Caring for Patients With Cancer in the Face of Self-Vulnerability During the COVID-19 Pandemic | Oncology | JAMA Oncology | JAMA Network
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Comment & Response
August 27, 2020

Caring for Patients With Cancer in the Face of Self-Vulnerability During the COVID-19 Pandemic

Author Affiliations
  • 1Department of Radiation Oncology, New York Proton Center, New York, New York
JAMA Oncol. 2020;6(10):1639-1640. doi:10.1001/jamaoncol.2020.3330

To the Editor We commend Dr Olazagasti for sharing her personal experience with pregnancy during this unprecedented time.1 For many health care workers, the pandemic has incited an innate call to arms and reminded us with great acuity why we chose medicine, but it also kindles concerns of protection for family, including unborn children.

As a radiation oncologist in the pandemic epicenter in New York City (NYC), my (J.I.C.) initial instinct was to answer calls to volunteer on coronavirus disease 2019 (COVID-19) wards of NYC’s overrun hospital systems. However, I also just discovered in December that I would be a first-time mother. With a high-risk pregnancy and uncertainty of my ability to carry again, I felt newfound protectiveness for the small heartbeat inside of me, a novel feeling I could not ignore.

I have read with bated breath accounts of the virus’s effects on pregnant women and babies. In addition to reports discussed by Olazagasti and Seetharamu,1 other series not mentioned in the editorial are worth highlighting. As the pandemic inevitably reached home, 2 NYC hospitals reported on 43 pregnant women with COVID-19, including 20% with severe/critical disease.2 Additionally, Dashraath et al3 found that pregnant women and fetuses are high-risk populations, as pregnant women are more susceptible to infection and more likely to rapidly progress to respiratory failure, and fetal complications of COVID-19–infected women include increased incidence of intrauterine growth restriction, preterm birth, and neonatal death.

At New York Proton Center, despite enacting early conservative measures to protect staff and patients, I watched our fears realized as 7 staff tested positive for COVID-19 in the last 2 weeks of March alone, along with 16 patients affected by the virus. Although not on the front lines of COVID-19 floors, our mission to patients with cancer remains critical. Patients with cancer are more likely to contract and die of COVID-19,4 and radiation treatment delays from restricted capacity owing to pandemic-induced staffing limitations directly decrease patient survival.5 Thus, I have decided to continue working at the same pace as my colleagues, caring for these vulnerable patients. Ultimately, the decision for every practitioner is a deeply personal one. I weighed the desire to support my center and patients over the thoughts of what might befall my future—now defined as my unborn child—should I contract this relentless virus. While not knowing the “right” answer makes this situation even more frightening, I know that by caring for patients with cancer and fighting alongside my colleagues, I am gaining fulfillment in my heart and spirit that I will carry with me and hopefully pass on some day to my baby girl.

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Article Information

Corresponding Author: J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, 225 E 126th St, New York, NY 10035 (ichoi@nyproton.com).

Published Online: August 27, 2020. doi:10.1001/jamaoncol.2020.3330

Conflict of Interest Disclosures: None reported.

Additional Contributions: This letter reflects the first-person account of Dr Choi. Dr Simone is Dr Choi’s husband and colleague at the New York Proton Center and made contributions to the writing and review of the letter.

References
1.
Olazagasti  C, Seetharamu  N.  Facing a pandemic while pregnant.   JAMA Oncol. 2020;6(7):985-986. doi:10.1001/jamaoncol.2020.1652PubMedGoogle ScholarCrossref
2.
Breslin  N, Baptiste  C, Gyamfi-Bannerman  C,  et al.  COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals.   Am J Obstet Gynecol MFM. 2020;2(2)(suppl):100118. doi:10.1016/j.ajogmf.2020.100118PubMedGoogle Scholar
3.
Dashraath  P, Wong  JLJ, Lim  MXK,  et al.  Coronavirus disease 2019 (COVID-19) pandemic and pregnancy.   Am J Obstet Gynecol. 2020;222(6):521-531. doi:10.1016/j.ajog.2020.03.021PubMedGoogle ScholarCrossref
4.
Liang  W, Guan  W, Chen  R,  et al.  Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.   Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6PubMedGoogle ScholarCrossref
5.
McMillan  MT, Ojerholm  E, Verma  V,  et al.  Radiation treatment time and overall survival in locally advanced non–small cell lung cancer.   Int J Radiat Oncol Biol Phys. 2017;98(5):1142-1152. doi:10.1016/j.ijrobp.2017.04.004PubMedGoogle ScholarCrossref
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