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The Challenges of Cancer Care in the Time of the COVID-19 Pandemic

Seven, Memnun PhD, RN; Moraitis, Ann Marie MS, RN

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doi: 10.1097/NCC.0000000000000852
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Since the World Health Organization announced the COVID-19 pandemic in February 2020, healthcare systems worldwide have been overwhelmed with the contagious nature of the disease and the explosion of new coronavirus cases.1–3 While COVID-19 currently is the leading cause of death in the United States, each day nearly 500 new cancer cases will be diagnosed in 2020.4 During this rapidly evolving COVID-19 pandemic, every aspect of life for the global population is impacted. However, those newly affected by cancer face additional threats and challenges that may impact them for a lifetime.

In an attempt to allow healthcare systems to manage the rapid influx of COVID-19 cases effectively, communities are practicing curfews, social distancing, and sheltering in place to “flatten the curve.” The Centers for Disease Control and Prevention recommends preserving supplies and access to healthcare providers by prioritizing delivery to only urgent healthcare needs at this time. The recommendation signifies delaying all “elective” ambulatory visits and inpatient and outpatient elective surgical procedures cases and postponing routine healthcare care visits.3 Early studies report that individuals with cancer have an increased risk of COVID-19 disease and severe events such as invasive ventilation or death due to COVID-19.5,6 For individuals newly diagnosed with cancer during the COVID-19 pandemic, in addition to a startling cancer diagnosis, an increased burden is experienced due to the compounded risks of COVID-19. This increased patient burden highlights the pressing need for healthcare providers to give attention to needs related to every dimension of cancer care, including treatment and survivorship.

Limited hospital capacity, lack of personal protective equipment for healthcare providers, lack of point-of-care testing, and the higher death rate of COVID-19 disease in immunocompromised hosts make patient burden more challenging for every aspect of healthcare.1–3 Because most cancer care for treatment is not typically considered “elective,” oncology specialists are advised to consider balancing a delay in cancer diagnosis or treatment against the risk of COVID-19 exposure.2 Cancer patients are often left alone to navigate complex and fragmented healthcare system7 during clinical appointments and treatments.2 These patients may additionally become more vulnerable to financial toxicity of cancer treatment by an unstable economy (ie, unemployment, limited sick leave or reduced payment, increased transportation cost) posed by COVID-19.8

Nurses assume multifaceted roles as healthcare providers, public health advocates, and scientists in both community and hospital settings. Nurses partner with individuals newly diagnosed with cancer to assess and navigate the entirety of their cancer care needs.7 Nurse-led care programs improve clinical outcomes (ie, morbidity, mortality, nutritional status, symptom burden), functional status, and psychosocial outcomes of cancer patients and their families.9 As the resources are being constrained during the pandemic, difficult decisions about posttreatment survivorship, including follow-up care and supportive care, need to be made.2 However, cancer care spans a continuum from diagnosis, treatment, and survivorship through end-of-life care. Survivorship goals focused on wellness and quality of life can be augmented through lifestyle behaviors (eg, symptom management, physical activity, nutrition, stress management, and initiating long-term-care plans).7 Alteration of the healthcare system that is embedded in both the hospital and community settings has direct or indirect effects on desired patients’ outcomes. Eventually, lack of access to regular care, the increased risk of COVID-19 disease, altered access to a healthy lifestyle and social supports, and financial worries caused by the COVID-19 pandemic pose additional challenges to individuals with cancer. During this time of disruption, because of COVID-19, cancer survivorship goals, needs, and preferences may not be well articulated or addressed.

Every person in need of cancer care is significantly disrupted by social distancing and the reservation of healthcare toward COVID-19 cases. This year alone, as the pandemic continues to disrupt healthcare systems, more than 1.8 million new cancer cases are expected to be diagnosed.4 Without doubt, healthcare providers and community support teams have rapidly altered the models of care delivery while acknowledging the crucial unknowns of how these changes may affect clinical outcomes at the time of the COVID-19 pandemic.1 More than ever before, we are concerned about every aspect of health impacted by the COVID-19 pandemic for the times when the dire effects of the COVID-19 pandemic end and the financial and other related crises start to begin or continue. Translational research is needed to understand public health and cancer care implications of the pandemic with timely dissemination. Moreover, data are needed in the context of cancer care during the COVID-19 pandemic to inform policies and procedures. Data can help us to utilize resources wisely and limit health inequities while ensuring better short- and long-term cancer care outcomes for every person affected during the COVID-19 pandemic. Oncology nurses and nurse scientists and leaders, in community and healthcare institutions, are uniquely positioned to initiate and lead this process, which requires commitment, communication, and collaboration at different levels.


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