The novel coronavirus disease 2019 (COVID-19) public health crisis has created substantial shifts in health care.1 The pandemic has led to a surge in patients needing care related to SARS-CoV-2 infection, and it also has led to considerations of how best to manage the care of patients who are especially vulnerable to the infection.1,2 The imperative of social distancing to reduce transmission of SARS-CoV-2 has itself also led to disruptions in the usage of health care services.2

These factors have impacted oncology care.2,3 Patients with cancer may have special vulnerabilities to COVID-19, either because of factors related to the cancer itself or to cancer treatment.2 In addition, health care facilities have had to operate in the context of more limited resources because of demands placed on the healthcare system by the pandemic.1,3

“As oncology care hangs on a fine-scale balance amidst the COVID pandemic, striking a balance between delivering or delaying treatment during the crisis, becomes crucial not only for oncology patients but also for the treating clinician,” wrote Divyesh Kumar, MD, and Treshita Dey, MD, in a recent perspective on oncology treatment delays during the COVID-19 pandemic.2

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The American Society of Clinical Oncology (ASCO) released recommendations to oncology teams regarding care during the COVID-19 pandemic.3 In their recommendations, the authors of the ASCO report outlined responsibilities of clinicians during this pandemic, including maximation of health care outcomes, patient care, stewardship of resources, fairness, consistency, transparency, communication, and accountability.3

Addressing Issues in Communication

Communication with patients on the topic of care in the era of COVID-19 has been a challenge faced by some in the oncology community.4 To address this, Laila A. Gharzai, MD, LLM, and colleagues from the University of Michigan, Ann Arbor, conducted a study on communication challenges between oncology physicians and patients with cancer during the COVID-19 pandemic.1 The research team presented their findings and key principles for guiding conversations in a recently published report.1

“This qualitative study provides a practical guide for communication in cancer care during the COVID-19 pandemic. We believe that it fulfills an urgent need for patients and oncologists,” wrote Dr Gharzai and colleagues in their report.1

In this study, the researchers interviewed 8 physicians and administered a survey to 48 patients with cancer.1 Physicians came mostly from oncology settings, with 3 in radiation oncology, 2 in hematology/oncology, and 2 in surgical oncology. One physician specialized in internal medicine.1

Based on the interviews with physicians, the researchers developed a set of scenarios that incorporated COVID-19–related concerns into oncology-specific situations.1 The patients were then asked to complete the surveys, which were designed to measure patients’ reactions to the given scenarios.1

In a news release, Dr Gharzai indicated that conversations about COVID-19 between clinicians and patients seem to be difficult and have been made more complicated by the fact that public health has also had to be a consideration in decisions.4

Responses from physicians revealed 8 topics around which communication appeared to be especially difficult1:

  • Poorer outcomes resulting from infection with SARS-CoV-2
  • Postponement of routine cancer screenings
  • Postponement of diagnostic workup
  • Treatment delays
  • Suggestions of atypical treatment
  • Breaks from treatment
  • Postponement of follow-ups
  • Limitations on hospital admissions for care

The clinicians shared examples of challenging questions they faced, involving topics such as a situation of needing to tell a patient that surgery is not currently an option, and that it is unclear when it will be an option.1 Another patient question indicated a concern, after hearing about the unavailability of a treatment, that the clinician may be empowered to decide who lives or dies.1

In their survey responses, patients commonly conveyed anger, fear, and/or anxiety.1 Patient concerns ranged from a fear that delayed diagnostic tests might result in a missed opportunity to control a cancer to a sense that their needs were unimportant.1,4

Some patients had concerns related to COVID-19 itself, such as whether they had increased vulnerability to infection.1 Some patients wished for clarity in understanding the relative seriousness of COVID-19 vs cancer.1 The possibility of delayed treatment also elicited frustration for some, including a sense of feeling punished even after following guidelines on social distancing.1

This article originally appeared on Oncology Nurse Advisor