In the midst of the COVID-19 pandemic, cancer survivors face heightened physical and psychosocial challenges, as well as barriers to health care delivery. The authors of an editorial recently published in the Journal of Cancer Survivorship have provided specific suggestions as to how health care workers involved in cancer care can help to address cancer survivors' needs during this difficult time.
"The recent COVID-19 pandemic has affected the world and has the potential to disproportionately affect and disrupt the lives of cancer survivors, including those currently in treatment, those who have completed treatment, and those who are now living cancer-free," write the authors, led by Larissa Nekhlyudov, MD, MPH, Clinical Director of Internal Medicine at the David B. Perini Jr. Quality of Life Clinic at Dana-Farber Cancer Institute. "Based on available data, COVID-19 appears to affect people of all ages; however, those who are older and have pre-existing medical conditions, including cancer, may be at higher risk for serious medical complications."
Of the more than 17 million cancer survivors currently living in the United States, more than two-thirds are over the age of 65 and have pre-existing medical conditions. Additionally, many cancer survivors who have received or continue to receive immunosuppressive therapy or have undergone bone marrow transplantation face an increased risk of contracting COVID-19 and developing serious complications.
Because there is currently no evidence that different precautions should be advised, Dr. Nekhlyudov and colleagues recommend that cancer survivors continue to follow the guidelines of the World Health Organization (WHO) for the general population, including physical distancing and frequent hand washing. However, the authors also note that health care providers should address their patients' individual risks and advise them regarding when and where to seek medical attention if necessary.
In addition to physical challenges, cancer survivors also face heightened psychosocial consequences during the COVID-19 pandemic, including increased anxiety due to family, interpersonal, and occupational changes. Patients who are continuing to receive treatment may experience anxiety regarding the availability of services and the risk of exposure in clinical facilities. Dr. Nekhlyudov and colleagues note that online cancer support groups are a valuable resource for individuals experiencing negative impacts of social distancing, adding that clinicians should provide appropriate psychosocial referrals when necessary. The authors also note the importance of consuming a nutritious diet, engaging in physical activity, and maintaining a healthy sleep schedule to reduce anxiety and improve quality of life.
Cancer survivors may also face barriers to the delivery of effective survivorship care in the midst of the pandemic, especially as the management of patients currently receiving treatment may be prioritized. In efforts to reduce exposure, many cancer centers are utilizing telemedicine and virtual appointments in place of face-to-face follow-up visits when feasible. Through the use of e-consultation, health portals, and phone- and video-based appointments, health care providers can continue to stay connected with their patients while eliminating the risk of potential infection. The authors note the importance of maintaining ongoing contact with cancer patients and survivors during this time, adding that the pandemic has provided an opportunity to explore new methods of health care delivery that could continue to enhance the quality of survivorship care in the future.
"Cancer survivors face challenges under the 'best' of day-to-day circumstances. We are currently experiencing an unprecedented crisis that has affected all aspects of the global community," conclude Dr. Nekhlyudov and colleagues. "While there is uncertainty in how this pandemic will evolve, what health care issues will emerge, and how technology will advance, this editorial was written as a reminder that all health care providers should remember that many cancer survivors need tailored, patient-centered care during these trying times. It will be important that the cancer survivorship community continue to collect and share evidence and resources that may be of benefit for this population at risk, today and as the pandemic eventually resolves."
In their publication, Dr. Nekhlyudov and colleagues include a list of resources for cancer patients, cancer survivors, and health care providers, including information on how to minimize risk, optimize care, and promote physical and psychosocial well-being during the COVID-19 pandemic.
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