The COVID-19 pandemic changed everything, but for many patients with cancer, the fear of contracting the virus, as well as the toll of social isolation, were even more heightened than in the general public. According to Michele M. Hubert-Fiscus, MSN, RN, CCM, who spoke on COVID-19 and cancer at the AONN+ 11th Annual Navigation & Survivorship Conference, patients with cancer need their navigators to advocate for them, perhaps now more than ever.
Understanding COVID-19
Coronaviruses are a family of viruses that can cause common colds as well as more serious respiratory illnesses like severe acute respiratory syndrome. COVID-19 is the virus first reported in China in December 2019, defined by the CDC as a disease caused by a new coronavirus not previously seen in humans.
The virus is spread from person to person by respiratory droplets, for instance when a person coughs, sneezes, talks, or sings. Protection recommendations include masks in public settings, social distancing, covering coughs and sneezes, hand washing, and disinfecting frequently touched surfaces often.
“Gastrointestinal (GI) symptoms are linked to COVID-19, adding to the concerns for patients who have cancer. Initially, COVID-19 was thought to be a respiratory illness, but additional studies have shown that up to two-thirds of patients with COVID also had GI symptoms that appeared before or instead of other symptoms like a cough or fever,” she noted. “That makes it difficult to determine if the symptoms are related to cancer treatment or the virus.”
Patients with GI cancers may have more severe symptoms of COVID-19, so they should be monitored closely, she added.
The Impact of COVID-19 on Cancer Care
At the start of the pandemic, there was a lack of access to literature on the coronavirus, which led to widespread confusion. The CDC and the American College of Surgeons advised hospitals to cancel elective surgeries and procedures to safeguard resources needed for the care of patients with COVID-19.
“That meant less aggressive cancer surgeries and other treatments could be delayed as well,” she said. “There was also potential for a reduction in early cancer detection due to a person’s delay of care for symptoms that could be related to cancer. People are nervous; they’re avoiding going to the emergency room or the doctor’s office, but cancers being missed now will still come out at a later stage.” She encourages sharing with patients the safety measures being taken at your hospital or cancer center, as this can allay some of their fears of contracting the virus.
Cancellations of elected procedures also restricted the ability to screen average-risk people for breast, cervical, and colorectal cancers. “So encourage your patients to talk to their doctors about the risks and benefits of cancer screenings,” she said.
Patients with cancer who contract COVID-19 are at a higher risk of serious illness from the infection because their immune system is already compromised from cancer and its treatment. A retrospective study from Wuhan, China, showed that patients with cancer and COVID-19 had a more aggressive response and worse outcome from the infection than patients without cancer. The study also showed that patients with lung, hematologic, and metastatic cancers had the highest risk for a severe response.
Patients with cancer are always encouraged to stay active, but the closure of churches, gyms, stores, and other social centers has resulted in a significant increase in sedentary lifestyles. Children being homeschooled may add to the stress of the patient or caregiver, as they now have to juggle competing priorities. The loss of jobs and health insurance mean some people are faced with the incredibly difficult choice between food/housing or cancer treatment, and transportation concerns and social isolation only add to the collective anxiety and fear.
“Patients with cancer feel even more isolated,” she added. “They can’t see their children, their grandchildren, or their friends—the people who have been their support.”
Advocating for Patients During COVID-19
According to Ms Hubert-Fiscus, advocating for patients has been crucial during the pandemic.
Copay for COVID-19 testing has been eliminated for almost all Americans. “Some insurance companies may not approve testing unless it’s proven to be medically necessary, so we still have some work to do in this area,” she noted.
Congress also passed legislation granting waivers for telehealth visits under Medicare. This has led to appropriate reimbursement for telehealth visits in a time when telehealth has become the only option for accessing care for many Americans. “And lawmakers from both political parties continue to push to make some telehealth waivers permanent after the COVID-19 pandemic is over,” she said.
Additional funding has also been made available for financial assistance for people with cancer who were impacted by COVID-19, and because FEMA declared an emergency due to the pandemic, a person can qualify for a special enrollment period on the health exchange if they lost their health insurance coverage due to COVID.
“Although some cancer prevention and screening events are on hold due to COVID-19, we need to continue to encourage people to get screened,” she noted.
Some clinical trials have been postponed or interrupted, whereas others have been redesigned so they could be continued. “They have been very creative with putting measures in place to try and keep active as many clinical trials as possible,” she said.
Under the emergency declaration, nonprofit organizations became eligible to apply for low-interest loans, permitting for up to 100% forgiveness of those loans under certain circumstances.
The Coronavirus Aid, Relief, and Economic Security Act was passed, allowing for direct payments to many Americans, as was expanded unemployment insurance, small business relief, and crisis relief to help provide basic living essentials to the most vulnerable.
New testing workflows have been put into place to help protect healthcare workers, patients with cancer, and their families. Patients are telephonically prescreened for COVID-19 symptoms and also undergo a COVID test within 48 to 72 hours of their procedures.
Appointments are spread out and scheduled appropriately to prevent the overcrowding of waiting rooms and patient care areas. Visitors are limited for patients, unless the patient requires assistance due to specific needs. Upon their arrival, patients undergo evaluation of temperature, symptoms, recent travel, or exposure to anyone with COVID. All patients, visitors, and staff must wear masks, and additional cleaning processes have been put in place as per the recommendations of the CDC.
“So advocate for your patients; provide credible resources to help educate and alleviate their fears, utilize the AONN+ COVID-19 Navigator Toolkit, and encourage healthy eating habits and increased activity,” she said.
Ms Hubert-Fiscus stressed the importance of educating patients and their caregivers on prevention and screening recommendations, empowering patients and their caregivers, and promoting informed decision-making, taking into account all available information.
“Finally, encourage the use of telehealth services where available,” she added. “Identify and address any barriers to care, and always transition patients into survivorship programs.”
