The present challenges COVID-19 poses to the healthcare infrastructure are bringing out the best in our medical professionals. Steven K. Libutti, MD, Director of the Rutgers Cancer Institute of New Jersey (CINJ) and Senior Vice President of Oncology Services at RWJBarnabas Health, explains to Steve Adubato, PhD, how the pandemic has ushered in unprecedented changes. Rutgers University, including the Cancer Institute of New Jersey, has been able to leverage its infrastructure and intellectual capabilities to gear up quickly for COVID-19 research. The following is an edited transcript of an MDAdvantage podcast with Steve Adubato and Dr. Steven Libutti that was recorded on April 9, 2020.
ADUBATO:Dr. Libutti, how are you and your colleagues holding up during this crisis?
DR. LIBUTTI: Thank you for asking, Steve. We’re holding up. I am extraordinarily fortunate to be surrounded by an amazing team of superheroes. They are working extremely hard under very challenging, and in many ways, unprecedented circumstances. I’m just humbled every day by the amazing job that they’re doing on behalf of the patients they serve. We’re hanging in there. We’re doing well, and I hope you and all of your team are doing well as well.
ADUBATO: We are, and thank you for asking. Right now, so much focus, appropriately so, is on patients dealing with COVID-19. But the question has to be asked: What are the challenges associated with managing patients with cancer during an infectious disease pandemic?
DR. LIBUTTI: It absolutely presents challenges. Cancer isn’t taking a holiday to let us make our way through the pandemic. So, we still have the mission and the obligation to take care of our patients with cancer at the exceptional level that we try to care for them each and every day. Some of the challenges come from the fact that cancer care is a very hands-on situation where you have an emotional bond with your patient and your patient’s family, and it’s our practice to be very engaged in an interactive way with our patients. The first major challenge in a pandemic and infectious disease crisis is that you have to distance to protect the patient, because patients with cancer are more vulnerable to the morbidity and mortality of COVID-19. Those who are immunosuppressed may very well be more susceptible to infection. Therefore, for the safety of the patients we care for, we’ve had to leverage technology. We’re using more telemedicine for follow-up visits with our patients, and even for initial visits, in order to make certain we’re still evaluating patients with cancer as best we can, but at the same time protecting them. But there are situations (like patients on active therapy, getting chemotherapy or getting radiation therapy) where obviously you can’t do that remotely. The pandemic challenges our ability to continue to deliver that care, keep those patients safe and keep our workforce safe during those encounters. We have things in place to do that. We use personal protective equipment. We use social distancing. We have extended our hours for caring for patients so we have fewer patients at any given time, and we’ll do some other things to try to create distance between visits and between patients. The main challenges are our inability to do what we ordinarily do and love to do (such as physically wrap that blanket around the cancer patient), and for their own protection, we have to do more distancing than we usually are comfortable with.
ADUBATO: Have any oncologists in your system been diverted to COVID-19 acute care teams? And if so, what impact did that have?
DR. LIBUTTI: We’re working very closely and in concert with our hospitals and the other healthcare teams and providers that are facing the pandemic and providing direct care to patients with COVID-19. We have volunteered to have our providers and staff available to serve on these various teams. So far, the hospitals across our system have not needed to call on our cancer providers, although they stand ready to help. We have had some of our nursing staff support some of these efforts, but we’re very careful with respect to that. While we are absolutely available, and want to be to helpful with the challenges of the pandemic across the workforce, we’re still careful to make certain that appropriate personal protective equipment is used, and there is appropriate separation of those who are caring for patients with COVID-19 and those who are caring for patients with cancer. We want to make sure that there isn’t cross contamination in how we’re structuring things. So far, we’ve been able to do that. It requires communication and partnership, and we are fortunate that within our system and the hospitals within our system, the cancer program works seamlessly with hospital CEOs, administration, Chief Nurse Officers, etc. to make sure that we can meet the needs of the pandemic, while at the same time continuing to care for our patients with cancer. Right now, at least, we are continuing to provide that care. We are still engaged fully in caring for and treating patients with cancer despite the challenges.
ADUBATO: Is the Rutgers Cancer Institute that you direct involved in COVID-19 research?
DR. LIBUTTI: We are very much engaged now with respect to leveraging our infrastructure and intellectual capabilities at the Cancer Institute, and Rutgers at large, in focusing on SARS COV-2 and COVID-19. Specifically, as a National Cancer Institute (NCI)- designated comprehensive cancer center, we have very well-structured and robust clinical trial operations. It became evident to me early on through conversations with my non-oncology colleagues at Rutgers that there was an urgent need to launch clinical trials to test agents that appear to have promise in treating patients with COVID-19 in Europe. We marshalled resources at the Cancer Institute and designed, wrote and launched a randomized clinical trial comparing hydroxychloroquine sulfate and azithromycin to hydroxychloroquine sulfate and then to a control arm receiving supportive care in an effort to try to answer the question definitively: Are these agents effective? That is a trial being run by the Cancer Institute and supported by Cancer Institute resources and some very generous philanthropy from individuals, as well as corporations. But I think it’s the strength of our infrastructure as a cancer center and the partnership we have with the Institutional Review Board (IRB) and the U.S. Food and Drug Administration (FDA) that allowed us to get that trial written and launched within 10 days. It’s a personal best that I don’t think I’ll ever break in terms of speed from trial concept to the first patient enrolled, but that’s one area where we are focusing our resources.
“A lot of research is happening at the bench and clinically at Rutgers, focused on the pandemic, and what we can do to help gain information and hopefully advance treatments and prevention strategies as quickly as possible.”
Another example from the Cancer Institute perspective is that we do a lot of work on cancer immunology and cancer immunotherapy, and we’re very interested in developing immune-based strategies for treating cancer. We focused some of the strength there, both intellectual strength from our researchers as well as resources, to focus those same immunology and immunotherapy studies now on SARS COV-2 and COVID-19 to perhaps develop new ways of vaccinating folks against the virus. We are also focused on new therapeutic strategies to mitigate some of the immune side effects we’re seeing. Our own immune systems fighting SARS COV-2 can actually cause some of the morbidity from COVID-19, and so we’re looking at that.
Rutgers, more broadly, is engaged in many efforts in this pandemic. It has created a center within our Institute for Infectious and Inflammatory Diseases focused on COVID-19 and led by Dr. David Alland who, some may be aware, developed the 45-minute SARS COV-2 test. That center is very focused now on supporting research specifically in this area, and our investigators involved with that institute actually launched a healthcare worker study in which they enrolled 700 healthcare workers and other controls within a week and tested all of them for SAR COV-2. The investigators will now follow them to understand how often healthcare workers are becoming infected on the frontlines and what we can do if they do become infected. A lot of research is happening at the bench and clinically at Rutgers, focused on the pandemic, and what we can do to help gain information and hopefully advance treatments and prevention strategies as quickly as possible.
ADUBATO: Will we ever be able to go back to “normal” after recovering from COVID-19? Or do you expect to see significant changes in the way medicine is practiced in the future?
“I think the new normal, if there is any silver lining in all of this, might make us better positioned to be even more effective in caring for our patient populations in the future.”
DR. LIBUTTI: I think it’s a very fair assessment to say that we will never go back to what was “normal.” A real-world example of change that I can give you that comes as a result of the pandemic involves the cancer programs across the state of New Jersey—not just within an individual health system. All of the major cancer programs in the state now get on a WebEx call every Friday morning, and we’re sharing best practices and what efforts we’re making in research and clinical trials. We’re sharing how we’re handling patient safety and how we’re handling our provider and our staff safety. This kind of collaboration that’s happening in the face of the pandemic is making all of us stronger and better at what we do. It’s certainly my hope that that kind of intersystem cooperation and collaboration will continue after the pandemic, making us better positioned to deliver even better care and service to our patients, and to be that much more prepared when we face something like this again. I agree there is no going back to what had been the norm, but I think the new normal, if there is any silver lining in all of this, might make us better positioned to be even more effective in caring for our patient populations in the future.
ADUBATO: Dr. Libutti, I cannot thank you enough for joining us.
DR. LIBUTTI: Thank you, Steve.