June 24, 2020
How the coronavirus pandemic has enabled Mayo Clinic oncologist Dr. Matthew Goetz ’92 to provide care for breast cancer patients in innovative ways
Dr. Matthew Goetz ’92 is on the front lines of the coronavirus pandemic as an oncologist at the Mayo Clinic. Located in Rochester, Minnesota, Mayo Clinic is the largest employer in the state and was recently recognized as the top hospital in America by U.S. News & World Report.
Goetz is the Erivan K. Haub Family Professor of Cancer Research Honoring Richard F. Emslander, M.D., where he is a Professor of Oncology and Pharmacology and chair of Mayo Clinic Breast Cancer Research. Goetz has practiced at Mayo Clinic since 2003. In addition to seeing hundreds of patients per year, he spearheads groundbreaking research trials funded by the National Cancer Institute.
The coronavirus pandemic has impacted Goetz’s cancer patients in a number of ways. Goetz notes that cancer patients diagnosed during the COVID-19 pandemic have anxiety not only about being diagnosed with cancer, but also have questions about whether or not they can receive treatment that will potentially cure their cancer. Cancer patients also wonder if they are at higher risk of contracting COVID-19 due to suppressed immune systems that may result from taking chemotherapy.
Goetz recognizes these are all extremely difficult questions, and notes that his Wheaton experience—which involved majoring in music and cello performance—provided him with a broad biblical worldview that directly informs the way he approaches patient management and care.
“These are difficult questions for patients, and my faith has absolutely, certainly, been a critical aspect of this,” Goetz said. “Knowing through very uncertain times that God is in control helps me to care for patients and address their concerns and anxiety.”
When the state of Minnesota made the decision to shut down all elective surgeries this spring, Goetz and his team had to figure out how to best serve cancer patients who needed surgery.
“The mandate that all elective surgeries had to be postponed presented quite a problem for patients who have a diagnosis of cancer,” Dr. Goetz says. “We started to have to think about and understand: Who really needed emergent surgery tomorrow, and who could potentially wait for surgery for a few weeks or months?”
Goetz pointed out that a major reason elective surgeries were postponed was because operating rooms across the country contained ventilators that were being prepped to care for COVID patients in ICUs nationwide. By postponing elective procedures, ventilators could be readied for the expected surge in ICU patients requiring ventilator support.
“Ventilators are a critical resource to support COVID-19 patients in intensive care units,” Goetz said. “To be prepared for the surge in ICU admissions, those ventilators had to be mobilized.”
Breast cancer continues to pose a threat to thousands worldwide, even in the midst of a global pandemic. To treat breast cancer patients as effectively as possible, Goetz and his team came up with an algorithm—based on patients’ clinical needs and response to therapies received before surgery—to decide how to best treat them.
“It was quite scary for some patients who were literally ready to go to the OR in early March to all of a sudden receive notice that their operation was going to be postponed,” Goetz said. “We had to come up with careful algorithms for who would and would not go to the OR. We based this on clinical need and response to systemic therapies given prior to surgery.”
Mayo Clinic approaches cancer treatment in a number of ways—one of which is to provide chemotherapy or endocrine therapy to patients before sending them to the operating room, an approach called “neoadjuvant therapy.” Goetz noted that neoadjuvant therapy went from being studied in research trials 10-15 years ago to being accepted as the standard of care at Mayo today. This approach of treating patients with therapy before surgery provided Mayo Clinic physicians an opportunity to strategically care for cancer patients with postponed surgery dates amid the COVID-19 outbreak.
“In many ways, the work of the last 15 years really prepared us for this epidemic,” Goetz said. “Fifteen years ago, nearly everyone went to the operating room first and following surgery, chemotherapy and/or endocrine therapy was administered when needed. However, prior research showed no differences in breast cancer outcomes whether patients received chemotherapy either before or after surgery. Today, we have an extensive track record for using these medications prior to primary surgery. One thing we have learned is that how patients respond to these medications prior to surgery is a very important factor for how patients will do long term.”
In this way, neoadjuvant therapy provided a “bridge to surgery” that allowed Mayo Clinic doctors to treat patients’ cancer while waiting for their postponed surgery dates.
In addition to seeing patients with new diagnoses of breast cancer, Mayo Clinic continued to treat patients with metastatic cancer during the outbreak of COVID-19. Mayo Clinic kept their chemotherapy unit open and available to patients in need. To protect chemotherapy patients with suppressed immune systems, Mayo created strict guidelines for all patients to be screened and tested for COVID prior to coming into the clinic for care. Patients that contracted COVID-19 were able to delay that round of chemo.
To continue to provide care for patients during the pandemic, Mayo Clinic and other centers also introduced video visits for patients through their patient portal. For patients on oral medications that would otherwise come into the clinic for a routine visit, doctors were able to develop and perform video calls.
“We are continuing to do that right now for patients who don't need to come back to the Clinic and need to be managed remotely,” Goetz said. “I have a number of international patients with whom I’m doing video visits, and this has become an important way to provide care to patients that cannot travel.
In addition to treating patients in the clinic, Goetz carries out a number of research projects to investigate new treatment regimens for patients. His laboratory research focuses primarily on developing new drugs for estrogen receptor positive breast cancer, and putting these drugs into the clinic for patients that require investigational therapy. The coronavirus pandemic has provided opportunities for Mayo doctors and researchers like Goetz to come up with innovative ways to enroll and monitor patients in research studies remotely.
“This pandemic has pushed us to think about ways we can practice differently, and of course we need to do that with great caution. With investigational drugs, there needs to be great oversight,” Goetz said. “We’ve been able to do this in ways we thought we couldn't in the past: By shipping out drugs, doing virtual video visits, and having patients do laboratory and full-body scans (e.g. CT scans) locally that are sent to our sites for review. Some of these new ways we practice throughout coronavirus will stick even after it’s gone. It’s truly remarkable and good for our patients long term.”
Beyond patient care at Mayo, Goetz noted that he’s encountered Wheaton alumni in healthcare professions nationwide making an impact in their respective spheres of influence. And he’s grateful that his daughter, Clara Goetz ’21, is an English major at Wheaton.
“It’s amazing as I go across the country, where I’ve met multiple professors that are also Wheaton alumni—to know the effect of Wheaton alumni and the impact they’re having in the world,” Goetz said. “I know the education and environment that students receive at Wheaton is preparing them incredibly well to have an impact for Christ and his kingdom.”-- Allison Althoff Steinke ’11