The COVID-19 pandemic has brought many challenges for oncology patients, including reduced screening services, treatment delays, altered treatment regimens, remote consultations and not having the support of their carers during outpatient visits and hospital admissions. They have endured this with the dual threat of cancer and COVID-19, having to shield from the people who matter most to them and, in some cases, losing those they love. Patients who have completed their treatment, even years ago, have not been spared these difficulties. This was emphasised when a patient expressed their sadness to me: ‘I don't know how many years I have left and I've spent this one shielding.’
Now shielding has ended, patients may feel nervous about venturing out again, but also want to live their lives, see loved ones and do the activities that they enjoy. Ticking off ‘bucket list’ wishes may be challenging with social distancing and enduring limitations on our freedoms. As nurses, we need to identify ways to help patients to make the most of their lives, which may be limited by cancer.
Primary care contacts for almost all conditions reduced considerably after the introduction of population-wide restrictions in 2020 (Mansfield et al, 2021). The largest reductions were in contacts for diabetic emergencies (estimated at less than half the expected number), depression and self-harm, with evidence of a reduction in contacts for all conditions. Delays in diagnostic services and urgent cancer referrals will affect services as referrals return to normal levels. No doubt some patients will present at a later stage of cancer, causing an increase in the number of lives and years of life lost to cancer (Sud et al, 2020).
We need to consider the wider effect on public health. Reduced contact with primary care may mean that chronic conditions are not identified or controlled as well as they might have been, so patients may have other health issues that are identified during cancer care. Restricted physical activity may mean that people are less able to do things that they did before and regaining pre-lockdown levels of fitness may be more difficult for people who have had a cancer diagnosis. Those with a more recent diagnosis may have found access to prehabilitation and rehabilitation services limited and those who previously had a long recovery and rehabilitation may feel that they have gone backwards, and need to regain ground. People experiencing difficulties that are harder to talk about, such as mental health issues or sexuality, may have found that the pandemic added another barrier.
The legacy of the pandemic includes a potential tsunami of grief, as many people will have lost loved ones to COVID-19. Cancer patients and their carers may be dealing with this in addition to their diagnosis, leading to complex psychological needs. They may also have a reduced social support network, making healthcare contacts more important.
Cancer nurses are well positioned to help patients and carers by doing what we have always done, considering the whole person and not just the person's diagnosis. Holistic assessment of patients and their support network will be key to helping them through what we hope will be the recovery phase of the pandemic. Ensuring that we consider how patients' physical, mental, emotional and spiritual needs affect their cancer care and overall quality of life are as important as ever.
In this supplement, Mary Williams and Gulen Addis present an exploration of the education required and tools available to ensure health professionals address patient sexuality issues in cancer and palliative care. This is an important part of holistic assessment that is often neglected. Having performed an extended literature review, the barriers to the assessment of sexuality are summarised and the effectiveness of educational interventions on patient sexuality considered. This is a useful summary in an area that is rarely addressed.
The pandemic has driven much education online so there are an increasing number of easily available resources. The UK Oncology Nursing Society recently hosted a webinar addressing issues of sexuality in cancer care, available in the member's section of the website for readers wishing to learn more (https://www.ukons.org/resources/#1090).