key: cord-0785532-d4qdd30m authors: Flannigan, Ryan; Sundar, Monita; Weller, Sarah; Ivanov, Nikita; Hu, Monica; Dayan, Marcy; Chen, Charlene; Wu, Eugenia; Goldenberg, Larry; Higano, Celestia S. title: Pearls to Pivoting a Multidisciplinary Prostate Cancer Survivorship Program During the COVID-19 Pandemic date: 2020-06-05 journal: Eur Urol Oncol DOI: 10.1016/j.euo.2020.05.008 sha: 16fab6265d112b2628e38d8f0e3fe7ba685b0e07 doc_id: 785532 cord_uid: d4qdd30m nan The Prostate Cancer Supportive Care (PCSC) program was established in January 2013 in order to provide education and multidisciplinary care for prostate cancer (PCa) patients and their partners and family from the time of diagnosis onward. The program is staffed by experts in sexual health, nutrition, exercise, pelvic floor physiotherapy, psychology, and medical oncology. PCSC has registered 2119 patients over the last 6 yr and has recently expanded to five sites across British Columbia. brief consultations are no longer available, although patients can ask questions via WebEx and are also encouraged to follow up with their own urologist or radiation oncologist. A biopsychosocial sexual medicine approach is offered to PCa patients and partners. Patients must attend the group education session providing an overview of normal sexual functioning, potential changes to sexual function following PCa treatment, and management strategies available. Patients and their partners attend individual clinic appointments every 3-6 mo for 2 yr. Patients may also engage in SHAReClinic [3] , which offers patient-tailored educational content and electronic interaction with a sexual health clinician. Patients and their partners fill out questionnaires that are repeated at specified time points. Individual consultations are offered using Zoom or alternatively through the SHAReClinic. In-person intracavernosal injection therapy (ICI) teaching is temporarily suspended. Instead, patients are provided with written information surrounding ICI and directed to the instructional video on the PCSC website [4] . The exercise module incorporates a group education session [5] to teach the clinical benefits of exercise for PCa survivors. Over 12 mo, four in-person, individualized clinic visits and one telephone appointment focused on exercise counseling and behavioral change are offered. Validated questionnaires establish baseline activity, fitness, barriers and facilitators to exercise, and task self-efficacy related to moderate-and vigorous-intensity exercise. Resting blood pressure, heart rate, waist circumference, height, weight, body mass index, 30-s sit-tostand performance, short physical performance battery, and grip strength are measured at baseline and at 3, 6, and 12 mo. Adaptations to virtual clinic visits include answering the questionnaires on-line and patientreported blood pressure, waist circumference, height, and weight. The clinical exercise physiologist guides the patient in measuring resting heart rate, 30-s sit-to-stand performance, and the short physical performance battery. Grip strength was removed because of the need for specialized equipment. Individual visits are carried out using Zoom. Patient resources and handouts are now available electronically. Limitations exist for precise physical measurements. Monthly group education sessions covering ADT-related side effects are offered to patients and families in person or via WebEx. Patients also receive in-person consultations with an oncology nurse practitioner to address side effects related to ADT. Individual consultations are performed via Zoom or telephone. Patient resources and a summary of the clinical session are available to patients via e-mail after their appointments [6] . After the group education session, a dedicated pelvic floor physiotherapist performs assessments and treatments during three appointments. Patients requiring surgical intervention are referred to a subspecialty urologist. Clinic visits are carried out on Zoom. Use of pelvic floor models is helpful in discussing concepts and anatomy. Follow-up requiring pelvic examination or electromyographic biofeedback is currently postponed until in-office visits are permitted. This module involves individual counseling sessions to navigate patient and caregiver emotional distress related to PCa diagnosis, treatments, and associated side effects. Counseling appointments are performed via Zoom. Strategies are implemented to create a comfortable virtual space for patients. At the outset, the counselor solicits the patient's location and emergency contact information. The clinician must pay closer attention to body language and other cues during virtual visits. Attention towards worsening symptoms of depression or cognitive impairment are especially important during times of social isolation [7] . Additional resources are e-mailed to the patient as appropriate. Monthly education sessions reviewing the biology of metastatic disease, distinguishing metastatic hormone-sensitive from castration-resistant PCa, and treatment options and their related side effects are offered via WebEx by a medical oncologist at one site. The only change for this module is that the sessions are now delivered by an oncology nurse practitioner as the physicians are not available. In British Columbia, different governing health care authorities have unique virtual health platform subscriptions and regulatory requirements. The Virtual Health Department at Vancouver Coastal Health advised the PCSC on platforms meeting the Information Privacy Office requirements. Many patients need additional assistance from PCSC staff to initiate virtual sessions, but most seem to learn quickly. In the beginning, calls to remind patients to fill out questionnaires were required, but patients are now developing this habit. Only a small proportion have declined virtual appointments, although this may change as more people become conversant with Zoom. In order to provide services to patients in remote areas, the PCSC program had already initiated some virtual health options. These ongoing efforts allowed us to pivot quickly to provide the entire program in the socially distanced manner required during the COVID-19 pandemic. Patients have adapted well to virtual visits and appreciate the fact they do not have the expenses associated with in-person clinic visits. Our clinicians have been very creative in J o u r n a l P r e -p r o o f developing new skills and insights into the delivery of virtual care and these will contribute to a new paradigm for the future delivery of virtual health care after the pandemic has passed. The authors have nothing to disclose. World Health Organization. Coronavirus disease 2019 (COVID-19) situation report 100 Introduction to prostate cancer and primary treatment options. Vancouver, Canada: Prostate Cancer Supportive Care Prostate Cancer Canada Managing the impact of prostate cancer treatments on sexual function and intimacy. Vancouver, Canada: Prostate Cancer Supportive Care Exercise for prostate cancer patients. Vancouver, Canada: Prostate Cancer Supportive Care Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care Effect of COVID-19 on the mental health care of older people in Canada