The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (coronavirus disease 2019 or COVID-19] has changed increasing the demands on health systems for the containment and management of COVID-19. In its wake, this change has greatly impacted the cancer of patients diagnosed with cancer.
In an effort to understand how cancer patients, in self-isolated at home as a result of the global COVID-19 pandemic, are coping, a group of oncology nurses in Italy surveyed their patients between March 29 and May 3, 2020
The group reported data from 195 patients who completed the survey. The respondents were mainly women (75.9%), with a mean age of 50.3 years (range 25-78) and a high level of education (66,34%). The majority of patients were diagnosed with hematological malignancies (51.3%), followed by patients with breast cancer (26.2%) and other solid tumors (22.6%). The majority of participating patients were from the north of Italy (38.9%), followed by those from the south (34.7%) and from central Italian regions (26.4%).
The findings of investigated survey topics demonstrated that 21.1% of study participants did not leave the home at all during the study period, while 59.3% did so only rarely. The reasons for leaving the home were mainly related to health or going to the supermarket, while only 8.3% left them home for employment reasons.
In terms of changes in relations with family members during the COVID-19 pandemic, 31.9% reported no kisses and hugs, 12% practiced social distancing, and 6.8% said that they used separate rooms. From all participating patients, 6.8% reported other measures to stay safe.
The oncology nurses commented that the patients with cancer not only were considered at higher risk for COVID-19 infection, but they also had to suffer from reduced cancer care. Almost one-third of patients (29%) reported that their cancer was not under control. Many patients experienced difficult access to safe cancer care (62%), especially regarding follow-up visits. The participating patients also reported that follow-up visits were often postponed.
The survey also demonstrated that cancer patients were afraid to go to the hospital, even when they needed to do so. Increased perception of hospitals as places where people get infected with SARS-CoV-2, the virus that caused COVID-10, added uncertainty and increased anxiety among patients who had been diagnosed with cancer.
Furthermore, 44% of study participants reported that they feared that their cancer diagnosis would be regarded as of secondary importance during the COVID-19 pandemic. As a result, the oncology nurses highlighted the importance that health professionals should help patients in prioritizing their own health needs.
Patients with cancer usually feel more vulnerable than the general population and are more used to hypervigilance and protective measures. As a result, many surveyed patients said that they have promptly adopted COVID-19 preventive behaviors. However, only 54% believed to be at higher risk for COVID-19 infection and 51% for complications.
In order to reduce the likelihood of being infected, about one-third of study participants said that they were taking supplements that were not recommended by their care team, due to the lack of evidence from ongoing clinical trials. However, in looking for self-care strategies, many patients underestimated or dismissed the benefit of a well-balanced diet and regular exercise. They also underestimated the benefit of good relationships as a potential of support.
Overall, oncology nurses emphasized that ensuring a continuum of care is the key to success in COVID-19 and cancer management. They also said that this is crucial in keeping the connection between healthcare needs and cancer management.
 Trapani D, Marra A, Curigliano G. The experience on coronavirus disease 2019 and cancer from an oncology hub institution in Milan, Lombardy Region. Eur J Cancer. 2020;132:199-206. doi:10.1016/j.ejca.2020.04.017
 Biagioli V, Belloni S, Albanesi B, et al. Comment on “The experience on coronavirus disease 2019 and cancer from an oncology hub institution in Milan, Lombardy Region” and reflections from the Italian Association of Oncology Nurses. European Journal of Cancer 2020; 135:8-10.
Featured image: Nurses. Photo Courtesy: Fololia – 2016 – 2019. Used with permission.