COVID-19 and cancer: The solitary nature of being at higher risk
Scene: A 38-year-old mother of two waiting in the health centre, six weeks since her breast lump biopsy.
Nurse: “Miss Made-up-name, Doc said that your result isn’t back. Call next week this time before coming in because of COVID-19.”
Patient: (Panicky and frustrated) “This is definitely not a good time to be diagnosed with cancer! Can’t I speak with the doctor?”
SERVICE DELAYS, disease progression and higher risk of complications are all frightful contemplations for a cancer patient in a frightfully isolating pandemic. For the average Jamaican cancer patient, the distress of having cancer is often left clinically unsupported in a lamentable state of service provision. Cancer patients must now grapple with being more susceptible to COVID-19 and its complications. This may be because of a weakened immune state as a result of their disease and/or their treatment.
Known as the ‘emperor of all maladies’, cancer has been associated with some level of distress along its trajectory, for all patients, regardless of its severity throughout the ages.
For many centuries, due to the stigma attached to the disease, patients were not told of their diagnosis of cancer. Hospital cancer wards operated on a consensus of prohibiting the use of the word ‘cancer’ to better cope with the distress-eliciting word. Even now, family members and even patients request of doctors, who often comply, to not disclose the cancer diagnosis to the patient. The distress associated with cancer has even resulted in populations being unwilling to get screened for fear that they may be diagnosed with cancer.
This distressful association comes most precisely from not just the cancer diagnosis, the effects of the disease, its treatment and survival, but from the possibility of having the illness. The precancer stage is a perpetual possibility. The distress morphs along the trajectory of the illness, evoking normal responses of common vulnerability and sadness. Fear and premature grief for early perceived losses like the possibility of losing a body part, body function, breadwinning role in family and friends, may follow.
Cancer patients may experience distressing problems that become disabling such as depression, anxiety, existential and spiritual crises. The disparity of care exists within Kingston with yearlong waiting lists for affordable care at the Kingston Public Hospital, and longer outside of Kingston. The distress associated with cancer is also experienced by those closest to the patient. Additionally, all anticancer treatments may have wide-ranging side effects of fatigue, pain and changes in body image and function. These will interfere with the patient’s ability to perform daily, essential activities independently. Those at risk of greater distress have other illnesses, social issues like living alone and communication barriers, among a number of other things.
There is the inherent distress of being at greater risk of COVID-19 and its complications for some cancer patients. While we await innovations in science for a cure, the physical separations of self-isolation, social distancing, quarantine and stay-at-home orders are the mitigating measures as directed by the World Health Organization. The Jamaican COVID-19 situation has elicited an infusion of perplexing emotions, despair and abandonment for the already distressed cancer patient. Is the cure (physical separation) worse than the disease (COVID-19) or is the cure (physical separation) creating another disease (side effect pandemic of mental illness)?
Now we can appreciate the amplification of the times and embolden the call of The Sunday Gleaner’s April 26 editorial ‘COVID-19 Demands Action on Mental Health!’
The COVID-19 pandemic has thrown a ring into the spokes of usual care. Imagine the scale of the risk/benefit balance being tipped in even more extreme ways globally, as it affects every aspect of health systems. While clinicians restrategise new guidelines for the continuation of safer cancer care as the crisis evolves, the benefits of staying at home outweighs the risk of going into health centres and outpatient departments for routine care. The pandemic has caused and worsened existing staff shortages because of reallocation and prioritisation shuffling of healthcare workers as seen in Europe, New York City, and even most recently as the call went out from the Ministry of Health and Wellness for community health aides. Global shortages in personal protective equipment and COVID-19 testing have restricted full-service delivery resulting in procedural delays of cancer screening and treatments like surgeries done by appointment.
In our next talk, we’ll look at the ripeness of the time. We look with urgency for a community-based, public-health level prioritisation of supportive cancer care.
Dr Tamara Green is a family physician, committee member of International Psycho-Oncology Society and member of the Jamaica Cancer Society.