In a letter to the editor published in the August 2020 issue of the European Journal of Cancer, a group of oncology nurses communicated an interim analysis of survey data collected between 29 March and 3 May 2020 by the Italian Association of Oncology Nurses, as an effort to map the situation of the self-isolated patients with cancer at home in the context of the COVID-19 pandemic.
They reported data from 195 patients who completed the survey. The respondents were mainly women (75.9%), with a mean age of 50.3 years (range 25-78) and a high level of education (66,34%). The majority of patients had haematological malignancies (51.3%), followed by patients with breast cancer (26.2%) and other solid tumours (22.6%). The majority of patients were from the north of Italy (38.9%), followed by those from the south (34.7%) and from central Italian regions (26.4%).
Findings of investigated survey topics indicate that 21.1% of study participants did not leave the home at all during the study period, while 59.3% only rarely. The reasons for leaving the home were mainly related to health or going to supermarket, while in only 8.3% for job reasons.
In terms of changes in relations with family members, 31.9% reported no kisses and hugs, 12% practising social distance, 6.8% using separate rooms and other measures were reported in 6.8% of cases.
The Italian oncology nurses commented that the patients with cancer not only were considered at higher risk for COVID-19 infection, but they also had to suffer from reduced cancer care activities. Almost one third of patients (29%) reported that their cancer was not under control. Many patients experienced difficult access to safe cancer care (62%), especially regarding follow-up visits, which were often postponed.
Furthermore, patients with cancer were afraid to go to the hospital even when they needed and even decided to cancel their appointments. Increased perception of hospitals as places where people get infected could have added further uncertainty to patients whose illness anxiety has already been negatively influencing their mental wellbeing. Moreover, 44% of study participants reported the fear that their cancer diagnosis would be regarded as of secondary importance in time of COVID-19 pandemic. Therefore, the oncology nurses highlighted that health professionals should help patients in prioritising their own health needs.
Patients with cancer usually feel more vulnerable than the general population and are more used to hypervigilance and protective measures, so it is not surprising that they adopted COVID-19 preventive behaviours promptly. However, only 54% believed to be at higher risk for COVID-19 infection and 51% for complications.
In order to reduce the likelihood of being infected, about one third of study participants reported taking supplements which are not recommended by health professionals due to the lack of evidence from ongoing clinical trials. On the other hand, self-care strategies such as a well balanced diet, regular exercise and good relationships seem to be underestimated for their potential to support the immune response.
The oncology nurses underlined that ensuring continuum of care is the key to success in COVID-19 and cancer management, as well as the strong need of keeping the connection between health needs and cancer management.
Biagioli V, Belloni S, Albanesi B, et al. Comment on “The experience on coronavirus disease 2019 and cancer from an oncology hub institution in Milan, Lombardy Region” and reflections from the Italian Association of Oncology Nurses. European Journal of Cancer 2020; 135:8-10.