A third of the world population is now experiencing some form of coronavirus lock-down to mitigate the spread of the pandemic. As health systems are forced to prioritise resources and individuals are asked to engage in social distancing, UICC organised on Thursday 26 March a webinar uniting 100 participants.
Panelists from the National Cancer Center of Korea (NCCK), the Geneva University Hospitals in Switzerland, the Swedish Cancer Society and the Global Chinese Breast Cancer Organizations Alliance shared their experiences and insights. Furthermore, UICC staff has directly contacted members at Fundación Aladina in Spain, the Behnam Daheshpour Charity in Iran, Cansearch foundation in Switzerland and the NCCK.
It emerged that while countries experience different levels of severity with regard to the COVID-19 outbreak, organisations faced similar challenges in terms of reconciling the continuance of medical care and the in-person nature of counselling, guidance and support, with the need to isolate patients, whose immune systems are weakened, and keep them safe from contagion.
Ishtar Espejo, Director of Fundación Aladina and one of UICC's Young Leaders, which provides support to children and teenagers, explained that it was impossible to replicate virtually the human touch and presence inherent in group activities such as card games or peer-to-peer support.
“We are doing everything we can, offering a maximum of counselling services and physical training programmes remotely, even pet therapy! They may not have the same level of effectiveness but they can still help reduce stress and the sense of solitude, and ward off fear and depression.“
- Ishtar Espejo, Director of Fundación Aladina, Spain
UICC webinar panellist Mary Wong, Chairman of the Global Alliance of Chinese Breast Cancer Organisations, underscored the psychological impact on patients, who are now forced to separate from others, are often isolated from their families and exhibit signs of depression. The Global Alliance has taken a three-prong approach to providing care: a phone helpline; emotional e-support, consisting of the creation of WhatsApp groups with mediator, survivor and patient, as well as weekly Zoom sessions for larger groups to exchange information and coping strategies; and a Facebook live session that offers dialogue with experts.
Lily Bahman, CEO of Behnam Daheshpour Charity in Iran, which provides medical and support services to cancer patients and their families, said that the organisation was continuing its in-patient in social work, providing staff with masks and other protective gear, as well as supplies, equipment and other services to university hospitals to enable free or low-cost treatment for patients. “We are also now paying for travel when patients live too far from the hospital so they do not have to stay on-site, and arrange for money transfers to pay for medication.”
A more pressing issue facing cancer care providers in Iran, said Ms Bahman, is that the country is currently on holiday for the new year and she is uncertain whether patients will return afterward for their treatment. They are used to suspending treatment during this period but now may be afraid of returning due to the pandemic.
“We need to provide patients with accurate and reliable information to reassure them and encourage them to come in for treatment.”
- Lily Bahman, CEO of Behnam Daheshpour Charity, Iran
Indeed the continuance of treatment is at the forefront of many patients' concerns as doing so possibly heightens their risk of exposure to the coronavirus. These risks also exist for caregivers, which can undermine their ability to dispense treatment effectively. Prof. Marc Ansari, Founder of the Cansearch research laboratory, a pediatric onco-hematology research platform, and head of Pediatric Oncohematology Unit at the Geneva University Hospitals, said that as of 19 March already four of his staff – trained practitioners who cannot be easily replaced – had tested positive for COVID-19 or fallen ill and were now quarantined for 15 days. He said that out of the 20,000 cases report in Italy mid-March, some 1,700 cases were healthcare professionals.
As in many other places, appointments that are non-essential or that are not time-sensitive are being pushed back, while surgery, chemotherapy and radiotherapy, continue as planned. The distinction between “essential” and “non-essential”, however, is not always clear. As Ms Espejo pointed out, some forms of treatment contribute considerably to a cancer patient’s well-being but are nevertheless forced to be discontinued. These include laser therapy to treat mouth sores that are often a result of chemotherapy.
To minimise as much as possible the risks of contagion, hospitals ideally are creating separate wards. According to Ms Bahman, this is fortunately the case in Iran for oncology and other medical departments; in fact, the attempt is being made to separate COVID-19 care units from other wards by following a set of principles and guidelines.
In Korea, which faced the MERS epidemic in 2015, there are designated institutions to treat exclusively pandemic victims. According to Dr Young Ju Choi, Chief of Infection Control Unit, multiple screening processes have been set up and extensive testing carried out in order to isolate suspect cases.
“In Korea, especially localized in Daegu city, asymptomatic patients or those with mild symptoms are kept separate in a large ‘holding area’ like a hotel or conference center, while those with severe symptoms remain in a transition ward. Depending on the test results, they are then rotated out to a treatment center or allowed to leave.”
- Dr Young Ju Choi, Chief of Infection Control Unit, Korea
Health systems in many other countries, however, are already or in the process of becoming overwhelmed and are suffering from lack of space and equipment. UICC webinar panellist, Ulrika Arehed Kägström, General Secretary of the Swedish Cancer Society and UICC Board member, said that field hospitals were being set up in Stockholm and Göteborg – something she thought she would never see outside a natural disaster area or a war zone. The production of personal protective equipment is also being ramped up to address shortages.
Some regions may be so hard hit that even essential treatment may have to be rationed. Choices may then have to be made depending on the stage to which a patient’s cancer has progressed. This is also true for cancer patients who contract the coronavirus. Dr Choi said: “If therapy can lead to complete remission, then the cancer should continue to be aggressively treated; similarly, if a patient gets COVID-19 with a good prospect of surviving the disease, then I would advise and push for full supportive care. With this aggressive treat, NCCK is successfully preventing patients from contracting COVID-19 during their visit.”
Dr Choi confirmed that thus far there were no compromised patients in NCCK. Prof Ansari also reported no cases at his pediatric ward; in fact, he said that there had been no pediatric onco-hematology cases reported in the large onco-hematology pediatric centres in northern Italy, one of the regions hardest hit by COVID-19.
Dr Alfredo Addeo, Senior Consultant Medical Oncologist at the Geneva University Hospitals, urged countries not yet hard hit by the pandemic to start planning on how to isolate patients and secure equipment and to act quickly and decisively.
Ms Kägström questioned the long-term implications for non-profit organisations involved in dispensing support and guidance. The Swedish Cancer Society has changed the way it provides support and guidance, offers up-to-date information on its website and has implemented a helpline (phone, email and chat functions); however, staff are also conducting risk analysis and assessing the long-term impact on their activities and ability to deliver their services, particularly with regard to their financial stability. Ms Kägström emphasised the need for NGOs to forecast donations and other revenue streams, secure their partners, and adapt their fundraising campaigns and communications messaging. Governments must know that cancer is not going away,
Mary Wong agreed, stating that organisations must campaign with sensitivity to account for the reality of COVID-19. She further emphasised the need to continue providing up-to-date and reliable news, reassuring patients and reaching out to them to let them know that they are not alone, and offer assistance and assurances that help will always be there.
Above all, create hope!
Visit UICC’s webpage dedicated to cancer and coronavirus resources
View the webinar on how UICC members are responding to the Coronavirus pandemic: