Prior to the coronavirus disease 2019 (COVID-19) pandemic, telehealth was rarely utilized for oncologic care in metropolitan areas. Our large New York City based outpatient breast/gynecologic cancer clinic administered an 18-question survey to patients from March to June 2020, to assess the perceptions of the utility of telehealth medicine. Of the 622 patients, 215 (35%) completed the survey, and of the 215 respondents, 74 (35%) had participated in a telehealth visit. We evaluated the use of telehealth services using the validated Service User Technology Acceptability Questionnaire. Sixty-eight patients (92%) reported that telehealth services saved them time, 54 (73%) reported telehealth increased access to care, and 58 (82%) reported telehealth improved their health. Overall, 67 (92%) of patients expressed satisfaction with the use of telehealth services for oncologic care during the COVID-19 pandemic. Telehealth services should be carefully adopted as an addition to in-person clinical care of patients with cancer.

This study evaluated the mental health and cancer treatment-related impact of the first wave of the COVID-19 pandemic on patients with breast and gynecologic cancers. An 18-question survey was administered in June 2020 at a New York City-based cancer center to assess the quality of life (QOL) and overall health (OH) during both the pandemic time period from March 1, 2020, through June 30, 2020, and the pre-pandemic period (prior to March 1, 2020). Survey questions were answered on a 5-point Likert scale and a 7-point EORTC QLQ-C30 QOL scale. Differences in mean QOL and OH scores were evaluated using a paired t-test. QOL and OH were significantly worsened by the pandemic, with significant increases in anxiety, depression, and mood swings.

A 66-year-old woman with pre-diabetes and hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer was started on fulvestrant, and referred to endocrinology prior to initiation of alpelisib. Because of anticipated possible hyperglycaemia, and the woman's reluctance to start fingerstick glucose monitoring, a continuous glucose monitor (CGM) was prescribed for safety. CGM data revealed the rapid onset of hyperglycaemia over the first 2 weeks of alpelisib treatment with nocturnal hyperglycaemia (Fig. 1). Hyperglycaemia occurred in the first 6 h after each dose was administered, and after 2 weeks average daily glucose levels were three times higher than baseline.Questions 1. What is alpelisib? Why does alpelisib cause hyperglycaemia?3. How is alpelisib-induced hyperglycaemia treated? FIGURE 1 Two-week continuous glucose monitoring data from woman with breast cancer the day after initiating alpelisib. The woman took alpelisib daily at 6pm. Daily average (Avg) glucose readings are shown.ª 2020 Diabetes UK

Background: Prior to the COVID-19 pandemic, telehealth was rarely utilized in providing oncologic care. At our large NYC based outpatient clinic, telehealth services were quickly adapted for utilization for visits that could be completed outside of the clinic, in order to limit patient exposure to the novel coronavirus. This survey-based study aimed to assess patient perceptions of the utility of telehealth in their oncologic care during a time of national crisis. Methods: A 34-question survey was administered to all patients receiving care at our outpatient center between March 1, 2020 and June 30, 2020 including those who had visits delayed or cancelled during this time period. Of the 622 patients who received the survey via RedCap online or physical copy in clinic, 211 (34%) completed the survey. For evaluation of the Telehealth provided during the pandemic, we have adapted the validated SUTAQ (Service User Technology Acceptability Questionnaire) which assesses patient acceptability of telehealth via measures of accessibility, comfort, usability, privacy and security, confidentiality, satisfaction, convenience and health benefits with in-home telemonitoring. Results: All patients who completed the survey had a history of DCIS/ADH/LCIS, invasive breast cancer or gynecologic malignancy. Of the total survey respondents, 72 (35%) participated in a telehealth visit during the four month evaluation period. For all survey questions, “agreement” was considered if the patient selected mildly, moderately or strongly agreed on the SUTAQ scale. Of patients who participated in telehealth visits, 66 (92%) felt that the telehealth saved them time, 52 (72%) felt it increased their access to care and 56 (81%) felt it helped improve their health. Only 8 (12%) of patients felt that telehealth made them feel uncomfortable and 4 (6%) worried about confidentiality related to telehealth usage. Overall, 65 (92%) of patients were satisfied with the telehealth services they received and 64 (89%) would recommend these services to people with similar health conditions. Twenty-five (35%) felt that telehealth can be a replacement for their normal health care and 67 (93%) reported it could be a good addition to their care. Fifty-four (76%) would be interested in participating in telehealth visits in the future. Conclusions: Overall, patients expressed satisfaction with the use of telehealth services for oncologic care during the COVID pandemic. Although most patients do not feel that this is a suitable replacement for their in person care, they expressed that it was certainly a good addition to their care. A large majority of patients expressed interest in continuing to participate in telehealth visits in the future. Telehealth services should be carefully adapted as a long term addition to the in person clinical care of patients with cancer. These services should be utilized to optimize patient satisfaction, save time and increase access to care, especially among high risk patients. Citation Format: Brittney S Zimmerman, Danielle Seidman, Natalie Berger, Krystal P Cascetta, Michelle Nezolosky, Kara Trlica, Alisa Ryncarz, Caitlin Keeton, Erin Moshier, Amy Tiersten. Patient perception of telehealth services for breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-08.

Background: The 2019 novel coronavirus has become a world-wide pandemic which has disproportionately affected patients undergoing treatment for cancer. Within the field of medical oncology, dramatic changes in practice patterns occurred rapidly to accommodate transition of resources, while maintaining safety of oncology patients. At our large cancer treatment center in NYC, there have been significant changes in the delivery of surgical and medical treatments, with a shift towards neo-adjuvant therapy, oral chemotherapy administration, extended ovarian suppression, as well as closure or delay of many clinical trials. This study aims to determine the impact of the COVID-19 pandemic on the perceived oncology related care of patients with breast/gynecologic cancers as measured by survey results, as well as the impact on quality of life (QOL) and overall health (OH). Methods: A 34-question survey was administered to all patients receiving care at our outpatient center between March 1, 2020 and June 30, 2020. Of the 622 patients who received the survey via RedCap online or physical copy in clinic, 211 (34%) completed the survey. Survey questions were answered on a 5-point Likert scale and 7-point EORTC QLQ-C30 QOL scale. There is no existing COVID specific questionnaire, therefore we designed several original questions. Difference in mean QOL scores prior to the pandemic and at the end of the response period were evaluated using a paired t-test. Results: Of the 184 patients who responded to the question about their diagnostic history, 54 (30%) of patients had a history of DCIS (ductal carcinoma in situ)/ADH (atypical ductal hyperplasia)/LCIS (lobular carcinoma in situ), 94 (51%) had a history of invasive breast cancer, 6 (3%) had a gynecologic malignancy and 30 (16%) responded “other.” Due to the COVID pandemic, 121 patients (58%) reported that they had a medical oncology visit cancelled, delayed or changed from in-person to video telehealth. Of the 156 respondents that had endocrine therapy or chemotherapy scheduled, 26 (17%) reported a cancellation or delay of their medical treatment. As a result of the pandemic, 186 (91%), 110 (57%) and 119 (60%) of patients reported new or increased levels of anxiety, depression and mood swings, respectively. A minority of patients (n=39, 19%) felt that the COVID pandemic negatively impacted their cancer care, and a majority (n=151, 73%) felt that the changes in delivering cancer care during the pandemic were in their best interest (somewhat/strongly agree). Overall, QOL was reported with a mean (SD) of 5.5 (1.3) out of 7 (1=very poor, 7-excellent) prior to the pandemic, and 5.1 (1.4) out of 7 by the end of the pandemic period (March 1 through June 30, 2020); p<0.0001. Fifty-three (26%) of patients reported having excellent (7) QOL prior to pandemic which decreased to 32 (16%) after the pandemic period; p<0.0001. Overall health was reported with a mean (SD) of 5.3 (1.3) out of 7 prior to the pandemic, and 5.1 (1.3) out of 7 by the end of the response period; p=0.0368. Conclusions: The COVID-19 pandemic required major changes in the care of patients with breast and gynecologic cancer in order to balance continued oncologic care with safety of COVID exposure. In our study population, 17% of patients at our center reported a delay or cancellation in their medical treatment and 58% reported a change to their medical oncology visits. Despite this, only 19% of all patients felt that the changes in care delivery as a result of the COVID-19 pandemic negatively impacted their cancer care, and the large majority (73%) felt that the changes were made in their best interest. The QOL for our patients was significantly affected by the pandemic, with increases in anxiety, depression and mood swings, and a numeric decrease in QOL and OH. Citation Format: Brittney S Zimmerman, Danielle Seidman, Natalie Berger, Krystal P Cascetta, Michelle Nezolosky, Kara Trlica, Alisa Ryncarz, Caitlin Keeton, Erin Moshier, Amy Tiersten. Patient perception of breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-02.