Cancer Patients Still Need Human Connection During COVID-19
NEW YORK (Reuters Health) - As social-distancing guidelines continue during the pandemic, cancer patients need quality care and ongoing connection with others, oncologists say in a pair of new editorials.
Many patients have felt particularly isolated in recent months, especially because friends and family may not be able to travel with them to appointments, the authors write in JAMA Oncology.
"Though most of us understand the necessity for social distancing, the pandemic has certainly shed new light on how valuable face-to-face human interaction can be," said Dr. Kiri Cook, who co-authored one of the pieces and directs radiation-medicine research at Oregon Health and Science University in Portland.
The pandemic has affected mental health worldwide, with increases in anxiety, depression, stress, insomnia and fear, she said, which has exacerbated the psychological distress that cancer patients already feel.
"For people with cancer in particular, a strong connection with their treatment team can even be therapeutic in the way it decreases anxiety and promotes adherence to treatment," she told Reuters Health by email.
Dr. Cook and co-author Dr. Jenna Kahn, also at OHSU’s radiation-medicine department, write about the delicate balance between minimizing patients' contact with the healthcare system and potential COVID-19 exposure, providing quality care and helping patients to feel less isolation as they go through treatment this year.
In-person visits, for instance, are often limited to the cancer patients themselves, and family and friends often aren't allowed to be there to offer support as patients receive information about their diagnosis, adverse effects of treatment or changes in the treatment plan.
During those appointments, doctors and patients sit far apart in a large room and wear masks, and it's more difficult to establish a rapport, provide emotional support or show facial expressions.
Virtual appointments can help in some cases, but chemotherapy and radiation treatments must be done in person. In recent weeks, Drs. Cook and Kahn have seen a dramatic increase in distress among patients, including concerns about their immune system, their risk of contracting the virus, the well-being of their loved ones, feelings of isolation and whether their cancer can be managed properly at this time.
They suggest several strategies for helping patients and recommend spending extra time on virtual or phone visits to talk about anxieties and concerns. Doctors should validate and normalize their patients' concerns and share concrete information, when possible. They can also check in more often, offer to hold conference calls with family members and tell patients about virtual support groups that may be helpful.
"We are all having a hard time with this, and that's okay," Dr. Cook said. "The important thing is to continue to help each other through this time. Sharing a bit more of ourselves with our patients is a good place to start."
Managing difficult news, grief and loss also requires careful consideration during the pandemic, said Dr. Hanna Sanoff of the University of North Carolina at Chapel Hill. Dr. Sanoff, a gastrointestinal oncologist, writes about the difficulties of terminal disease and end-of-life care in a separate perspective article in JAMA Oncology.
"We don't treat cancer in petri dishes. We treat it in people,"
"We don't treat cancer in petri dishes. We treat it in people," she told Reuters Health by email. "For the 'best' treatment to actually be the best, it has to fit with each individual patient's values, their hopes and their wishes for their life."
Dr. Sanoff describes a video visit with a patient, where she acknowledged the inadequacy of virtual interactions and then shared the news of her patient's pancreatic-cancer progression. She saw grief overtake her patient and the patient's spouse, and she felt at a loss for words. In person, she would have hugged them and comforted them, but from afar, she could only offer words of support.
At the same time, virtual visits have allowed Dr. Sanoff to ask about other types of distress, such as financial strain and food insecurity, and she's scheduling more frequent visits to talk with patients. She also suggests being open about the struggles of virtual communication and encouraging laughter whenever possible.
"Outside of the terrible strain we see with COVID itself, other diseases haven't gone away," she said. "Cancer treatment matters, and cancer patients matter."