Challenges Facing the Cancer Community During COVID-19

COVID-19 is the single most unexpected challenge of 2020, pushing our world and economies to the brink. The impact on cancer is chaotic. Managing cancer patients during the pandemic poses a variety of unique circumstances and issues for patients as well as caregivers and oncologists, including access to care, timing of treatments, resource availability and risk reduction.

Representing a particularly vulnerable, high-risk and frail population, the cancer community is learning there are many parallels between dealing with cancer and living through a pandemic like COVID-19. Similar to a diagnosis, this pandemic causes panic and fear. Patients feel out of control with disruptions in every part of their “normal” lives. Never having experienced something like this before, the unknown can really be stressful and emotionally taxing for everyone, including physicians. 

For oncologists and healthcare providers, navigating the uncertainties of COVID-19 is their biggest worry, hence the need for planning is crucial. Physicians’ overarching goal is to continue to provide compassionate, safe care for their patients. So today, the medical community needs to think ahead to best care for them. Having conversations now with their patients, even as the situation evolves, is key. Additionally, in the midst of uncertainty, it is important to reassure patients that their doctors remain available and are here to treat and manage their cancer. Patients need to feel unconditionally supported.

The pandemic has only complicated cancer treatment for patients and, in an already challenging reality, COVID-19 will now be one more potential daunting diagnosis with which to be concerned. COVID-19 symptoms can include fever, cough and respiratory issues. It can be difficult to determine whether these signs indicate a coronavirus infection or an oncology treatment-related issue. However, erring on the side of caution, in a cancer patient, if there are respiratory symptoms and fever, there is a high index of suspicion for COVID-19.

To help patients navigate this unknown era, physicians could consider triaging patients with respiratory symptoms to reduce exposure to other patients and staff. If a patient is receiving immunosuppressive therapy, a fever is considered a medical emergency, regardless of the current pandemic. In these cases, to avoid going directly to the emergency room and exposing themselves, patients could call their doctor first; symptoms can be assessed, hence determining the best moment and place for evaluation and management. All “under-control” patients can usually be safely rescheduled or delayed until a safer time, or transitioned for follow-up care via telemedicine. Telemedicine can offer a preventive strategy to keep vulnerable cancer patients safe and under an effective treatment. Nevertheless, scans to evaluate patients’ therapy response should probably be conducted to avoid potential ineffective treatments. It is critical to take precautions that help minimize or avoid exposure, and limiting traffic in the hospital or clinic definitely helps.
Looking more deeply, cancer patients are going through tough times as they face serious unknown factors, which is taking an emotional toll, as well as real issues with daily living. To help deal with the uncertainty of the situation, cancer patients need to plan ahead as much as possible, considering in advance such things as the steps they should take if they or a caregiver becomes ill, how they can obtain food if they have to shelter in home, and how to maintain a “healthy” routine while in isolation.  Moreover, to mitigate exposure risk, patients with active cancer should practice extreme distancing from others. This means not going out in public, as well as educating family members and people with whom they have contact, to ensure they are also taking strict precautions. 

We do not know what is going to happen in the future, the information about the virus is constantly evolving, and many of us feel helpless as we watch what is happening in our families, our communities and around the world. It is a scary and unfamiliar place. Like cancer, this pandemic has again changed and shattered cancer patients’ lives as well as any of their projections and plans for the near future. Today, everyone is facing the stress and anxiety brought into our lives by COVID-19. However, one of the cruelest aspects, albeit unintentionally, has been the necessary isolation, whether hospitalized or not. Human beings are social by nature, and being away from those we hold dear and not being able to experience life, in general, is beyond difficult. This affects us emotionally, physically, mentally and even spiritually. We know there has been a vast number of patients in hospitals under either care or dying without a loved one there to hold their hand. We are appreciative of the selflessness of the healthcare workers who are stepping in to be there and it is heartbreaking for all involved.

The reality is this connection deficit may exacerbate the negative effects of stress and diminish the physical and emotional resilience that patients will need to fight the COVID-19 virus and cancer. Social distancing, in my view, is the wrong concept, especially in these cases. It should be named “physical distancing” instead. You should not be out of touch from the people you care for and about; emotional distance can be detrimental during these times. Yes, patients should stay home as much as they can, have physical contact with as few people as possible, but they do need to keep in touch, virtually, with their loved ones to warm their hearts and souls. The warmth of compassion and care from a family member or a friend is indeed the very best medicine. Loneliness is frequently the cause as well as the effect of a decline in a patient’s condition.

Patients can still, and should, find ways to talk to people and share their feelings, to establish a strong support network. Trying social networking through video calls or chats can build strong secure bonds. Making an effort to reach out to loved ones, friends, acquaintances or online support groups during this time is crucial for mental and emotional sanity. The emotional power and strength that connections can build is amazing.  

Like cancer, this pandemic has slowed our pace and forced us to reevaluate how we spend our time. It forces us to focus on what really matters in our lives. It forces us off the hamster wheel of our crazy, busy, "important" lives and slows down our gait. Like living through cancer, when we get through this pandemic, we will need to decide what lessons we want to learn from it and how we want to live differently. 

Before we can really think about the restarting of “normal” life post-COVID-19, we have to figure out how to live each moment in the midst of the pandemic. Nothing is certain about the future we worked so hard to plan for and believed we would experience. Perhaps, we even took for granted a future with all the good things we had in mind.

The truth is we cannot control cancer or pandemics, but we can choose how we live through the process.