Kiri A. Cook, MD.

The stress of having cancer and the physical and financial toll of treatment can be difficult for patients, even under normal circumstances. During the COVID-19 pandemic, patients face additional stressors, including not only the fear of mortality from COVID-19 but also the emotional impact of isolation. This sense of isolation can be present even in patients' cancer care, as many appointments take place through videoconferencing and telephone calls; even when in-person appointments do take place, family members are often not allowed to attend. Kiri A. Cook, MD, and Jenna M. Kahn, MD, both of the Department of Radiation Medicine at Oregon Health & Science University (OHSU) School of Medicine in Portland, Oregon, recently published a perspective piece in JAMA Oncology about connecting with patients and helping them to cope with the challenges of the pandemic. In this interview with i3 Health, Dr. Cook discusses strategies that members of the cancer care team can employ to provide emotional support for patients during this difficult time.

How can radiation oncologists, medical oncologists, and other members of the cancer care team establish good rapport with patients, even while participating in online or telephone appointments?

Kiri A. Cook, MD: It's important to recognize that a virtual or phone interaction may not have the same quality as an in-person one for either patients or providers, but it's up to us to make the best of a difficult situation. I think we all have a tendency to want to wrap up a phone or video call once all the information sharing is over, but it's important to leave space for patients to be able to share their feelings as well. Additional check-ins, either by phone or through the electronic medical record (EMR), can also help to reassure patients that while we may not be seeing them in person, we are hard at work on their care.

How can members of the cancer care team best notice signs of psychological distress in their patients?

Dr. Cook: Patients can sometimes be reluctant to volunteer their feelings of distress. It can be especially difficult with telemedicine, where they may feel a sense that it isn't a good time to bring feelings up. Long pauses may indicate that there is something else on their mind. Gentle probing questions such as, "How are you doing with all of this?" or "How has the pandemic been for you and your family?" can provide an opportunity for patients to share more if they wish to do so.

How can members of the cancer care team best help patients who are experiencing psychological distress?

Dr. Cook: Even seemingly simple things like providing active listening and acknowledging distress can make a big difference. Normalizing distress and common problems also can help to determine what resources might be useful. For instance, it can be helpful to say, "Many patients are having difficulty with employment during the pandemic. Would you like a social worker to get in touch with you about available resources?" or "Going through cancer is hard enough even without the pandemic. Would you be interested in connecting with other patients via a virtual support group?"

Is there any additional advice that you can share with members of the cancer care team as they help patients to cope with the emotional impact of the pandemic?

Dr. Cook: The pandemic can cause feelings of isolation in both patients and providers, and it may lead providers to feel like they're tackling every problem alone. On the contrary, it's more important than ever to stay connected with and lean on our colleagues; we are all in this together. A strong sense of teamwork will make us more effective and help our patients to feel secure in our care.

About Dr. Cook

Kiri A. Cook, MD, is an Assistant Professor and Clinical Research Director in the Department of Radiation Medicine at the OHSU School of Medicine. A radiation oncologist, her practice focuses primarily on the treatment of breast and gynecologic cancers. Dr. Cook was a recipient of the Radiological Society of North America Research Award. She is a member of the American Society of Clinical Oncology, the American Society for Radiation Oncology, and SWOG (formerly the Southwest Oncology Group). In addition, she serves on the Cancer Prevention and Control committee within the Knight Cancer Institute at OHSU. Her research focuses on analyzing and improving the patient experience during treatment, particularly with respect to patient-reported outcomes research, patient education, and supportive care.

For More Information

Cook KA & Kahn JM (2020). Distancing without isolating––connection in the era of COVID-19. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2020.2725

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of i3 Health.