We are living in virtually unprecedented times—‘virtually’ because pandemics have happened before, notably the ‘Spanish’ flu of 1918. The effects of the COVID-19 pandemic have been magnified by its enormous impact on the way people live their lives. We are used to being cushioned from the effects of disease as a natural catastrophe—at least in Western societies—but the current situation has changed this.
My specialty has been profoundly affected by the pandemic. In nearly 30 years as an oncology nurse, I have seen systemic anticancer treatments become more sophisticated. In the past 5 years, novel immunotherapy agents have offered patients with previously extremely poor prognoses renewed hope of extended, good quality lives. In the UK, patients have been encouraged to present to their GPs early with symptoms and there is a 28-day cancer target and investment in diagnostic capability. The pandemic has meant a huge reduction in patients presenting to GPs, leading to fewer urgent referrals (Philpotts, 2020).
No doubt this has been due to a combination of not wishing to add to NHS workload and fear of contracting coronavirus in hospital. As I write in early May, there is evidence that the publicity aimed at encouraging patients to present with symptoms has had an impact and there may now be a cancer ‘surge’. This will be another challenge: caring for an influx of people with cancer to hospitals still dealing with coronavirus.
Another effect of the pandemic has been the need to discuss altered risks. We have been used to offering patients with advanced disease treatments in the hope of offering improved quality of life, while managing the associated risks. In the context of COVID-19, this has been rapidly reframed. Treatments that expose frail and/or immunocompromised patients to higher risk of contracting the virus may no longer be viable both in terms of outcome and workload for services.
The necessity to assess individual risks has been highlighted by guidance from the National Institute for Health and Care Excellence (2020). This has resulted in many palliative treatments not being started or discontinued. It has also had an impact on patients requiring surgery or receiving systemic anticancer treatments with a curative intent. There is no doubt that an open discussion of the risks with patients is both necessary and desirable, but these discussions are difficult and inevitably lead to distress, worry and many uncertainties. There is a real role for cancer nursing in mitigating and helping manage this distress while acting as patient advocate.
In response to the crisis cancer nursing has seen its staff redeployed and scattered across acute areas of hospitals. Contact with patients has been lost and we find ourselves working in unfamiliar environments. Other cancer teams find themselves isolated in their clinical area as a way of minimising the risk to patients.
However, our biggest challenge as cancer nurses has been the threat of isolation for patients, whose families are unable to visit and support them. This is distressing and tests our ability to communicate effectively with relatives; we have had to adapt to making greater use of technology. Patients in the community, many of them elderly and living alone, are largely isolated in their homes. How do we best support them and what services can be provided? As the situation develops this will be an ongoing challenge.
It is hard to assimilate everything that has changed over the past 8 weeks. I am, however, sure that things should not go back to exactly how they were before. The ability to ‘see’ patients virtually using technology has been revelatory. Oncology teams' move to ‘virtual’ follow-up clinics has allowed specialist cancer nurses to review how they work and shift priorities from sitting alongside medical staff in clinic to more effective, patient-focused working. It is also right that the risks of undertaking treatments should be discussed with patients more openly, which should extend beyond the pandemic. COVID-19 has forced us into a position where all nursing has had to be reviewed— and the outcomes are not all negative.
One thing is certain: the healthcare settings we worked in at the beginning of the year will never be the same. Our role as nurses must be to ensure that patients and their loved ones remain at the centre of our services. We have learnt so much as a consequence of the pandemic and tested our coping mechanisms and support networks. We will all need time to reflect on this ‘once in a lifetime experience’, which will have altered us both as individuals and professionals.