reports, patients receiving intravenous chemotherapy drugs generally need to be hospitalized in the hospital for 1-5 days or even longer, in the context of epidemic prevention and control, in addition to the lack of manpower and energy in the hospital, tumor patients will also worry about the risk of epidemic in the hospital.
He pointed out that active doctor-patient communication, more convenient medication and smooth drug delivery routes are the key elements to solve the problem that tumor patients cannot be admitted to the hospital under the epidemic. "As a surgeon, patients are mostly perioperative gastrointestinal tumor patients, and under the current circumstances, oral chemotherapy regimens are preferred, which can reduce the time patients spend in the hospital and ensure patient safety."
Taking stomach cancer as an example, some patients have been delayed or changed in treatment during the epidemic, especially some patients who have had surgery before but have doubts about the integrity and efficacy of chemotherapy. At this time, the interruption or postponement of treatment due to the epidemic situation is an immeasurable blow to patients' confidence and compliance in treatment.
In this regard, Professor Huang Chen will repeatedly emphasize to patients during online consultations that "don't worry too much". He understands the anxiety of patients who want to get treatment as soon as possible, and then uses professional knowledge to make scientific interpretations for patients and increase their self-confidence in treatment.
"I have always talked about the '532 law', for tumor patients, the expected survival time is a statistical result, such as stage IIIA gastric cancer patients, the five-year survival rate is about 40%, but the individual is not the same, the '5' degree depends on the biological characteristics of the tumor and its specific stage; the '3' depends on the actual treatment, including surgery and its perioperative radiotherapy and chemotherapy; and 20% is directly related to the patient's mentality." He suggested that patients should maintain a positive and optimistic mood during the closure period, try to maintain contact with the attending physician, and strengthen exercise and nutritional support.
In addition to establishing a personalized diagnosis and treatment plan, Professor Huang Chen's gastrointestinal surgery department also provides different emergency plans for patients in Shanghai who seek medical treatment in different places.
"For patients with initial gastrointestinal tumors in Shanghai, if surgery is needed, they can be admitted to the hospital in an orderly manner, improve preoperative examination and limited-term surgery; for patients with perioperative chemotherapy, 1-2 courses of oral chemotherapy drugs are generally prescribed in the outpatient clinic, and at the same time, dynamic adjustment and feedback on the line are actively taken to minimize the frequency of patients to the hospital." For patients who want to come to Shanghai for surgery or adjuvant chemotherapy or follow-up, for example, I have two new adjuvant treatment of rectal cancer patients, originally about to undergo surgery after the Qingming Festival, at present, it can only be recommended to perform surgery locally according to the plan, or preoperative treatment first. ”
In the context of the normalization of the epidemic
Calls for more convenient ways to administer cancer
As a surgeon who has been practicing for more than 20 years, Professor Huang Chen admits that the treatment of cancer has undergone earth-shaking changes in recent years, especially after the advent of immunotherapy, even for advanced patients, doctors can come up with "killer skills" to fight it.
"As a new type of treatment plan, immunotherapy is still very surprising for patients with locally advanced tumors, and the conversion rate brought about by combination chemotherapy is still very surprising. For patients with advanced cancer, immunotherapy is an important treatment strategy, but most of the current immunotherapy drugs are intravenous, which has also caused a 'dilemma' in the use of drugs during the epidemic. ”
Specifically, the average dosing time of intravenous dosage forms is 0.5-2 hours, during which hospitalization is required to observe whether there is a local reaction to injection, and patients often travel to and from the hospital, and in the context of the normalization of the epidemic, time costs and economic costs indirectly increase the physical and mental burden of patients. More importantly, the epidemic lockdown has caused patients to purchase drugs inconveniently, and even unable to be admitted to the hospital for treatment.
It is understood that at the most severe time of the epidemic in Shanghai, Mr. Liu (pseudonym), who received subcutaneous immunization agents, was "a blessing in misfortune". As a patient with advanced liver cancer, he had received immunotherapy, but because of his paralysis, it was inconvenient to go to the hospital for infusion, and the attending doctor prescribed him a PD-L1 drug called envolizumab.
Unlike traditional immune drugs, envolizumab, which was launched in 2021, has been innovated in the way of administration, upgrading from intravenous infusion to subcutaneous injection, the whole process can be completed within 30s, and it is currently the only approved subcutaneous PD-L1 monoclonal antibody in the world.
The patient's family made an appointment after uploading the prescription through the online platform, and with the support and coordination of the neighborhood committee, Mr. Liu completed normal treatment even at the worst of the epidemic.
"The subcutaneous injection of immune agents has been developed and marketed, which means that for patients who need long-term medication such as immunotherapy, it is likely that the community hospital near their homes can be administered in the future, which greatly reduces the risk of cancer patients stopping during the epidemic lockdown and can also reduce the inconvenience caused by traveling to and from the hospital."
Professor Huang Chen said that under the premise that safety is guaranteed, for tumor medication, convenience and accessibility are the general trend, and it is also a good choice for tumor patients in the epidemic. The subcutaneous injection of envolizumab provides us with a convenient and effective choice under the epidemic.
"Under the epidemic situation, it is the original intention of every oncologist to protect every tumor patient; the long-term survival of patients with quality is the greatest expectation of every oncologist!" I will continue to fight alongside them. Professor Huang Chen said.
Expert Profiles
Huang Chen
Director of the Department of Gastrointestinal Surgery, The First People's Hospital Affiliated to Shanghai Jiao Tong University
Chief physician, doctoral supervisor, postdoctoral supervisor, doctor of surgery, post-doctoral degree in oncology
Shanghai Pujiang Talents, Shanghai Best Gastrointestinal Surgeons, Shanghai Outstanding Young Medical Talents
Shanghai Science and Technology Daystar, Shanghai Songjiang Leading Talent, Shanghai Jiao Tong University Morning Star Scholar
Member of the Colorectal Tumor Committee of the Chinese Medical Doctor Association
Member of the Gastric Cancer Professional Committee of the Chinese Society of Clinical Oncology
Member of the Young Expert Committee of the Chinese Society of Clinical Oncology
Member of the Anorectal Surgeons Committee of the Surgeon Branch of the Chinese Medical Doctor Association
Member of the Digestive Tract Surgeons Committee of the Surgeons Branch of the Chinese Medical Doctor Association
Member of the Gastrointestinal Stromal Tumor Diagnosis and Treatment Committee of the Surgeon Branch of the Chinese Medical Doctor Association
He is a young member of the Accelerated Rehabilitation Surgery Committee of the Surgeon Branch of the Chinese Medical Doctor Association
Standing Committee Member of Laparoscopic Committee of Gastrointestinal Tumors of Shanghai Anti-Cancer Association
Member of the Gastrointestinal Surgery Group of the General Surgery Branch of Shanghai Medical Association
Member of youth group of General Surgery Branch of Shanghai Medical Association
Member of General Surgeons Branch of Shanghai Medical Doctor Association
Member of the Endoscopic Surgery Group of Shanghai Anti-Cancer Association
He has presided over four projects of the National Natural Science Foundation of China, and a number of projects of the Shanghai Municipal Science and Technology Commission and the Health Commission
He is a review expert of the National Natural Science Foundation of China, the Dissertation of the Ministry of Education, and the China Postdoctoral Fund
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