- Many regional and peri-urban (Illawarra, Newcastle, Central Coast) head and neck cancer patients are nervous about traveling to Sydney during the COVID pandemic.
- Effective surveillance for recurrent and metastatic disease requires careful physical examination. This cannot be completed via telehealth.
- Patients need help to compare the risks of catching COVID to the risks associated with a delayed cancer diagnosis.
- This article includes answers to frequently asked questions plus practical tips for a safer trip.
Here are some frequently asked questions and comments I am hearing from patients:
Contents
I am recovering from cancer. Should I attend my hospital based appointment?
Is it safe to visit the hospital?
I am afraid of catching COVID when I stay in Sydney
But isn’t Sydney a COVID hotspot?
I don’t want to travel on public transport
Are taxis and Ubers safe?
I don’t want to eat out at cafes or restaurants
But Sydney is so busy!
My top tip – practice social brevity as well as social distancing
Anxiety related to cancer recovery can impact your ability to assess risk
Sorry, you can’t convince me
I am recovering from cancer. Should I attend my hospital based appointment?
If I say I need to see you, I need to see you. Much of head and neck cancer surveillance depends on careful physical examination of the head and neck, including examination of the pharynx and larynx, often by flexible fiberoptic nasolaryngoscopy. As your surgical oncologist it is my job to monitor your progress and check for recurrent or metastatic disease. The consequences of missing, delaying or postponing those checks can be critical especially when you consider the extremely rapid and aggressive nature of head and neck cancers.
Is it safe to visit the hospital?
Yes, it is as safe as any other part of Sydney. St Vincent’s Sydney is working hard to keep patients and staff safe from coronavirus. If I did not have confidence in our processes then I would not be turning up to work each day. A couple of things to note:
The hospital has screening protocols which includes checking every visitor’s temperature before they are allowed to enter any building on the campus.
- Everyone on the campus wears a mask – all staff, all patients.
- There are limits on the number of people who can travel together in a lift.
- The number of visitors and visiting hours have been modified to reduce the number of people on the campus.
- The seating in my waiting room has been modified to accommodate social distancing.
- More time has been allowed between appointments to ensure less traffic in the waiting area.
- And in the public hospital all patients with suspected or confirmed COVID-19 are in special isolation rooms to prevent the spread of infection.
I am afraid of catching COVID when I stay in Sydney
Fair enough, it is reasonable for you to be afraid of catching coronavirus. But cancer does not take a rain check because of a pandemic. Delaying trips to Sydney for medical appointments until after the pandemic has passed may result in a delayed diagnosis of recurrent or metastatic disease. You may be afraid of COVID but my fear is that your long term survival and quality of life may be compromised in the process. For tips on how to conduct a risk analysis and comparison of the risks of COVID versus delayed diagnosis please see my earlier article.
But isn’t Sydney a COVID hotspot?
The term hotspot can be very misleading. It is a term used by the media to refer to a geographically based cluster. The more accurate terminology is “areas identified requiring increased surveillance”.
When making a decision about traveling to Sydney it is worth ensuring that you have the most up to date information about known, active COVID cases in the specific parts of Sydney you need to visit. The geographic area of Sydney is 12,368 km². The population is 5.23 million people. As I write this blog the number of identified active cases is less than one hundred. You can make an informed, up to date decision by visiting the NSW Health Map of NSW COVID-19 cases and testing by postcode. It is unlikely your trip to Sydney will include a tour of every postcode. For example, these are the case numbers in Darlinghurst and surrounding suburbs (at time of writing):
| Suburb | Post Code | Active Cases | Population |
|---|---|---|---|
| Darlinghurst, Surry Hills, Taylor Square | 2010 | 1 | 27,734 |
| Kings Cross, Elizabeth Bay, HMAS Kuttabul (including Potts Point) | 2011 | 2 | 21,196 |
| Centennial Park, Moore Park, Paddington | 2021 | 0 | 15,313 |
Compare that to other parts of NSW outside the Sydney area;
| Batemans Bay, Benendarah, Batehaven | 2536 | 3 | 17,716 |
| Airds, Ambarvale, Appin | 2560 | 14 | 76,521 |
Source: ABS 2016 Census QuickStats
I don’t want to travel on public transport
Some patients are lucky enough to be able to drive or have a friend or family member do the driving for them. Others have no choice but to use public transport. If this applies to you then there are several things you can do to reduce your risk. This list of tips and additional information can be found on the NSW Transport COVID-19: Travel advice and information page:
- Wear a face mask
- Avoid peak times
- Check capacity before you travel
- Follow hygiene guidance
- Look for the green dots
- Practice physical distancing
Are taxis and Ubers safe?
Point to point transport service providers such as taxis and other driver services want your business and are working hard to maintain high hygiene standards. The NSW Government has recently introduced new free COVID clean-up kits for point to point drivers and established eight vehicle sanitation stations across parts of NSW. Typically drivers ask you to sit in the back seat of the car and to avoid paying with cash.
I don’t want to eat out at cafes or restaurants
If you are making a return trip to Sydney in the same day then you can pack the provisions you need and avoid eating at any commercial venues. If you need to stay overnight then the good news is that there is plenty of self-service accommodation near the hospital such as the Quest Potts Point which has apartment style rooms with kitchen facilities. You can pack all your food and drink requirements before you leave home. Alternatively, Quest will organise room service or meet food delivery service personnel in the foyer and deliver your food to your door. Here is a list of changes Quest and similar accommodation providers have introduced to help customers feel more at ease:
- Room cleaning and service on request – you can choose to have no one enter your room during your stay
- Room service via request
- Social distancing restrictions in the foyer, lift, roof terrace and all shared areas
- No food delivery drivers allowed to deliver to guest rooms. Instead Quest staff will receive your delivery at reception and deliver it to your door. This ensures they have a complete record of all guests, staff and visitors entering the building and numbers are kept to a minimum.
But Sydney is so busy!
But probably not as busy as you remember. Many patients reluctant to travel to Sydney think of Sydney as busy and bustling. But this image is currently out of date. Pedestrian and vehicle traffic is much lower compared to pre-COVID levels. This is certainly true around our hospital, especially as we have reduced visiting hours and the number of people who can accompany patients to appointments. Here is a link to an Opal chart which demonstrates changes in train network patronage which is down 50% on the same time last year Train Patronage Monthly Opal Trips. This data is also consistent with the Citymapper Mobility Index which shows the percentage of city traffic moving compared to usual traffic levels. Last week (week ending Sun 30th August) only 40% of Sydney was moving compared to normal.
My top tip – practice social brevity as well as social distancing
Remember the formula:
Successful Infection = Exposure to Virus x Time
When we are busy learning about new cases and clusters in the news we typically pay attention to the geography and the type of venue but very little attention to the amount of time infected people have spent there. It is important to remember that the longer you spend close to an infected person the greater your chances of infection.
The vast majority of infected people met the virus while in close proximity to an infectious individual for an extended period of time. Prolonged exposure not only results in a much greater chance of being infected, but it also makes it likely that one will be heavily infected (a ‘high viral load’) – a major factor in determining the severity of any subsequent illness.
For more information I recommend you read his article here.
Anxiety related to cancer recovery can impact your ability to assess risk
Undergoing treatment for head and neck cancer is a very difficult process for patient and carers alike. This is abundantly clear from the excellent Head and Neck Cancer Video Series produced by broadcaster and cancer survivor Julie McCrossin, especially the videos Innovations in Managing Distress & Recovery. And the pandemic is compounding anxiety further. If you are struggling to balance the risks of visiting Sydney for ongoing surveillance with your fear of contracting COVID-19 then you may find it helpful to discuss your fears with your general practitioner, psychologist or other health professionals involved in your care.
Sorry, you can’t convince me
Okay, okay, I’m disappointed, and I understand your reluctance, but I also need to pass on a warning. If you choose not to maintain the post treatment cancer surveillance regimen I have prescribed then the statistics I quoted about long term survival at the start of our doctor-patient relationship begin to shift. I would prefer not to use fear to scare people into action but I cannot with a clear conscious allow potential consequences go unmentioned. If you refuse to attend a face-to-face consultation I will do my utmost to maintain your care via telehealth. But if I need to scope you I need to see you, and the only way I can do that is if you come to see me in my clinic at either Griffith or Darlinghurst.
