Navigating Kidney Cancer Treatment During COVID-19

Mike Kelly, 67, was diagnosed with stage IV clear cell renal cell carcinoma (RCC) last fall and had a nephrectomy to remove his left kidney at MD Anderson Cancer Center (MDACC) in Houston, Texas soon after. Kelly also began participating in a clinical trial early in 2020 for which he takes the tyrosine kinase inhibitor Cabometyx® (cabozantinib).

Already attentive to news about the novel coronavirus COVID-19 and his increased risk as someone over age 60 with cancer and a compromised immune system, Kelly began modifying his behavior even before Houston residents were officially advised to distance from each other. He stopped going to his office where he works as an attorney, opting to work from home, and eventually moved from his home into the home where his daughter, son-in-law, and three grandchildren live.

In mid-March, his visits to MDACC changed as well and became more regimented as the hospital put protective protocols in place.

“I wore gloves and a plain mask, like you’d buy at the hardware store,” Kelly said about one of his previous visits to MDACC. “Before, only the people who might have a cold were wearing masks but since coronavirus, everyone is wearing a mask”

Entry into the hospital required a questionnaire about travel and contact with others who may have coronavirus, Kelly said, as well as checking body temperature. He found waiting rooms were kept sparsely populated to maintain distance. There were always people ready to direct him to his intended destination. Kelly observed staff frequently changed gloves and wiped down surfaces with cleaners, including things like computers and keyboards, which he didn’t recall them doing previously.

“It was orderly and methodical,” he said. “I was paying attention to things like distancing and handling things. People must be dealing with some level of stress because of being exposed to other people but they didn’t show it. They were polite and caring and I felt a keen appreciation for them being there.”

Because Kelly is participating in a clinical trial, he needs CAT scans and to have blood drawn on a regular schedule. His care team try to stack such appointments to minimize Kelly’s hospital visits. Even for general appointments, things like checking temperature or blood pressure still require close contact.

“I felt ok,” Kelly said about such contact. “[People] gave no impression that I was not to be treated well and well cared for. They were not cavalier… they did what they had to do and they didn’t linger.”

Speaking with his oncologist, Dr. Nizar Tannir at MDACC, about how he is doing and how the clinical trial is going is a little different when done from some distance across an exam room, Kelly said, but he is still generous with his time.

And through these new conditions and protocols, Kelly and his care team still need to manage his cancer. That meant adjusting the cabozantinib dose from 60 mg to 40 mg to bring the fatigue, diarrhea, dry skin, and a few other side effects to manageable levels. That meant scheduling a telephone appointment with a nutritionist to adjust Kelly’s diet based on his treatment and single kidney. And continued communication will be important to make sure Kelly can continue to get effective treatment and manage his energy in order to spend time with his family.

“Since I’ve had more energy, I’ve cooked meals for everyone and spent more time playing around with my grandchildren [who are 4 years, 2 years, and 6 months old],” Kelly said. “They’re big puzzle builders, they read stories, we’ve gone on a few walks… We went on a walk to a little bridge near the house that’s green and has trees. Today we saw five turtles and one was really large! The 6-month-old doesn’t delight in the turtles, but the two older girls do.”

The presence of coronavirus may have very practical impacts for cancer care, but Kelly said it also heightened his awareness of others in specific ways too.

“Certainly, there’s a sense of care for the people impacted directly by the illness, or who have economic issues, or who are separated from family. Just like everybody else, I’m concern about getting through this and recuperating with minimum loss of life and illness and difficulty. There’s a lot of sacrifices, especially from our caregivers who expose themselves to even more risk. So I try to thank everybody.”