Navigating Breast Cancer Care During a Pandemic

Lauren Chatalian, LMSW, Women & Children’s Program Manager at CancerCare

At the start of the COVID-19 outbreak, it was unclear how cancer treatments would transpire and how the length of time the pandemic would be impacting those diagnosed with cancer. Individuals diagnosed with cancer have faced many obstacles in receiving care. While COVID-19 continues to present much uncertainty for many people, those diagnosed with breast cancer are faced with unique challenges in navigating continued treatment.

Because of the pandemic, people diagnosed with breast cancer may have experienced adjustments in their treatment regimen. Some may have begun neoadjuvant treatments due to postponed surgeries, while others have transitioned to oral treatments rather than receiving consistent infusion treatments at one’s treatment center.¹ Clinical trials have also been adjusted with enrollment briefly paused. However, those who were in a clinical trial were able to continue to receive treatment (most likely delivered to one’s home)². While many precautions have been put in place, many concerns have arisen in accessing necessary cancer care. Treatment approaches are on a case-by-case basis, as each diagnosis may exhibit different concerns³. It is important for patients to know that research continues and medical professionals are exploring ways to balance the concern of breast disease progression and COVID-19.

Unfortunately, due to COVID-19, many surgeries and procedures have been postponed. This specifically causes concern for individuals diagnosed with breast cancer who may have been scheduled for a lumpectomy or mastectomy. When someone is newly diagnosed with breast cancer and awaiting tumor removal, it may be difficult to comprehend the precautions necessary to ensure that surgical staff can continue to provide these services. While procedures have been termed elective, these surgeries may not appear to be elective for those diagnosed. They are still medically necessary and, in some cases, time sensitive even if they are not considered emergencies. Nevertheless, precautions must be taken. Surgical procedures and recovery may be different than initially expected due to COVID-19⁴.

Reconstructive surgery procedures may continue to be delayed until the pandemic is over. Preparing patients for these possible changes can help to alleviate uncertainty. Open communication and continued education about one’s diagnosis as well as COVID-19 is particularly vital during this time.

Individuals diagnosed with breast cancer may also be unsure if going into the hospital or treatment center poses a risk to their health. During a time of heightened anxiety, it is necessary to inform patients who they can contact if any concerns arise. For example, if it is possible for a patient to experience skin irritation due to radiation, and it could be useful to know ahead of time how to treat this or what specific circumstances require medical attention. If there is someone on the medical team that could be the point person for a patient to contact, this may offer a sense of comfort and reassurance throughout a breast cancer treatment, especially during COVID-19. There may be a nurse helpline through one’s medical insurance that could also be helpful.

Telemedicine, or telehealth, has become increasingly useful throughout COVID-19 to provide remote health care services. If patients express hesitancy, explaining the benefits of this option could provide a new perspective. Telehealth could offer a more flexible schedule, limit physical contact with others, and reduce the stress of traveling to and from medical appointments. In addition, explaining how to prepare for these appointments, as well as sharing what an appointment entails, may help to put a patient’s mind at ease. Step-by-step instructions for the video platform being used may be requested, and so healthcare professionals should consider having reading material on hand that patients can refer to, such as Telemedicine: What You Need to Know.

It may be helpful to consider a patient’s worries and stress. Throughout the pandemic, individuals diagnosed with breast cancer may experience increased feelings of isolation and a limited sense of community. Strong emotions when first diagnosed with breast cancer may be amplified throughout the pandemic. Oncology support staff may engage with individuals diagnosed with breast cancer regularly; however, this is a very new experience for many patients. Whether an individual is diagnosed during the pandemic or is navigating ways to continue treatment throughout these difficult times, patients are attempting to manage several stressors and may feel overwhelmed. It is imperative for patients to have a sense of security with their medical team to feel supported throughout his or her treatment.

As those impacted by a breast cancer diagnosis are faced with much uncertainty during COVID-19, financial strain may be an additional and powerful concern for many individuals. The loss of a job or loss of medical insurance poses increased stress for those in the cancer community. Connecting patients with the financial department, hospital social worker or patient navigator at the treatment center can help patients and families become aware of options available to them. Non-profit organizations, such as CancerCare, may be helpful in connecting with financial resources, support services and educational workshops, including Managing the Cost of Living with Cancer. During a time when people feel increased loneliness, connecting with others who may understand what he or she may be experiencing can be extremely beneficial. This could be through support groups, peer matching or individualized counseling. It is important to continue to address the emotional and practical concerns of a breast cancer diagnosis throughout one’s treatment and care, especially during a pandemic.

References

• Citgez, B., Yigit, B., Capkinoglu, E., & Yetkin, S. G. (2020). Management of Breast Cancer during the COVID-19 Pandemic. Sisli Etfal Hastanesi tip bulteni, 54(2), 132—135. https://doi.org/10.14744/SEMB.2020.23326
• Bauchner H, Fontanarosa PB. Randomized Clinical Trials and COVID-19: Managing Expectations. JAMA. 2020;323(22):2262—2263. doi:10.1001/jama.2020.8115
• Chia, C. L. (2020). Being a surgeon in the pandemic era. Journal of the American College of Surgeons.
• Citgez, B., Yigit, B., Capkinoglu, E., & Yetkin, S. G. (2020). Management of Breast Cancer during the COVID-19 Pandemic. Sisli Etfal Hastanesi tip bulteni, 54(2), 132—135. https://doi.org/10.14744/SEMB.2020.23326