Oncology nurses are responsible for educating patients and caregivers on central venous catheter (CVC) usage after bone marrow transplant, but in the wake of the COVID-19 pandemic, in-person classes were restricted.

So, a team at the Wayne State University Barbara Ann Karmanos Cancer Institute created patient education videos to enhance the skills and improve confidence in patients and caregivers performing CVC care.

“The need for the video actually became imperative in March 2020 when the COVID-19 pandemic struck. What we have traditionally done for our bone marrow transplant patients that will be going home with their central venous catheters still inserted is instruct their caregivers how to safely and effectively take care of it. When the pandemic struck, visitor restrictions prohibited [these] classes,” said Denise Henderson, Med, BSN, RN, OCN.

Henderson presented her team’s process during a poster presentation at the 46th Annual ONS Congress. She said that the project started before the pandemic, when the most frequently asked question by patients and caregivers in the class was, “Is there a video for this?”

Once COVID-19 swept the nation, the nurses realized how important video instructions would be.

Nurses served as producers, voice over recorders, script writers, and onscreen talent, while the hospital’s media specialist did pre-/post-production, editing, and graphics. The result was a 7-minute video called “Taking Care of Your Central Venous Catheter.”

The video helped to ease patient and caregiver apprehension when it came to the complex skills of CVC care. At the time of the poster publication, “Taking Care of Your Central Venous Catheter” had more than 300 views on YouTube.

As the hospital’s visitor policy begins to loosen, oncology nurses are still using the video to help educate patients and caregivers.

“We use this now in adjunct [to in-person education], as caregivers are slowly allowed back in the institution,” Henderson said. “They still say, ‘is there a video?’ and because of the process that we put in place to get the video done, we can now say yes.”

Henderson D, Beaver C, Mitchell J, Cook S. Developing Effective Patient Education Videos, From a Not So Simple Process to Implementation. Presented at: 46th Annual ONS Congress. April 20, 22, 27, 29, 2021. Virtual

Articles

When in-person classes on central venous catheter care were limited due to the COVID-19 pandemic, educational videos became even more important. 

‘Is There a Video for That?’ Caregiver Education Video Boosts Confidence

Ethical dilemmas are unavoidable when caring for patients with cancer, and oncology nurses are often tasked with resolving such issues, relying on professional codes and standards to help guide what is best for the patient.

“One thing about ethical issues is that there’s usually not a right or a wrong. We’ve always tried to go for the best solution for the patient and the family, as well as the care team in the situation,” said Joyce Neumann, PhD, APRN, AOCN, BMTCN, FAAN, an advanced practiced registered nurse and adjuvant ethicist at The University of Texas MD Anderson Cancer Center. Neumann recently led a presentation on ethical dilemmas in oncology nursing at the 46th Annual ONS Congress.

While end-of-life care can highlight ethical dilemmas, the challenges actually start at diagnosis, when nurses are faced with educating patients and their family members, determining goals of care, discussing clinical trial participation, and assessing patients physically, cognitively, and psychologically.

Then comes the informed consent process, preparing for possible outcomes of treatment, establishing advanced care planning and goals of care – both through treatment and potentially at the end of life.

For example, nurses may need to balance being positive and providing hope with providing realistic information and expectations to patients and their loved ones.

Neumann explained that there were 669 ethics consults at MD Anderson between September 2015 and August 2020; 29% were filed by nurses. The most common reasons for these requests were inquiring about the appropriate levels of treatment.

“Probably the most major ethical challenge that we come to is when is enough enough, and when do we transition patients from curative or aggressive care to comfort care?” Neumann said.

One major way to address these ethical dilemmas in cancer care is to promote advanced care planning – where patients’ wishes, delegation of medical decision maker, and more are clearly documented for the patient, family, and clinical staff members.

Nurses should also consider patients’ comorbidities, prognosis, religious or spiritual views, and goals to help guide the best possible care.

“We obviously need to know patient preference – I can’t stress that enough,” Neumann said. “Does the patient have capacity for their decisions and those type of questions on quality of life? What does that mean to the patient? … If the patient does not have the capacity, can the family explain to us what conversations they’ve had with the patient prior to treatment starting, [regarding] views of care?”

Knowing your patient’s beliefs and goals is key to providing ethical cancer care.

Expert Talks Ethics in Oncology Nursing

Oncology nurse practitioners are a crucial population in the healthcare arena. In an attempt to usher more nurses into the oncology NP career path, City of Hope teamed up with Azusa Pacific University School of Nursing to create the Oncology Nurse Practitioner Fellowship.

The results of the program were evaluated in a presentation at the 46th Annual Oncology Nursing Society Annual Congress.

“The role of the oncology [advanced practice provider] requires extensive training and education in a specialized area practice,” said Katherine Butcher, NP, MSN, a nurse practitioner at City of Hope who recently completed the program.

Of note, many states have given full practice authority to nurse practitioners, and 

 that this become the norm across the nation.

The fellowship consisted of 12 months of clinical rotations as well as 3 semesters of coursework and learning opportunities. It allowed fellows to collaborate with experts in important oncology specialties, such as genomics, infectious disease, palliative care, hematology, medical oncology, and survivorship. Individuals who were accepted into and enrolled into the fellowship program could also enroll in Azusa Pacific University’s Doctorate of Nursing Practice program.

“The exposure and collaboration with clinical experts in each specialty provided an experience and a wealth of knowledge that I will carry into my career moving forward,” Butcher said. “Participation in this fellowship has direct implications on the improvement of nursing practice, investing the education of APPs.”

Fellows were expected to reach a number of milestones that would not only help evaluate the program, but also promote their growth as a provider. They included:

Clinical rotations in hematology, medical oncology, supportive medicine, and the department of medicine

Obtaining an ASCO Advanced Practitioner Certificate

Presentation at a local or national conference

Graduation from Azusa Pacific University’s Post-Masters ONP Certificate program

“It is well known that the number of individuals with cancer and cancer survivors continues to grow. And with this growth, advanced practice providers are relied upon to ensure that patients receive high-quality care,” Butcher said.

Butcher K. Oncology Nurse Practitioner Fellowship: A Reflection on the Educational Benefits of a Postdoctoral Fellowship Program. Presented at: 46th Annual ONS Congress. April 20, 22, 27, 29, 2021. Virtual.

Nurse practitioners are more valuable than ever in the world of cancer care.

NP Fellowship Helps Prepare Providers for Oncology Career

Certain factors such as being younger in age, having more comorbidities and having had a higher number of prior cancer treatments all contribute to higher levels of sleep disturbance in patients with gastrointestinal (GI) cancers, according to Yufen Lin MSN, RN, of the Duke University School of Nursing.

At this year’s Oncology Nursing Society’s Annual Congress, Lin explained that chemotherapy is a common primary treatment for various GI cancers, and sleep disturbance is a frequent and distressing symptom that patients experience as a result of treatment. These disturbances often lead to a decrease in patients’ functional status, treatment responses and quality of life (QOL).

Previous studies have focused on various aspects of sleep disturbance and its impact on patients with cancer, including risk factors, but few have looked at sleep characteristics or combined all of this information into one study.

“Most studies have focused on patients with breast cancer, lung cancer and prostate cancer. Less is known about sleep disturbance in patients with GI cancer,” Lin said in her presentation.

Therefore, Lin and her team took a “person-centered approach” to identify the subsets of patients with GI cancers with distinct sleep disturbance profiles and evaluate the differences among these subgroups in demographic, clinical, and sleep characteristics, co-occurring symptoms, as well as QOL outcomes.

To do so, 405 participants were asked to complete questionnaires 6 times over 2 cycles of chemotherapy. Levels of sleep disturbance were evaluated using the General Sleep Disturbance Scale (GSDS). This was also the first study to use latent profile analysis (LPA) to identify subgroups of patients with GI cancers with distinct sleep disturbance profiles.

In this analysis, researchers evaluated the differences in demographic, clinical, and sleep characteristics, co-occurring symptoms, and QOL outcomes among the subgroups, using parametric and non-parametric analyses.

In total, 3 different sleep disturbance classes were identified across the six assessments: Low (35.8%), High (48.6%), and Very High (15.6%). When compared to patients in the Low class, those in the High and Very High classes were significantly younger, had more comorbidities, had a higher number of prior cancer treatments, were less likely to be married or partnered, and were less likely to exercise on a regular basis.

Compared to the Low class, patients in the Very High sleep disturbance class were less likely to be employed and had a diagnosis of back pain, while patients in the Very High class were more likely to report having childcare responsibilities.

Among all 3 sleep disturbance classes, significant differences that gradually increased in each group were found for comorbidity burden, occurrence of depression, and the GSDS subscale and total scores. Additionally, patients in the Very High class reported higher levels of anxiety, depressive symptoms, morning and evening fatigue, and pain, and lower levels of attentional function and QOL scores at enrollment.

According to Lin, these findings provide new insights into the risk factors and co-occurring symptoms that could lead to higher levels of sleep disturbance in patients with GI cancers, which can, in turn, help health care providers identify and address these problems before they start.

“Clinicians can use common and distinct factors to identify high-risk patients with sleep disturbance, and also initiate appropriate sleep hygiene education and referrals,” Lin said.

Additionally, these findings highlighted the need for further research into the underlying mechanisms that contribute to the development of sleep disturbance, and could prompt providers to develop personalized symptom management interventions to reduce symptom burden and improve QOL.

Yufen L., Bailey D., Docherty S. Distinct Sleep Disturbance Profiles in Patients with Gastrointestinal Cancers Receiving Chemotherapy. Presented at: Oncology Nursing Society 46th Annual Congress; April 20, 22, 27, and 29, 2021. Late-Breaking Abstract #5.

Factors such as being younger in age, having more comorbidities, and more prior cancer treatments all contribute to higher levels of sleep disturbance in patients with gastrointestinal cancers.

Factors Correspond With Higher Levels of Sleep Disturbance in Patients with GI Cancers

Patients with breast cancer may benefit a rehabilitation program that provides guidance as they transition from active treatment to survivorship, according to a poster presentation at the 46th Annual ONS Congress.

“Patients often expressed feeling anxious and overwhelmed as they transition to survivorship. In addition, they noted decrease in support from their health care team. Therefore, our team created the breast cancer rehabilitation program to provide guidance and support to patients as they transition from active treatment to survivorship,” Laura Kaminski BSN, RN, OCN, a nurse navigator at INOVA Life with Cancer, said in a recording presented at the meeting.

The Breast Cancer Rehabilitation Program – led by a specialist team comprised of an oncology nurse navigator, physical therapist, oncology dietician, fitness instructor, and oncology clinical therapist – is a 6-week multidisciplinary series, with each week addressing a different survivorship topic.

“A multidisciplinary team is particularly valuable for addressing the variety of challenges that survivorship patients face,” Kaminski wrote in her poster.

Each specialist led sessions that focused on the following:

survivorship and surveillance with a nurse navigator

physical therapy, occupational therapy, and speech-language pathology’s roles in survivorship with a physical therapist

brain fog with an oncology clinical therapist

coping with survivorship’s emotional impact with an oncology clinical therapist

exercise guidelines for survivors with a fitness instructor

nutrition in survivorship with an oncology dietician.

To evaluate the effectiveness of the program, survivors completed a survey before and after the program. Before the program, patients, on average, rated their knowledge of survivorship topics as 3.2 on a 5-point scale. Post-survey responses showed that there was an increase in knowledge of all survivorship topics, with an average knowledge score of 4.7. Knowledge of survivorship/surveillance and brain fog were the topics of greatest improvement.

Kaminski noted that this program could offer similar education across various cancer types to contribute to improved survivorship outcomes.

INOVA Life with Cancer launched the program on January 14, 2020, and now offers it quarterly.

“Our organization plans to continue offering the breast cancer rehab program and has already made adjustments to the program based on patient feedback. For example, and 2021. A session was added to address sexual health and intimacy and survivorship,” Kaminski said.

Kaminski L. Breast Cancer Rehabilitation Program: Healing Mind, Body and Soul. Presented at: 46th Annual ONS Congress; April 20, 2021; virtual.

In particular, patients reported improved knowledge in survivorship/surveillance and brain fog following the 6-week program.

Survivorship Rehabilitation Program Provides Education to Improve Transition Following Active Treatment 

The COVID-19 pandemic has added significant challenges to individuals who are hearing impaired – about 15% of the American population, and a third (33%) of the population over the age of 65 – as mask mandates make it so that they can no longer rely on lip-reading.

“Hearing-impaired patients have reported frustration, isolation, and fear as a result of being unable to understand and communicate with their providers in hospital settings. In addition, impaired patient-caregiver communication is a safety issue, as patients with communication barriers are 3 times more likely than those without to experience adverse events in acute care settings,” Brianna DiTullio, RN, BSN, a nurse at Memorial Sloan Kettering Cancer Center said.

DiTullio’s research, which was presented at the 46th Annual Oncology Nursing Society Congress, found that clear face masks can decrease these communication barriers and increase trust between clinicians and patients with cancer who are hearing impaired.

She was originally inspired to conduct this research when a partially deaf patient – she called him John – was at MSK’s bone marrow transplant unit in 2019. He was immunocompromised and on neutropenia precautions, so everyone in his room had to wear a mask.

“Given that lip reading is impossible to do through a traditional face mask, he essentially lost his ability to communicate every day during rounds with the transplant team,” DiTullio said. “I would watch him nod his head along with the conversation as 5 or 6 masked doctors talked to him about his symptoms and his plan of care. But as soon as the team left, he would admit that they didn’t really understand most of what was being said.”

The pilot project involved 6 patients who were hearing impaired and 12 staff members (nurses, patient care technicians, doctors, occupational and physical therapists) who used clear face masks over a 2-day trial period. Ultimately, there was a major difference in patient understanding and trust as a result of the clear masks.

Before the clear masks, 67% of patients reported that they often have difficulty understanding what staff is saying through the masks, and 33% said that they almost always face this issue. After the new masks were implemented, a third (33%) of patients said that they never have issues understanding what staff is telling them. Seventeen percent reported rarely facing this issue, 17% reported sometimes facing it, and 33% reported often facing it.

The clear masks also increased the amount of communication between patients and their providers. At baseline, 50% of patients reported that they almost always have conversations with hospital staff while they are wearing masks, and after the clear masks were implemented, this number increased to 83%, with the rest of participants (17%) reporting that they often have conversations with hospital staff.

“Anecdotally, patients loved that they could now see the faces of the staff caring for them, point out that they could now see their smiles,” DiTullio said.

Finally, the clear masks improved trust between patients and providers. Before they were implemented, 34% of participants said that they were neutral/unsure of their trust levels for hospital staff, 33% were trusting, and 33% were extremely trusting. After 2 days with clear masks, 67% of participants said that they were extremely trusting of the staff, and 33% said that they were trusting. Of note, after the clear masks were used, no patients reported being neutral/unsure.

DiTullio recommended that hospitals invest in clear face masks to better communicate with this patient population.

“While this project was originally carried out in a pre-COVID-19 setting, it now has much more far-reaching implications,” DiTullio said. “Health facilities have a responsibility o accommodate the specialized needs of patient populations they care for, just like how they provide interpreter services for non-English—speaking patients. The hearing-impaired population nis no different.”

DiTullio B. Clear-faced masks for hearing-impaired patients. Presented at: 46th Annual ONS Annual Congress. April 20, 22, 27, 29, 2021.

When patients rely on lip-reading to communicate, mask mandates have major effects on their care. 

Clear Masks Improve Care, Build Trust for Hearing-Impaired Patients

Implementation of an onboarding reference guide served as a useful resource for advanced practice providers (APPs) in treating patients who are undergoing bone marrow transplantation (BMT), according to a poster presentation at the 46th Annual ONS Congress.

“It is known that bone marrow transplant patients are quite complex and require careful management by their providers. As cancer services continue to expand across organizations, advanced practice providers, or APPs, are playing a central role in patient care,” Tanya Lalani, DNP, NP, AOCNP®, a nurse practitioner at Ochsner Health said during a recording at the meeting. “Organizations are growing rapidly and more and more APPs are being hired.”

With this expansion, for example at Ochsner Health, it has become apparent that a structured orientation is necessary to allow for appropriate training for APPs, Lalani added. As a result, she created an onboarding reference guide, also known as the cheat sheet for new BMT APP hires, for reference during and after their orientation period.

In particular, the guide includes step-by-step information on how to perform daily tasks like admissions, discharges, and graft versus host disease documentation. In addition, it includes important phone numbers, frequently used order codes, and the process for performing and documenting procedures, as well as common labs and advanced testing guidelines for BMT patients categorized by hematologic malignancy.

In particular, Lalani added that the guide includes a checklist and a shadowing schedule, which allows an APP to know exactly where they need to be at any given.

Lastly, the guide also includes a quiz to help with discussion points during the orientation period.

Since its implementation, the guide is updated frequently to allow for the most up-to-date information, Lalani said.

“This onboarding guide has been very well received by new hires as well as management,” she concluded. “It has been used by leadership when asking the system for new hires. It has inspired other departments within the organization to create a more structured orientation guide as well. It has also been shared with hematology oncology fellows, and there are future plans to share it with internal medicine residents who rotate through the bone marrow transplant service.”

Lalani T, et al. An Onboarding Reference Guide for New Bone Marrow Transplant Advanced Practice Providers. Presented at: 46th Annual ONS Congress; April 20, 2021; virtual.

The “cheat sheet” assisted advanced practice providers using a step-by-step guide that is updated frequently to allow for the most up-to-date information.

Onboarding Reference Guide Aids APPs Treating Patients Receiving Bone Marrow Transplant

Virtual visits from cancer care coordinators with veteran colon cancer survivors decreased anxiety and improved patients’ satisfaction during the COVID-19 pandemic, according to a virtual poster presentation at the Oncology Nursing Society Congress.

Due to social distancing requirements during the COVID-19 pandemic, many veterans who are cancer survivors experienced changes in treatment protocols and schedules. This resulted in higher levels of stress and anxiety about changes in their outcome and survival, on top of stress about their cancer diagnosis, noted Janice Schwartz, MSN, OCN, RN, an oncology certified nurse at the New Mexico VA Healthcare System, said during the presentation.

“As a cancer care coordinator, my role morphed abruptly in March 2020. I was faced with calling veterans living with a cancer diagnosis to advise them of cancelled procedures, visits and surgeries due to the COVID-19 pandemic. I found veterans living with a cancer diagnosis were experiencing new stressors. Already experiencing anxiety related to the diagnosis of cancer that we are all familiar with, they now face limitations of [COVID-19] further impacting their lives.”

Providers found a new way to connect with this population to improve communication through virtual visits to potentially decrease stress about COVID-19 and improve patients’ satisfaction regarding their survivorship care.

“I have found maintaining visual contact with a veteran allows them to feel connected, to know that we are still here for them and has improved patient’s satisfaction,” Schwartz said.

Prior to the virtual appointments, veterans were emailed instructions on how to use the platform and scheduling on a personal laptop, tablet, computer or smartphone. Upon completion of the appointment, they were emailed a survey, of which 100% were returned.

During the virtual appointments, veterans were given reassurance regarding cancer treatment and recommendations, in addition to COVID-19 safety measures and processes to decrease possible exposure.

A total of 95% of the veterans reported an overall decrease in anxiety after the virtual appointment. The appointments decreased COVID-19 related stress in 90% of veterans and led to improved patient satisfaction in 96% of veterans.

The virtual appointments resulted in the following:

overall convenience (less time off work, avoidance of travel and expenses, not having to search for parking and ability to stay safely at home),

decreased anxiety (decreased post-traumatic stress disorder symptoms, less worry and less nervousness),

decreased stressors (ability to stay safety at home, understanding safety measures implemented in the hospital and review of recommended)

and improved satisfaction (personalized visit vs. phone call, ability to see their chart and reports through shared screen options and requested to have virtual post COVID-19).

Limitations of the virtual appointments included requiring an electronic device with a camera, connection to internet, Apple misfunctions, remembering usernames and passwords.

“I’ve learned by saying that perhaps if we look to the end of the rainbow and search for the silver lining of [COVID-19], we would see the many advances in care such as virtual platforms that will continue to improve care and decrease barriers for our veterans long after [the COVID-19 pandemic],” Schwartz concluded.

Schwartz J, Valdez-Boyle L. Colorectal Cancer Survivorship: Enhancing Communication During COVID-19 Through Cancer Care Coordinator Virtual Visits in the Veterans Healthcare System. Presented at: Oncology Nursing Society 46th Annual Congress. April 20, 22, 27 & 29, 2021. Virtual.

Due to the COVID-19 pandemic, many patients’ and survivors’ care has changed, but one nurse and her team sought to make this population more comfortable and safe during these times with virtual visits.

COVID-19 Pandemic Shows ‘Silver Lining’ of Virtual Visits for Veterans Who Have Survived Cancer

Early results showed that a new care delivery model improved breast cancer care, according to a poster presentation at this year’s Oncology Nursing Society (ONS) Annual Congress.

The 4R Care Sequence® is a one-page, multimodality, personalized care project plan that is used by the care team to plan and deliver care. The 4 Rs in the title represent the right information, care, patient and time. It incorporates recommendations for patient-centric care pathway plans from the Institute of Medicine, Medicare’s OCM and NCCN guidelines, which include multi-modality planning from diagnosis to survivorship that specifies the clinical team, identification of therapy and side-effects and supportive care.

“The 4R model provides a roadmap for the patient and also for the patient’s care team,” said Janeen Bazan, RN, OCN, BSN, lead author of the poster and an oncology nurse navigator from Advocate Sherman Hospital, during the presentation. “It’s very helpful in time management for the patient.”

To understand how the 4R Care Sequence® plans impacted care, researchers surveyed 77 patients with stage 0-3 breast cancer from September 2019 to August 2020 at Advocate Sherman Hospital. Of the patients, 28 received 4R Care Sequences® and 49 received a baseline control model.

A survey given to all patients asked whether or not the patients’ care provider instructed them to do certain activities. The researchers found that all patients who received the 4R Care Sequences® were more likely to have been counseled in 8 areas:

Getting an immunization (flu, pneumonia, shingles) before starting cancer treatment (52% of baseline cohort, 70% of 4R cohort)

Seeing a dentist before starting cancer treatment (13% of baseline cohort, 33% of 4R cohort)

Getting a genetic counseling appointment before surgical decision (39% of baseline cohort, 44% of 4R cohort)

Managing weight if over or under weight (16% of baseline cohort, 26% of 4R cohort)

Getting a nutritionist consult about how to eat during cancer treatment (15% of baseline cohort, 26% of 4R cohort)

Getting emotional support (46% of baseline cohort, 52% of 4R cohort)

Keeping up appointments with primary care for routine care (67% of baseline cohort, 75% of 4R cohort)

Caring for a chronic disease (43% of baseline cohort, 46% of 4R cohort)

Early results showed that the use of the 4R Care Sequences® improved the referrals of recommended breast cancer care. Due to the small sample size, Bazan reported that the results are not statistically significant, however, the trend is still encouraging. The researchers’ plan to continue using 4R Care Sequences, collecting patient surveys and assessing their impact.

“I’m very excited to look at our next data and share with other programs, and hopefully bring in other cancer types,” Bazan said.

Bazan J. Early results: Impact of 4R (Right Info / Care / Patient / Time) care sequence plans, provided to patients by oncology nurses, on timing and sequence of guideline recommended care. Presented at: Oncology Nursing Society 46th Annual Congress; April 20, 22, 27, and 29, 2021. ePoster 1567. 

https://ons.confex.com/ons/2021/qi/eposterview.cgi?eposterid=1567

Early research showed an improvement in provider recommendations of care for patients with breast cancer based on eight guideline metrics.

A New Care Delivery Model May Positively Impact Care Referrals for Patients with Breast Cancer

Survivors of cancer who recently finished treatment and are at least 60 years of age struggled with coping during the COVID-19 pandemic, which may highlight the need for the development of a remote-access resource for coping during this pandemic.

“We all know that in 2020, COVID-19 affected numerous people around the globe, and the World Health Organization acknowledged that those who are the most vulnerable to the negative effects of COVID-19 are those who are older than 60 years of age,” said Jacqueline Galica, RN, PhD, CON(C), nurse scientist at Queen’s University in Kingston, Ontario, Canada, during the presentation at the virtual Oncology Nursing Society Congress. “And given that nearly 9 out of 10 cancer diagnoses occur among people who are older than 60 years of age means that this group is an important group to study during the pandemic.”

After the first year of treatment, survivors have many needs and require resources for support, including psychological and informational support. This is especially true for those over the age of 60 because of other comorbidities they might have. Due to the COVID-19 pandemic, these resources were limited to these patients. Researchers sough to see how this population who completed treatment in the last year were coping during the pandemic.

Researchers interviewed 30 participants (56.7% women, mean age, 72 years). According to the presentation, questions asked of these participants included:

How does the COVID-19 pandemic affect their access to formerly used and/or desired resources/supports?

What coping recourses are they using during the pandemic?

How do these resources help (or not) to meet their cancer-related care needs?

What are their reflections on the pandemic? What are their suggestions for suitable resources and delivery methods when traditionally offered resources are limited or unavailable?

Results showed that survivors were initiating coping mechanisms on their own including acceptance (29 participants, 96.7%), self-distraction (28 participants, 93.3%) and taking action (28 participants, 93.3%). Participants also reported using instrumental (26 participants, 87%) and emotional support strategies (25 participants, 83.3%).

During the analysis, the researchers found interconnected themes in the population such as drawing on lived experiences, redeploying coping strategies and complications of cancer survivorships in a pandemic.

Drawing on lived experiences meant survivors were using coping strategies that they had already known about through pasts illnesses or through someone they knew who had a past illness, as well as other life experiences such as work, specifically those who had a background of knowledge in health.

The second theme seen was redeploying coping strategies, meaning they were not new. Participants continued on their way of life during the pandemic or “even magnified their formally used strategies during the pandemic,” said Galica. Participants also reported taking up new and old activities to keep them distracted from their concerns.

The last was complications of cancer survivorships in a pandemic. “Sometimes cancer survivors observed a dissonance between the coping strategies that were available to them versus those that were familiar. And this made it challenging for them to cope with their cancer-related concerns,” said Galica. This was seen specifically in participants who still experienced side effects that affected their ability to engage in former activities that they enjoyed; some either modified expectations or stopped altogether.

Participants had 4 general recommendations for future care. The first being enhanced baseline information, meaning given more knowledge in the beginning from their oncology team to prepare for self-management if there were to be an interruption in care. Secondly, participants reported that changes in visitor care was a concern. Thirdly, older patients acknowledged the need for technology integration and felt it could be used more and less in certain settings. Lastly, participants valued the use of masks and other personal protection equipment and felt it increased awareness to help protect people who are vulnerable to a common cold or the flu even after this pandemic.

Implications of this study include that clinicians can use a strength-based approach in survivors as they draw from their past experiences. Also, the need to enhance resources to support coping, specifically using remote methods when patients cannot attend and in person session during a pandemic or not.

Limitations of the study include not collecting data on functional status, timing of recruitment (the summer allowed participants to get out and enjoy outdoor activities) and response bias.

Galica, J. Haase, K. Liu, Z. How older cancer survivors are coping amid the COVID-19 pandemic: A mixed-methods study. Presented at: Oncology Nursing Society 46th Annual Congress. April 20, 22, 27 & 29 2021. Virtual.

Survivors of cancer go through coping during the first year after treatment and require specific resources. But these were limited due to the pandemic resulting in survivors self-coping with known mechanisms. 

ONS Annual Congress