In March 2020, it became apparent that across the world, our lives were going to change significantly though few of us would have predicted that one year on we would be still be facing restrictions. Here at HRW, our specialist oncology unit, OR:BIT, has been privileged to have conducted oncology research throughout COVID-19 with healthcare professionals, patients, carers, and patient support organisation staff across a range of cancer types. It is very clear to us and the world that COVID-19 has had a massive impact on cancer care worldwide, and three of the areas that have stood out to us most are treatment choice, patient experiences with healthcare professionals and patient support.
When talking to healthcare professionals about how they choose treatments, it has become apparent that there has been a shift in thinking during COVID-19. Understandably both patients and healthcare professionals are keen for cancer patients to avoid hospital visits as much as possible. Regardless of their treatment, cancer patients can be more vulnerable than the general population, but this is especially true when the treatment is immunosuppressive such as chemotherapy or immunotherapy. Whilst cancer patients still receive the treatment they need, wherever possible we know HCPs are considering oral alternatives instead of treatments which require hospital visits to prevent risk to the patient. There have even been guideline relaxations (for example NICE in the UK) allowing HCPs more prescribing freedom. This has resulted in clients looking to quickly develop solutions to allow their treatments to be administered at home. We have also seen a shift in thinking, whereby some HCPs have appeared reticent to prescribe newer treatment options, often defaulting to more traditional approaches. This is a clear demonstration of the familiarity bias, meaning we tend to prefer things that are similar to things we already know and have familiarity with; this bias being particularly true when people are in situations with high levels of uncertainty or change as we have seen with COVID-19.
Patient experience with healthcare professionals
Undeniably there have been many challenges on healthcare systems over the last year, which has unsurprisingly had an impact on cancer patient management throughout their whole journey. Due to patient fear of going to the hospital or their GP, compounded by delayed investigations, referrals and appointments, cancer diagnoses are happening late which is concerning both from a healthcare professional and patient point of view. Treatment initiation and surgical procedures may be delayed which can cause fear of progression amongst patients. A cancer diagnosis is such an earth-shattering moment for many patients and we frequently see that patients find it difficult to take in all the information when talking to HCPs. This is especially challenging when conversations must happen over the phone, as is frequently the case during COVID-19. Patients have reported feeling disconnected from their treating physicians and don’t feel as well looked after when they’re not seeing an oncologist, for example, face-to-face. Patients have admitted not asking the questions they wanted to, as they didn’t feel comfortable doing so over the phone. Similarly, oncologists have told us that they have had to deliver news such as progression to metastatic disease over the phone, although some healthcare professionals are still able to deliver news in person, for example discussion options for best supportive care. The challenges continue into ongoing management, for example monitoring needing to happen virtually, patients having to go to different centres for blood tests and then liaise with their treating hospital, and delayed appointments. We have seen many of our Oncology clients focusing and developing tools to aid tele-medicine.
In our many years of cancer research, we have found that patients lean heavily on their loved ones for support and without support sources being available, cancer can be a very isolating disease. Due to various COVID-19 restrictions across the globe (cancer in many instances), patients have been cut off from face-to-face contact with their support network; even where the rules are less restrictive, cancer patients often still cannot meet friends or family as they are a vulnerable population. The lack of being able to socialise with friends and family, or indeed leave home at all in some situations, has led to some patients reporting feelings of loneliness. Some support groups have shut down, often relying on face-to-face group meetings, as well as support offerings from healthcare professionals such as psychological support, thus removing a source of support for patients who are, understandably, anxious about the COVID-19 situation.
Whilst there is a light at the end of the tunnel in the form of COVID-19 vaccinations being rolled out globally, there is no denying that the last year has seen significant challenges in cancer care, and whilst the world has been so focused on COVID-19, cancer is still a significant disease affecting many of us. In the words of one patient “COVID-19 might go and might be alright, but I’ll still have cancer, which is more important than COVID-19”.
By Sophie Bone