An Institutional Perspective on COVID-19 and Cancer Care

Sap Partners | Cancer Centers | <b>John Theurer Cancer Center, Hackensack University Medical Center</b>

Gabriella Magarelli, MSN, ACNP-BC, AOCNP, reflects on lessons learned caring for patients with cancer and COVID-19.

Dealing with COVID-19 has been difficult for everyone. However, patients living with cancer face an even more complex battle.

As the Director of Nursing, RCCA at Hackensack Meridian Health John Theurer Cancer Center at Hackensack University Medical Center in New Jersey and a Lymphoma Research Advanced Practice Nurse, I, like many other nursing professionals, witnessed firsthand how complicated cancer care has become in the era of COVID-19. However, I am proud of how my colleagues and I worked to provide top-notch care during this trying time.

Learn to Adapt

At the John Theurer Cancer Center, our patients are always our top priority. During the pandemic, the oncology care team remained involved in the care of our patients even when they received a diagnosis of COVID-19. Although we sometimes needed to pause cancer treatment in order to effectively treat COVID-19, our team remained active in working closely with the primary medicine and infectious disease teams in order to safely and swiftly return the patient to their cancer treatment.

For patients with a diagnosis of both cancer and COVID-19, it is important to ensure that their immune system is not further compromised by cancer treatments. There are lots of factors to consider while treating these patients, such as the severity of their COVID-19 symptoms, disease status, and the types of therapy the patient is receiving. Every patient is different and every situation calls for different treatment tactics, such as withholding therapy. In some patients, pausing chemotherapies or other treatments that cause severe suppression of the immune system is not an option.

In order to safely continue care for patients in the inpatient and outpatient settings who also tested positive to COVID-19, my team and I implemented a number of novel strategies. These included screening patients prior to visits to assess them for signs and symptoms, limiting the number of permitted visitors, and dedicating elevators and pathways specifically for patients with COVID-19 to use. In some cases, we would use telemedicine check-ups in lieu of in-person visits.

Patients with cancer were and continue to be encouraged to receive their COVID-19 vaccinations and booster shots. We also urged them to avoid large crowds, wear a mask in public, and alert the team immediately with any signs or symptoms of infections.

Address The Emotional Toll

Any type of infection on top of a cancer diagnosis is difficult; however, COVID-19 and cancer is a complicated combination and is ever evolving as we learn more about the virus and the new therapies to treat it. Although there are general guidelines in place, our multidisciplinary team looks at each patient’s care independently to determine whether to proceed with or hold cancer directed therapy.

Moreover, there is more to cancer care than just physical treatment. Having cancer and COVID-19 at the same time can be a very scary experience and providers should acknowledge this when communicating with patients.

Patients have strong relationships with their oncology team and lean on them for advice and support throughout the process. It is important for the care team to remain actively involved with their patient. Maintaining lines of open communication is the best thing a provider can do throughout treatment.

Acknowledge the Team

Overcoming COVID-19 and suffering from cancer is a difficult obstacle for the patient, but these new challenges also take a toll on the care team. I have experienced lots of health care challenges in my 17 years as an oncology nurse, however nothing has compared with this. In the beginning of the pandemic, I remember feeling helpless, which goes against the very essence of why I went into nursing: to help people.

However, in these trying times, I also felt a strong sense of unity among health care workers. We all came together to work tirelessly to care for our patients, develop standard operating procedures and workflows, and develop testing and vaccines to combat the virus.

As the pandemic evolved and we learned more about COVID-19, it reignited my passion for medicine and research. From the moment I became a nurse in 2004 and started my career in oncology, I was always proud to call myself a nurse. More, now than ever, nurses and healthcare professionals have demonstrated selflessness, compassion, and a hardworking nature of their colleagues. With COVID-19, the world’s eyes have learned to see us in this light, as well.

Thanks to the efforts of my entire team at the John Theurer Cancer Center, patients with cancer and COVID-19 are able to continue their treatment with undivided support and attention. I could not be prouder of this profession and how everyone pulled together during the pandemic.