Covid-19: The impact on people affected by cancer, oncology nurses and the wider healthcare community

The coronavirus disease 2019 (COVID-19) pandemic is placing unprecedented pressures on healthcare systems around the world. Resources have been channelled towards treating COVID-19 and other conditions such as cancer have been significantly impacted. Irrespective of speciality, nurses have been at the forefront of the care provided and for many it has taken its toll emotionally, physically, and personally. For oncology nurses, they are all too aware that cancer does not recognise there is a pandemic. The risks have not disappeared, and the distress associated with a cancer diagnosis remains, amplified by a new threat that is enveloping our lives. It is only a couple of years since the World Health Organisation announced that cancer caused 1 in 6 deaths worldwide and was rapidly becoming a global pandemic. The reality is that despite being common and killing many people across international boundaries, cancer is not infectious, a key defining factor in the description of a pandemic.

The restrictions placed on populations to protect and reduce cases of COVID-19 have seen new cancer presentations reduce dramatically and treatments delayed and/or postponed. The true extent of the impact of these delays may never be known according Collateral Global¹ but we know enough about cancer to be concerned that later presentations will be less treatable and reduce life expectancy.

The pressure on intensive care beds to treat COVID-19 has been universal but this has also disproportionately affected people requiring cancer surgery. Depending on case numbers, some countries and regions have adapted rapidly. In London, cancer hubs² were set up through specialist cancer hospitals such as the Royal Marsden hospitals to maintain critical surgical pathways. Not all areas were able to do this and, in many places, surgery all but stopped. It is still too early to fully understand how this, coupled with changes in treatments, and suspension of clinical trials will impact on cancer survival outcomes going forward.

The vulnerability of people exposed to COVID-19 and cancer has created a new level of uncertainty for people affected by cancer. This high-risk group are susceptible to infection due to underlying disease and compromised immune systems. To keep them safe, many hospitals have minimised contacts, used virtual platforms to communicate and patients have attended hospitals alone without their critical support structures: family, friends and loved ones. The usual support structures locally have also been impacted. Oncology nurses have stepped forward and utilised their skills to comfort patients. The supportive care framework, first introduced by Fitch in 1994^3,4 is just as relevant now and is worth re-visiting at this time. It draws upon the constructs of human needs, cognitive appraisal, coping and adaptation to underpin how people experience and deal with cancer.

She described supportive care as “the provision of the necessary services for those living with or affected by cancer to meet their physical, emotional, social, psychological, informational, spiritual and practical needs during the diagnostic, treatment, and follow-up phases, encompassing issues of survivorship, palliative care and bereavement”.³ While it is not profession specific, it often resonates with nurses who can identify with this holistic approach, a core concept within their nursing practice. The changing situation that faces people due to COVID-19 has created new demands and anxieties in addition to a persons’ daily needs due to cancer, therefore their usual way of meeting their daily needs may no longer be effective. They may seek new information and support. Coping becomes everything an individual does to deal with and manage a situation and its inherent distress. Predicting the specific combination of coping strategies is difficult but the therapeutic relationship⁴ that develops between the cancer patient and healthcare profession is even more important now than ever.

Distress is not just something patients experience, nurses have described some harrowing accounts during the pandemic. A qualitative study by Robinson & Stinson⁵ describe three major themes: “the human connection”, “the nursing burden” and “coping”. It resonates other reports by nurses throughout the pandemic and ultimately the focus on human connection and the vulnerability of the situation many have found themselves in. Some authors talk about resilience, strength, and determination of cancer nurses to continue to provide care to those with cancer but equally nurses describe compassion fatigue, burnout, and stress.⁶ Fundamentally it is the provision of compassionate, person centred care that has shone through. It is now time for some self-compassion to ensure we can deal with the difficult road to recovery in cancer services.

A quote by the Dalai Lama cited by Mills, Wand & Fraser⁷ argues that, for someone to develop genuine compassion towards others, first he or she must have a basis upon which to cultivate compassion, and that basis is the ability to connect to one’s own feelings and to care for one’s own welfare.. . Caring for others requires caring for oneself” (2003, p. 125). The question many of us ask is how best do we care for ourselves? Although there is limited research in this area, some oncology settings and, some roles may have already integrated elements of self-care within professional development. However, often nurses find their own path. Perhaps the first step is to reflect on how we act when communicating with patients and/or having challenging, and difficult conversations. We listen, we advise, we empathise, we provide information, and we share. Translating these skills towards ourselves and our colleagues may be a good start as we connect with our own feelings and build our own coping skills.

Although the pandemic is far from over, there is a sense of hopeful optimism for the future. Some of the digital technologies we have embraced rapidly through necessity may be here to stay. Indeed, investment in digital services has been welcomed and access in clinical settings improved immeasurably through social distancing requirements. Alas it took a pandemic to do this. Cancer nurses have shown innovation, adaptability, and creativity in keeping cancer services going. They need to continue to play a leading role as services recover. Unfortunately, cancer will be here long after the pandemic eases.