U.S. Army Spc. Reagan Long, a horizontal construction engineer assigned to the 827th Engineer Company, 204th Engineering Battalion, 53rd Troop Command, New York Army National Guard, alongside Pfc. Naomi Velez, a horizontal construction engineer assigned to the 152nd Engineer Support Company, 42nd Infantry Division, register people at a COVID-19 Mobile Testing Center in Glenn Island Park, New Rochelle, Mar. 14, 2020. Members of the Army and Air National Guard from across several states have been activated under Operation COVID-19 to support federal, state and local efforts. (U.S. Army National Guard photo by Sgt. Amouris Coss)

In these changing and often challenging times, it’s difficult to know how to react or what to think. This new landscape brought on by the novel coronavirus – better known as COVID19 (COrona VIrus Disease 2019) –  and the uncertainty it carries, is not only challenging our physical health but also our emotional health and may adversely impact or our daily interactions and routine.

Taken together, it may feel that our world is a bit upside-down.

Taking care
Whether you’re adjusting to working from home for the first time, missing visits with loved ones now quarantined in nursing homes or rehab facilities, or concerned about treatments already in progress, there are plenty of things to worry about. With closures of restaurants and travel bans in place, these worries may even relate how to pay your next month’s rent, mortgage or car payment. Or even worse, how to get food for proper nutrition. These worries may be exacerbated for people with cancer.

COVID19 and Cancer
Although more data becomes available on a daily basis, scientists know that COVID19 directly affects the immune system. Based on recent data from a small Chinese study of 2,007 cases of COVID19, published in The Lancet, the virus seems to attack the immune system early, knocking down the white blood cells that fight infections. In turn, this translates to a respiratory disease for most patients who become sick with COVID-19. [1]

One key point to remember is if a cancer patient is having symptoms such as fever (99.1°F [37.3°C] or higher), persistent cough, or shortness of breath, they need to call their doctor. [2]

The rapid spread of the disease and the way the disease affects the immune system makes cancer patients especially vulnerable to contracting the COVID19.  One reason why cancer patients may be more vulnerable is the systemic immunosuppressive state caused by their malignancy and ongoing anticancer treatments, including chemotherapy and surgery.[1]

While there is not a lot of data from published, peer-reviewed studies discussing COVID19, an early analysis published in The Lancet found that out of the 2,007 patients who contracted COVID19, 18 cases had a history of cancer.

The analysis showed that these patients had a higher risk of severe events that required admittance to the intensive care unit, ventilation support, or that resulted in death. However, because the number of patients with cancer being infected with COVID19 are relatively small, it very difficult to draw real conclusions from these findings.

What’s known today is that because the virus seems to cause the highest severity of illness in older people and people with underlying comorbidities, including diabetes, heart disease, and lung disease, cancer patients should be considered as having a greater risk of being infected.[1]

While this may be concerning, a lot has been done to avoid the spread of the disease. As a result – regardless of the doom scenarios presented by some fearmongers – the vast majority of people in the United States will, most likely, not become infected with COVID19 and will not be at risk for severe illness and complications.  And this includes patients with cancer.

Where to find help
Although daily anxieties and fear may be part of our daily life, the overload of often depressing media reports with breaking COVID19 news, and well-intentioned, often flawed anecdotal reporting on social media, may create or add unnecessary stress, increasing the emotional burden. While it may be difficult to deal with stress and anxiety, one way is to try and live one day at a time and get support.

What’s more, the increased stress and anxiety may cloud our ability to think clearly, requiring emotional, mental or psychological help and support. This may be especially the case for patients with cancer. And keep in mind, asking for professional help in dealing with mounting stressors, including fear and anxiety, is not an admission of failure, but rather a sign of strength.

Fortunately, there are, multiple (patient) organizations ready to help.

Cancer Hope Network
One such organization is the Cancer Hope Network (877.HOPENET or 877.467.3638). For nearly 40 years, this organization has been providing one-on-one peer support for cancer patients and the people who love them through a network of support volunteer survivors and caregivers.

In a statement by the organization’s board, the Cancer Hope Network confirmed that it is committed to continuing to be available by phone, email and chat throughout this health crisis. To help people cope and limit fear and anxiety.

The social work and nursing professionals working for the Cancer Hope Network offer training and continuous support to the organization’s volunteers as well as guidance and care to its clients, supplementing the efforts of support volunteers with referrals and other help.

They also offer tips on how to deal with the uncertainty as these (mandatory and voluntary) changes affecting our daily life keep rolling in and the newness of social distancing wears off.

Listen to the experts
From the Center for Disease Control and Prevention (CDC) to state and local governments as well as established organizations with longstanding expertise, find organizations you trust and will listen to! The editors of Onco’Zine will continue to share information from experts across the nation and around the world with the latest science-based facts to support cancer patients and their loved ones. In doing so, we aim to dispel fear and confusion. [3]

Manage fear
With all the stressors, fears, unknowns and anxieties about COVID19, it may be difficult to find help and remain calm. The first rule-of-thumb should be to never make decisions based on anger, fear or angst.  When we make decisions based on fear, our brains automatically switch on the “lower-level processor”, which makes decisions based on a fight-or-flight response.

Such a response takes us into a protect and defend mode, causing us to shelter in place, retrench and protect our own interests. But it also pulls us away from making ethical choices, as shown by the worldwide incidents of hoarding and panic-buying as a result of a global fear of possible shortages of food and hygiene products. Such fear leads to less than optimal decision-making based on biased, risky, retaliatory thinking and ethical blindness.

An article published in CURE magazine’s Heal edition featured words of advice from support volunteers across the nation. While focused on the fear of recurrence (of cancer), their advice rings true in the face of uncertainty and fear brought on by the spread of COVID19. [4]

In a statement to patients and patients support groups, phyicians at California-based West Medical (855.690.0565) urged people to make time to relax, and where possible, try to enjoy their lives, even if they may be staying home or are takeing care of their loved ones.  They recommend outdoor walks in uncrowded environments as one good measure against stress. They warn that one very real health impact of the COVID19 pandemic is that the increased stress many are experiencing, can make them more vulnerable to all sorts of illnesses.

But even under the unnatural and strenuous circumstances related to the combination of COVID19 and Cancer, managing stress is possible.

Stay informed
Using legitimate sources of information, such as the CDC website and website of the World Health Organization (WHO), is also helpful in limiting the spread of false information designed to foment a mad-panic, which may prevent reasonable thought and action.

According to Newsguard, a service that rates the credibility and transparency of web news content, a vast majority of COVID19 information shared across social media networks comes from fake news sites, while official and legitimate sources of information may only receive a fraction of the social engagement concerning COVID19. So, while it is important to stay informed, make sure to check the references.

Mistakes will happen: take a deep breath
Our changing landscape of “new normals” means you’ll make mistakes. But it also means that those around us will make mistakes. Tempers may get frayed as boredom, worry and anxiety sets in. The time-honored advice of taking a deep breath and counting to 10 will be particularly helpful in the coming days or even months.

Helping others
If you take care of patients – as a family member or friend – one looming question may be how you can help? How can you make a difference? Cancer patienst may have access to a robust front-line support system they can rely on for help, including family members, friends, and neighbors. Others may lack such a support network — they may have no one to rely on. So, how can you help? Keep in mind, help does not need to be complex. While many may say things like “If there’s anything I can do, just let me know…,” you may need to take some initiative if you are truly willing to help someone. Here are some suggestions:

  • Listen patiently and sympathetically but don’t feel that you have to provide answers or solutions. Some people simply need a hearing ear.
  • When possible, be reassuring. Some times the only thing to say is to reassure a patient that the emotions they are feeling, including sadness, anger, guilt, are not at all uncommon.
  • Make yourself available. In some parts of the country, patients may have to drive long distances to visit a clinic for treatment. Can you help them get there? If they have children, can you help them by taking care of their children? Are there errands that need to be run? Your inititive may indeed make a difference!

Telemedicine
To help patients, the Center for Medicaid and Medicare Services, earlier this week, lifted restrictions on telemedicine. As a result, the costs of telemedicine services will temporarily be reimbursed at rates on par with in-person visits, removing the dis-incentivization that medical practitioners have previously faced. This comes at a time when it is critical to remove barriers to providing remote care in order to prevent the spread of COVID19. While critical now, these decentralized services will most likely retain their value in the future.

Stay connected
As we all work together to flatten the curve – a concept that remains controversial – by implementing social distancing, and other mitigating measures to make sure that the healthcare systems around the globe can cope with the influx of sick people, keep in mind that you – whether you are a cancer patient or someone helping cancer patients – are not alone. Stay connected via social networks, telephone, and tools like video chat services such as Zoom and Skype and other, similar services. Count on the support and guidance provided by the social work and nursing professionals working for many patient and patient support groups like the Cancer Hope Network and others. They are designed to offer hope and comfort in challenging times. [5]

References
[1] Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335–337. doi:10.1016/S1470-2045(20)30096-6 [Article]
[2] Coronavirus Disease 2019 (COVID-19). Symptoms & Testing. Center for Disease Control and Prevention (CDC). Online. March 16, 2020. Last accessed March 18, 2020
[3] Taking Care of Your Behavioral Health: Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak. Substance Abuse and Mental Health Service Administration. Online. Last accessed Match 18, 2020.
[4] Cassidy S. Wisdom of the Crowd: Five Tips for Battling Fear of Recurrence. Cure Magazine. Online. February 22, 2020. Last accessed March 18, 2020.
[5] Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M, et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College COVID-19 Response Team. DOI: https://doi.org/10.25561/77482 [Article | PDF]

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