Oncology nursing during a pandemic: realities and challenges
A nurse by profession, I am currently serving as a nursing officer at the Uganda Cancer Institute since 2010. I hold a Bachelor’s Degree in nursing and am currently finishing an internship at Mengo Hospital. I have a lot of interest in research and I was awarded an RSTMH grant in 2020. The following blog is taken from my own experience as a nurse managing cancer patients, highlighting how COVID-19 greatly affects oncology care.
In December 2019, COVID-19 was first reported in Wuhan, China. It presented as a pneumonia-like infection that later intensified as a global pandemic. COVID-19 is a severe acute respiratory syndrome that causes renal, cardiac, haematological and neurological problems. This has affected heathcare services worldwide.
During the COVID-19 pandemic, cancer clinics responded to the pandemic by implementing processes such as segregated work flow, prioritising certain subgroups for immediate treatment while postponing therapy for other groups, modifying certain treatment protocols and incorporating telemedicine into their workflow.
Why cancer patients?
The virus has significant impact on patients with underlying malignancy. Cancer patients in low- and middle-income countries have faced particularly difficult changes during the pandemic. In East Africa – Kenya, Tanzania, Rwanda and Uganda – there are many cases of cancer and they are bound to increase.
Patients with cancer require multiple hospital visits for diagnoses and treatments including radiotherapy, chemotherapy immunotherapy and targeted therapy over many weeks. This weakens their immune systems, predisposing them to a higher risk of contracting hospital and community acquired infections, including coronavirus.
Studies report that people with pre-existing conditions like cancer are at a greater risk of acquiring COVID-19. Nurses have always been on the frontline in managing cancer patients. They play an important role in cancer care delivery in all forms of treatment. Oncology nurses spend a lot of time with cancer patients, putting them at increased risk of acquiring coronavirus.
Cancer therapy is complex and this makes patients immunocompromised. Patients with blood cancer are expected to be amongst those at increased risk of COVID-19. This is due to a weakened immune system from the effects of their cancer and the nature of cancer treatment they receive. This can make them present with covid-like symptoms. This is one of the most concerning findings because nurses are usually the first contact of patients making them more exposed to COVID-19.
Oncology nurses have always developed and used evidence-based guidelines relevant to nursing practice so as to prevent treatment-related side effects in both adults and paediatric patients. With the onset and continuation of the pandemic, oncology nurses have continued to provide patients with the education, communication, tools, and compassionate care to successfully navigate through cancer diagnoses and treatment.
Oncology nurses had not previously cared for patients during a global health emergency so regulations from professional organisations on paramount practices were revised and assimilated into the hospital’s daily practice as needed. These include; social distancing, regular hand washing, wearing masks and being vigilant on the signs and symptoms of COVID-19.
As a nurse researcher, I realised that many more patients were recorded at the cancer institute than usual. This is because cancer patients experience distress during and after treatment but this time because of the pandemic, the levels of distress are higher.
Cancer patients come to hospital more often hence increasing the workload and crowding at the Institute. Studies show that in times of epidemics and natural disasters, patients with long-term conditions have a higher risk of illness complications being exacerbated by increased stress.
When stay at home orders were mandated and lockdowns implemented, most patients didn’t follow up due to travel restrictions. Once restrictions eased, patients came back for review but with advanced disease.
The Institute developed a hospital telephone line for patients who could not make an in-person visit. The institution also developed guidelines as to how to prioritse between patients and treatments during the pandemic. However, use of telehealth has not been utilised by most cancer patients. Many are in a lot pain and require full assessments, allowing for the continuation of supportive care as usual.
Oncology nurses have been relocated to COVID-19 centres for confirmed or suspected cases with COVID-19. Proper protective wear for nurses managing patients is not sufficient. This increases the risk of exposing nurses to the virus.
Emotional and physical burden
The COVID-19 pandemic continues to deliver an emotional and physical burden on patients, all healthcare providers, and our global community. Every nurse committed to the care of patients with COVID-19 and other diseases deserves the most sincere gratitude for selflessly putting their lives on the line every day.
Supportive care of patients with cancer during the pandemic has pushed oncology nurses to continually update their knowledge base on the effects of COVID-19 on cancer treatments and what used to constitute standards of care.
Nurses are key stakeholders in developing and implementing policies regarding standards of care during pandemics, therefore nurses suggest that these strategies would help to mitigate the spread of the virus among cancer patients.
Patient education, managing supportive care needs, and providing reassurance and information regarding the coronavirus are all necessary care components offered by dedicated oncology nurses globally.