COVID-19 has put the health system in check , which has led to a growing virtuality that has been imposed on a day-to-day basis as the main measure to avoid possible contagion. The most palpable consequence has been the distancing between doctor and patient, which in some pathologies such as cancer entails risks and questions.
In addition, pain control has also become one of the great challenges . A symptom that before the pandemic was estimated to affect between 30% and 40% of patients at the time of diagnosis and between 70% and 80% when the disease was more advanced. Now, probably, the figures will have worsened.
The fight against SARS-CoV-2 has thus become a major challenge for cancer care, especially during the first wave, which took us by surprise and “the hospital became a dangerous place for the patient ” . This is how Javier de Castro, head of the Medical Oncology Service at Hospital La Paz in Madrid, tells it. “We learned to return to a medicine based on the patient and the doctor’s experience,” he says.
One of the main changes was the need to adapt to remote medicine through teleconsultation, something that is not always possible . “We have used the telephone in those queries that could be resolved briefly, such as results or evolutionary assessments. In no case have they been used for first consultations or doubtful situations, ”says Yolanda Escobar, medical oncologist at the Gregorio Marañón University General Hospital and coordinator of the Continuous Care Section of the Spanish Society of Medical Oncology (SEOM).
In this way, the adaptation to the pandemic caused a shift aimed at maximizing patient safety and minimizing their presence in the hospital, as far as possible. “We have made attempts to change protocols, as well as to make it easier for the patient to dispense and administer drugs,” Escobar says. On the other hand, “we have limited the number of oncology consultation companions to one, since the lack of company would be very unsettling for the patient ,” he adds.
All this situation has generated a difficulty in the follow-up of cancer patients, not to mention the suspension of surgeries and complementary tests . A chaotic situation that has motivated, in many cases, a significant change in their clinical evolution, with diagnoses in higher and less early stages, according to Esther Holgado, head of the Medical Oncology Service at Hospital La Luz.
Elisabet Hernández, a nurse at the Palliative Care Unit of the Oncology Service at the Vall d’Hebron Hospital in Barcelona, makes the same observation. “Patients have come with a high tumor load, so many have not survived or have not reached the first lines of treatment.”
The situation has resulted in a double threat for cancer patients, who have faced not only COVID-19 infection, but also cancer . “We have tried to make an oncology link with Primary Care so that patients are not afraid to go to the hospital and that they do not stay on the path of a late diagnosis of cancer, which is much more deadly”, indicates De Castro.
The role of professionals has therefore gone much further, extending humanization as much as possible in the context of telematics and virtuality. At the hospitalization level, for example, video calls have been used “to bring together people who were experiencing loneliness in their situation,” according to Hernández. Something that can only worsen the prognosis. “Loneliness greatly influenced pain, understanding that this is a symptom, but that the person is divided into multiple spheres. We have to approach everything holistically”, stresses the palliative care expert.
pain is bad medicine
In the telematic context derived from the pandemic, the psychological part has been “essential” in this process within the doctor-patient relationship. “Pain is a subjective symptom and, in the remote consultation, you only have what the person who suffers from it says. To be able to treat it, you have to take a very extensive clinical history,” says Holgado.
The fact of not adequately alleviating pain can lead to greater dissatisfaction and lower quality of life for patients, regardless of the effectiveness of their treatment against the disease. In addition, it has been shown to influence the development of oncological pathology .
In this sense, the importance of multidisciplinary work becomes key. Nursing professionals, for example, play a fundamental role given their closeness to the patient who does not dare to say that it hurts.