Cancer Patients Face a Health System in Crisis

“Since the pandemic’s start, we’ve worried about the health system’s dramatic collapse but, like my dying patients, we’re witnessing a slower death; a system imperceptibly degrading until one day, like a cancer-riddled body, it just stops working entirely.”

Dr. Gabriel Fabreau

Doctors, nurses and patient advocates in both Canada and the U.S. are sounding the alarm that after two years of COVID-19, our hospitals have never been worse off. This incredibly disturbing quote describing the health care system is from a recent opinion piece in my local newspaper. The piece was written by Dr. Gabriel Fabreau, a general internist and an assistant professor at the O’Brien Institute for Public Health at the University of Calgary. Fabreau argues that the quality of care in Alberta is degrading, increasingly unsafe and often without dignity.

When I was first diagnosed with cancer in November 2011 I was like many Canadians, I was proud of our universal health care but I had never really been required to test it. I had never dealt with a chronic or life-threatening illness before. I’d never even been hospitalized for surgery or seen the inside of a cancer centre. My innocence of what’s involved in being treated for cancer was shattered almost literally overnight. It took three surgeries and five cycles of chemotherapy to force my disease into remission, along the way there were too many outpatient appointments, tests and scans for me to count. I’ve currently logged thousands of hours in hospitals and seen dozens of physicians and physicians in training, that’s enough to consider myself an insider when it comes to the basics of Canada’s health care system.

Photo by Anna Shvets

Even a decade ago, long before the pandemic, there were many warning signs that the system was under strain. During my cancer surgeries I often felt an urgent need to leave the hospital and go home, I never felt relaxed or like I could take my time to heal. Even then, it may have been easier to define hospitals by what they are not. They’re not places for the sick to get well, not unless healing takes place in the brief interval of time that makes the stay a compensated expense. My hospital treatment was primarily covered by Alberta’s universal health insurance, but I needed my personal Blue Cross insurance plan as well. Through it all I was aware that hospital beds in Alberta cost around $1000 per day and that those beds are in limited supply.

I remember watching in surprise as some short-term stay patients were relegated to the hallway due to the unavailability of rooms. Unfortunately, what I witnessed was a typical example, an unpleasant reminder of how drastically the situation for patients and their families has changed in the past couple of decades. Once hospitals were where you stayed when you were too sick to survive at home; now it’s become customary to go home anyway, cobbling together your own nursing services from friends, relatives and drop-in professionals.

Justifiably the deteriorating situation during the pandemic has me concerned. As a cancer survivor and someone who has relied heavily on health care, I’m becoming more worried each day. The reality is that if my cancer recurs or if I have to resume active treatment, I may not be able to obtain the essential care I need. Fabreau cites the growing deficit in cancer screening and follow up care as the most troubling to him.  “Most tragically, we’re seeing missed cancers, illnesses so advanced they are now incurable. We know delayed diagnosis and treatment increase cancer deaths. Canadian research predicts over 21,000 excess cancer deaths by 2030. Preventable deaths because patients couldn’t or didn’t have appropriate cancer screening.”

Photo by Cedric Fauntleroy

I’m enraged and disheartened because, as Dr. Fabreau explains, the disastrous situation that we now find ourselves in was mainly avoidable. Even before the pandemic, the supply of health care workers was becoming inadequate. Canada has among the lowest physician and an average nurse supply per capita among high-income countries. Both workforces are running on empty: over half of physicians and more than 75 per cent of nurses in Canada are burnt out. It’s now disturbingly obvious that action should have been taken years ago to hire, train and recruit more health care workers. 

Finally, to reduce hospital demand, we must stop pretending COVID-19 is over when it is not. The pandemic is far from ended, particularly for cancer patients and others who are immunocompromised. It’s true Canadian COVID transmission is cresting as we enter the spring and summer seasons, but that simply means we must use this short reprieve until fall to prepare. Governments and health authorities would be wise to use this time to focus on important initiatives such as improving indoor ventilation and uptake of vaccine booster doses.

COVID’s Second Bitter Winter

Omicron, the rapidly spreading COVID variant that seems to be more successful at evading the body’s immune response, is enough to break anyone’s spirt two years into the pandemic. But for many cancer patients it’s been like a punch in the face followed by a hard kick once we’ve hit the floor.

First, we must live with the awareness that COVID is far more dangerous for us than it is for ordinary people who aren’t dealing with a malignancy. The truth that cancer patients remain at a much higher risk of hospitalization and death from COVID-19 even if they are fully vaccinated, was recently verified by a small-scale study. The study, published in the journal Annals of Oncology, found that cancer patients had a 13 per cent mortality rate if they suffered a breakthrough infection. This important research was conducted by the COVID-19 and Cancer Consortium, a group of 129 research centres which have been tracking the virus’ impact on cancer patients. It’s considered to be the first study to investigate the risk levels for cancer patients who experience breakthrough cases.

The most demoralizing issue is that many individuals in government and society continue to abandon us, they treat the vulnerable or high risk as if we are inconsequential. For the past two years I’ve witnessed the casual selfishness of those who are considered healthy and able bodied. I’ve also seen cancer patients endure hardships that are far worse than what should be expected of them. Not only is there the prolonged stress of undergoing cancer treatment as anti-vaxxers picket hospitals, there’s also the exasperation of flip-flopping politicians who wield power over our lives. I’ve become incredibly frustrated with a number of provincial and state governments during the pandemic, because to me it’s disturbingly obvious that cancer patients, the elderly or citizens with chronic health conditions aren’t their priority. Some politicians will jeopardize our lives for their political careers and the economic advantage of a privileged few.

Official statistics report that globally about 5.5 million people have died of COVID-19. However, it’s still unknown how many deaths there have been indirectly as a result of the strain on heavily overburdened health care systems. Of course, individuals must take some personal responsibility for this problem, but governments are primarily responsible. In Canada almost 560,000 fewer surgeries were performed between March 2020 and June 2021 due to cancellations and delays, compared with the pre-pandemic period. Often, we’ve been reassured by government and health officials that it’s only elective surgeries that are being significantly impacted. But doctors and patients argue that the term “elective” is deceptive. For example, cancer surgery is not “elective” like a class in school. It just means you likely won’t die if your surgery happens on Thursday instead of Tuesday, unlike a burst appendix. 

Naturally cancer patients and their families are concerned about access to care as well as the potential disruptions to treatment as the pandemic drags on. Unfortunately, experts are now warning us that cancelled surgeries are only a single manifestation of this crisis. Two years into the pandemic some oncologists are seeing first-hand the “tsunami” of advanced cancers that are less curable than if they’d been diagnosed at an earlier stage. This increase is happening due to a combination of factors: 

  • Patients with cancer symptoms feared coming to hospitals, which are taking precautions to reduce the risk of contact with COVID-19.
  • People missed preventative screenings like mammograms and colonoscopies.
  • There were cuts to operating room time during lockdowns, slower diagnostic tests and biopsies, and reduced intensive care unit staffing for surgical patients.

Finally, it’s never been more isolating or lonely to be a cancer patient and the journey has never seemed more precarious. Those with advanced or incurable disease have had their lives impacted the most. “I knew that when they told me I was incurable, my years of life had shrunk down. I was not prepared to be robbed of experiencing them by being locked in my home for two years,” wrote one woman. “Of the few people that can visit, I have to warn them that I look very different. I’m a skeleton compared to the happy, size 14 I once was (and yes, I was happy at 14). Now my bones stick out all over. I need help getting up, and none of my clothes fit.”

Even during their medical appointments or hospitalizations, cancer patients are often required to abstain from close physical contact. This comes at a time in their lives when they probably need this type of support the most. “My family doctor delivered the diagnosis over the phone. Whenever I received bad news at the hospital, I walked to my car without holding anyone’s hand. The day of my surgery in July 2020, I lay on a gurney, my chest marked up with Sharpie where the incisions would be to remove my breasts, and waited for hours staring at the chair no one was allowed to sit in,” recalls Ann Cavlovic. Worse, wearing masks and other PPE sometimes means that even doctors and nurses are unable to offer the comfort of a warm hand in situations when a patient’s relatives are absent, trapped on the other side of the world or quarantined. As the longstanding slogan argues, no one should have to face cancer alone.

Crushing the Third Wave

It’s around lunchtime on a windy spring day as I walk into the building and begin navigating the checkpoints that have been set up for the COVID vaccination clinic. As I make my way to the old gymnasium in the former children’s hospital, I’m relieved that I’ve managed to book an appointment—after several months of waiting it’s finally my demographic’s chance. Like hundreds of thousands, I had to first wait in anticipation while following the latest updates from the Alberta government concerning a complex vaccine rollout plan. 

I’m intensely aware as I’m about to be vaccinated, that our province has one of North America’s highest COVID-19 rates. Of course, it’s a dubious distinction and our third wave outbreak has garnered international attention in the media. In recent weeks American. television networks including CNN have covered the crisis and so has the venerable British newspaper The Guardian. As a cancer survivor and someone who is potentially vulnerable to complications from the virus, I’ve become extremely angry and frustrated.

Many physicians and leading public health experts have argued that it didn’t have to become this bad and that Albertans shouldn’t have to go through this nightmare. The third wave has been terrifying, especially for those of us who are not young or perfectly healthy, On the day that I’m ready to receive my first dose of Pfizer vaccine, Alberta has around 570 active cases of COVID-19 per 100,000 residents, more than twice the Canadian average. It’s the highest rate recorded anywhere in Canada at any point during the pandemic.

Regrettably, the province is now mired in its third major round of restrictions since the pandemic began last March. The latest surge has forced the reintroduction of strict, sweeping public health measures, closing all schools provincewide and temporarily shuttering many non-essential businesses. Most experts are citing a variety of contributing factors to explain exactly how we got into this situation or why Alberta’s third wave has become so severe. Here is their general consensus of what went wrong:

  • A premature easing of public health restrictions
  • An underestimation of COVID-19 variants 
  • An inequitable vaccine rollout
  • Non-compliance and non-enforcement regarding health restrictions
  • Refusing to prioritize the province’s schools and teachers

For the time being, I’ve joined a steady stream of hopeful Calgarians at the vaccination centre. There is light at the end of the tunnel I tell myself as I enter the gym and a woman takes my registration confirmation number and asks for my ID. Suddenly, I’m not just thinking about myself or my immediate geographic region, but the entire world. I wonder how many people will also get vaccinated today—both in Canada and around the globe. I believe in science and I understand mass vaccination will be one of the keys to ending this unprecedented pandemic that has claimed millions of lives.

Naturally there are segments of the population that are hesitant or sceptical about the new COVID-19 vaccines and are unsure if they should be immunized. History reveals that vaccine scepticism is as old as vaccines themselves. Increased resistance to compulsory smallpox vaccination during the 1870s and 1880s exposed the fragility of trust in both the political and medical establishment. The most radical opponents to vaccines used demonstrations and publishing to rally their cause. The situation is similar today, many doctors and infectious disease experts acknowledge that their work has been made more challenging due to the anti-vaccine movement. 

As I meet the diligent young nurse who is about to administer my injection, I know I trust both her and the medical and scientific community. Perhaps it’s my experience as a cancer survivor that allows that trust to come more easily. Sometimes I marvel that I’m alive because of medical science and what it’s capable of in the fight against cancer, during the search for a COVID-19 vaccine my sense of wonder was renewed. Never before in human history have vaccines for a pathogen entered final stage clinical trials and received approval for distribution to the public so rapidly. To me this doesn’t mean they cut corners or that proper clinical trials weren’t conducted— it’s only a testament to what the scientific community can accomplish when it works together toward one crucial goal.

Following my shot, I get up and move to the waiting area full of masked and freshly immunized patients. As a routine precaution people are asked to wait for at least fifteen minutes after their injection before leaving the vaccination centre. As I sit in my socially distanced chair, I think to myself that I will probably remember this moment for the rest of my life. Someone said that the stories you hold on to about the pandemic will be coloured by your own experience—but also by the experiences of those around you. In a way we’re already shaping our future pandemic narratives—the stories we will tell as individuals, as communities, as societies, and as nations about this epoch. 

Why Most Cancer Patients Should Be Vaccinated Against Covid-19

Sometimes I marvel that I’m alive because of medical science and what it’s capable of in the fight against cancer, during the search for a COVID-19 vaccine my sense of wonder was renewed. Never before in human history have vaccines for a pathogen entered final stage clinical trials and received approval for distribution to the public so rapidly. Just over a year ago, when the death toll from the coronavirus stood at one and neither it nor the disease it caused had a name, a team of Chinese scientists uploaded its genetic sequence to a public site. That kicked off the record-breaking rush to develop vaccines. It’s difficult to associate anything to do with this pandemic with good fortune, but the fact that the culprit was a coronavirus — one that was strikingly similar to others that had previously leapt from animals to people — meant scientists could quickly rejigger vaccine projects in the works for those. It was almost like swapping a blue Lego for a red one in their assemblies.

In December 2020, Health Canada authorized the Pfizer-BioNTech COVID-19 vaccine. Soon there was more encouraging news when they officially authorized a second vaccine for the virus, an injection manufactured by Moderna. The first Canadians to be offered the country’s limited inventory of the vaccines were those considered to be most vulnerable, the staff and residents of nursing homes and long-term care homes were prioritized. The frontline doctors and nurses who have been risking their own lives during this pandemic were also given appointments to receive their immunizations against COVID-19. I watched, as some of the health care workers receiving the vaccine shed tears of joy and relief. Many proudly posted photographs of themselves getting vaccinated on social media, reassuring the public and preparing us all for when it would eventually be our turn.

Naturally there are segments of the population that are hesitant or sceptical about the new COVID-19 vaccines and are unsure if they should be immunized. History reveals that vaccine scepticism is as old as vaccines themselves. Increased resistance to compulsory smallpox vaccination during the 1870s and 1880s exposed the fragility of trust in both the political and medical establishment. The most radical opponents to vaccines used demonstrations and publishing to rally their cause. The situation is similar today, many doctors and infectious disease experts acknowledge that their work has been made more challenging due to the anti-vaccine movement. 

Making sure that patients receive clear and accurate information is essential and everyone has a role to play. Ultimately preventing misinformation is a shared responsibility. The flow of medical knowledge works best when researchers, journalists and the public are strongly connected and considerate of one another. Nineteenth-century doctors tried to maintain boundaries between scientific journalism and the media, but were unable to prevent the public and journalistic demand for health information. That desire remains with us today. But even working together, the solution isn’t simple, experts maintain that changing behaviour in vaccine hesitant patients, isn’t always as easy as correcting misinformation. There’s still an emotional gap and trust gap that physicians regularly need to bridge in order to elicit this behavioural change.

Like all informed people, I accept the scientific conclusion that if you have active cancer, you’re at a higher risk for more serious outcomes if you acquire COVID-19. Cancer is considered an underlying medical condition. It’s a scientific fact that many cancer treatments, including surgery, chemotherapy and radiation therapy, can weaken your immune system, making it harder for you to fight the virus. Initial clinical trials on COVID-19 vaccines did not include people with cancer or those receiving treatments that can suppress the immune system. However, many professional organizations are endorsing the vaccines’ safety and efficacy for this group. Since individuals living with cancer are at increased risk of serious illness resulting from COVID-19, there is growing consensus among health authorities and oncologists that the benefits of vaccination outweigh the risks. Some exceptions include people who are severely immunocompromised or who have certain severe allergies .The National Cancer Institute emphasizes that people, including those with underlying medical conditions such as cancer, may get vaccinated if they have no history of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine.

As a final point, cancer patients going through active treatment are definitely at higher risk for COVID-19 complications, but what about cancer survivors or those whose cancer is in remission, such as myself? Little data is available to date on how the virus affects cancer survivors, but some early research suggests that we might also be at a higher risk for severe COVID-19 outcomes. One UK study found that the majority of comorbidities thought to be associated with poor COVID-19 outcomes were more common in the cancer survivors than the cancer-free controls. In general, cancer survivors had significantly higher rates of diabetes, asthma, and other respiratory disease, as well as more chronic heart, liver, and renal disease, and neurologic conditions, than controls. Nine years after my cancer diagnosis I appear fortunate to have few of these lasting health complications. Still I’ve made up my mind, after considering the research and the scientific facts, that I will be getting vaccinated as soon as I’m given the opportunity.


Further Reading

COVID-19 Vaccines: Separating fact from fiction on side effects, blood clots and more

Delaying second vaccine dose leaves cancer patients vulnerable to virus

For High-Risk Cancer Patients, Experts Consider Any Vaccine-Induced Covid-19 Protection Beneficial

How can I overcome my fear of needles to get a COVID-19 vaccination?

What 2020 Has Taught Me

This year’s global pandemic has taught me many valuable lessons, some of them I had previously learned by being a cancer patient but had almost forgotten. Ironically, I’ve found that cancer and a pandemic have much in common in terms of the emotional and psychological impact that they have on an individual. The world order has been shaken by this once in a century global crisis and I doubt that we will ever go back to the exact same existence that we knew before. People will divide their lives into before and after the pandemic like I now divide mine into before and after cancer. An article in the British newspaper The Guardian compared the COVID-19 pandemic to a magnifying glass, noting that it has illuminated deprivation, inequalities and political unrest, while reminding us of the power and beauty of nature and humanity.

Here are some of the issues that the pandemic has shed a light on for me:

We are surrounded by a materialistic and competitive culture. 

As I was forced to spend more time at home or in solitude due the pandemic restrictions, I was reminded of what is essential or important. Too many of us can’t imagine life without frequent trips to shopping malls and beauty salons, if we’re younger we don’t know what to do when our weekend isn’t spent going to night clubs and parties. Meanwhile, the pandemic has allowed some of us to regain focus on what really matters, things like our relationships, our sense of self, perhaps in the end our definitive contributions to this world.

The gap between Canada’s richest and poorest continues to widen. 

“There’s a convenient fiction perpetuated that Canada hasn’t experienced the great extreme inequalities of wealth at the top end that the United States has,” a report from Canadians for Tax Fairness said. “It’s true that our wealthiest don’t have fortunes at the same level as Jeff Bezos or Warren Buffett, but the number of Canadian billionaires has increased at a far faster rate than the number of American billionaires and their total wealth has also increased at a much faster rate.” The pandemic hasn’t stopped the wealthiest from growing their fortunes. The report found Canada’s 44 wealthiest people, all billionaires, grew their wealth by a total of $53 billion between April and October of 2020. 

The sick, elderly and disabled continue to be marginalized.

Figures compiled by the Canadian Institute for Health Information uncover the devastation of the pandemic on our most elderly and vulnerable citizens. During the first wave of the pandemic, more than 80 per cent of COVID-19 deaths in the country occurred in long-term care homes and retirement homes. During the second wave, seniors in nursing homes and residents of institutions once again bore the brunt of the pandemic. This was despite vows from federal and provincial governments to make improvements, changes aimed at preventing the second wave from ravaging long-term care facilities. Tragically the pandemic has revealed the systemic failures in how the world’s most developed countries choose to respond to aging, disability and the need for end of life care. 

The lowest paid people in the country are essential to its functioning.

As COVID-19 has invaded the country’s communities, there are many Canadians who cannot — must not — stay home and avoid it. Among them are the recognizable and well-paid heroes, the doctors, nurses and paramedics. These essential workers always have to be there in national or local emergencies, and they have risen to the call time and again. But in 2020, Canada’s essential workforce expanded its ranks. It now includes people who never expected to be on the front lines of a crisis, workers whose jobs have been traditionally invisible or undervalued. These truck drivers, grocery store clerks, cleaners, personal support workers and municipal workers had little time to prepare themselves for their newly dangerous roles. They entered the pandemic without masks, face shields or plexiglass barriers. Along with those in health care, they’ve had to learn on the job how to protect themselves from the virus. A lot of them have gotten sick. And yet, they show up day after day.

Science and medicine are the greatest wonders of our time.

I’m alive because of medical science and what it’s capable of in the fight against cancer, during the search for a COVID-19 vaccine my sense of wonder was renewed. Never before in human history have vaccines for a pathogen entered final stage clinical trials and received approval for distribution to the public so rapidly. Just one year ago, when the death toll from the coronavirus stood at one and neither it nor the disease it caused had a name, a team of Chinese scientists uploaded its genetic sequence to a public site. That kicked off the record-breaking rush to develop vaccines. It’s difficult to associate anything to do with this pandemic with good fortune, but the fact that the culprit was a coronavirus — one that was strikingly similar to others that had previously leapt from animals to people — meant scientists could quickly rejigger vaccine projects in the works for those. It was almost like swapping a blue Lego for a red one in their assemblies.

Cancer Communities Face the Challenges of 2020

Sometimes I find it easy to despair given current world events, including the ongoing global pandemic. This year has been especially stressful for cancer patients undergoing treatment, it has even been difficult for those of us who are in remission. There’s tremendous anxiety around the world as we witness the strain on cancer centres, major hospitals and just about every health care system. I like to remind myself of the resiliency being displayed by cancer communities as they carry on with hope and the determination to make it through this global crisis. I’m especially proud of the cancer organizations here in Canada. and in Calgary, the city where I live. 

Building During COVID-19

Despite the pandemic there is a much needed new cancer centre rising in Calgary. On my many visits to the current Tom Baker Centre, I was alarmed by the obviously overcrowded quarters. When it opened its doors in the 1980s, the Tom Baker Cancer Centre was spacious and featured state-of-the-art design. Flash forward thirty or forty years and the aging centre is crowded and serving a volume of patients that is well beyond the capacity that it was built for. 

After my first couple of appointments, I found it impossible not to notice how filled to capacity the Tom Baker Centre is. Like most patients, I was subjected to the overflowing parking lot, the busy chemotherapy beds and the often packed or standing room only waiting areas. 

Finally, in the fall of 2017 ground was officially broken for the new Calgary Cancer Centre. The facility is scheduled to open in 2023, it will have double the capacity to treat patients and feature ultramodern technology. I don’t know when or if my cancer will return, but I’ve been following the construction of the Calgary Cancer Centre—I’ve been watching throughout the pandemic with anticipation and hope for the future.

I captured this photograph from the Calgary Cancer Centre’s public webcam on the evening of May 26, 2020. I was awestruck by this beautiful image of the sun setting on the massive structure. 

The Walk Must Go On

Meanwhile, I’ve registered for Ovarian Cancer Canada’s largest annual fundraising event, the Ovarian Cancer Canada Walk of Hope. This year it’s become the  Virtual  Edition and will take place on Sunday, September 13. The Walk will certainly look different this year, but the community is focused on achieving our goal  and raising much needed funds to help women live fuller, better, longer lives. 

The pandemic does not change the simple fact that ovarian cancer research is significantly underfunded and that more has to be done to develop better treatments. Scientific progress in the field has been agonizingly slow, more than half of women who are diagnosed with ovarian cancer still die within five years. Like many who have battled the disease, I dream that perhaps one day soon there will be a test that can detect ovarian cancer in its early stages. The majority of women are currently diagnosed after the cancer has spread beyond their reproductive system. In the meantime, funds raised for research in the area of immunotherapy might give renewed hope to some of us—especially the thousands who are already living with ovarian cancer or facing a recurrence.

COVID Disruption: Slipping Through the Cracks

One of my greatest fears is that I will get a recurrence of my ovarian cancer as an unprecedented global pandemic continues to inundate hospitals and limit medical services. COVID-19 has really made a mess of healthcare across the board—not just in Canada and the United States, but for the entire world. Elective surgeries have been cancelled, meanwhile family doctors and oncologists are only seeing their most urgent patients. To minimize the risk of infection, cancer clinics and family practices are using virtual appointments whenever possible.

Perhaps the most distressing thing to me is that cancer treatment has lost its sense of predictability and continuity. The way doctors and health care teams are treating cancer continues to change day by day as the coronavirus pandemic unfolds. Because this is wholly uncharted territory and protocols don’t exist, surgeons are considering data from previous studies to guide their treatment decisions. 

For example, in some cases this means changing the order of treatment and administering cancer medicines before surgery. Ovarian cancer is typically treated with surgery first, but since elective surgeries are on hold at many hospitals, some oncologists are choosing to start patients on chemotherapy. “We’re fortunate to know from prior research that the order of those doesn’t matter, that the outcomes are similar even if a patient starts with chemotherapy,” one prominent oncologist explained.

Chemotherapy, though, poses its own set of risks and challenges because it can compromise a patient’s immune system. During the COVID-19 pandemic cancer specialists have to be very thoughtful and careful about the type of chemotherapy they recommend. Fortunately, in most cases there are various treatment regimens that may decrease the risk of immune suppression, and oncologists can also alter the chemotherapy doses as they deal with an unprecedented situation.

According to leading oncologists, the easiest patients to handle at this point are those who are in remission and are just being watched. In those cases, patients connect through teleconferencing, which allows doctors to get a sense of a patients’ general well-being, to interact, and discuss how they’re doing. While this approach eliminates the risk of infection, the majority of cancer patients argue that virtual appointments are not the same as having a doctor who can see you in person, actually measure your temperature, and actually feel any lumps or bumps that you may be experiencing.

The next group, which faces more challenges, is chemotherapy patients. Doctors say people on chemotherapy are the ones that they are the most worried about, because they know the patients have cancer and they know that the window to treat that cancer is fairly limited. Personally, I am extremely grateful that I’m not among the thousands of women with ovarian cancer undergoing active treatment. At most cancer centres patients are still getting chemotherapy, but their oncologists are having them essentially go right from their home to the lab to the chemotherapy suite to avoid coming into contact with as many people as possible.

This routine is very stressful for patients and their caregivers because at most centres social distancing measures are in place that prohibit friends or family members from being in the treatment area. Rules can change almost weekly or with very little notice.  Leading cancer centres acknowledge that their protocols will continue to be adapted throughout the pandemic as circumstances change.

Newly diagnosed patients who may require surgery are another major concern for oncology teams. One oncologist said that the most challenging are the diagnoses where someone comes in with findings that are suggestive of ovarian cancer, but unconfirmed. Sometimes a benign tumor can appear quite abnormal on a scan, and can look quite like cancer. The oncologists have to decide about whether they should bring that person to surgery. Obviously, the operating room is another area where patients are compromised or at risk. Furthermore, surgical procedures require a ventilator, which means the hospital is short one ventilator for another individual who may need it.

These are very tough decisions for doctors. They want to make sure that they’re not putting off the actual ovarian cancer patients a lot more than necessary, but they’re also not taking every single mass that probably is benign to the operating room. And while there’s some notion that specialists can just say, “that’s probably the right call, or that’s probably wrong” … it’s a much trickier discussion. Sometimes I ask myself if what cancer surgeons or decision makers are being forced into doing is gambling with somebody’s health and, potentially, with their life.

COVID-19 and Déjà Vu

There is much that all of us have experienced since the beginning of the COVID-19 pandemic that is shocking, unexpected, unpredictable, unknowable and new. Life like this for some people has become almost overwhelming because there is so much that hasn’t been felt before or seen. I think that ovarian cancer patients might have a unique advantage, we’re already familiar with this type of uncertainty. We suddenly find that we must try our best to live today while we do not know what tomorrow and the day after will bring.

Before I was diagnosed with cancer, I had no true sense of how precarious human existence is or of how uncertain my future had probably always been. Then, on November 3, 2011, I received a phone call from my gynecologist’s office, I was told that he wanted to see me in person immediately. With that meeting I learned that the course of my entire life could change in just a single day, all at once I was forced to acknowledge my own mortality and how fragile life is. 

Lately I’ve signed up for text messages from Alberta Health Services, each day there is a message designed to provide advice or some encouragement during this universally stressful and uncertain time. What I didn’t expect is how closely messages for people during a pandemic would echo the standard counselling that I was given throughout my cancer treatment. Here is some of the familiar advice that I’ve received over the past few weeks.

  • When bad things happen that we can’t control, we often focus on the things we can’t change. Focus on what you can control; what can you do to help yourself (or someone else) today?
  • Set goals for today, even if they are small. Goals should be SMART; Specific, Measurable, Achievable, Realistic and Timely.
  • Panic is extreme anxiety that creates tunnel vision and doesn’t solve problems. Take a minute, step back, and think.
  • A healthy body can set the stage for a healthy mind. Do your best to maintain a healthy diet and try to exercise.
  • If your best friend or loved one was having the same negative thought as you, what would you tell them? Try applying that to yourself.
  • Advocate for your needs using assertiveness. Assertiveness is being respectful to you and the other person. Be direct, non-aggressive, and highly specific with your request. 
  • Notice when you’re feeling sad, angry, lost or overwhelmed about life changes. Don’t push the feeling away—acknowledge these feelings and give yourself time to grieve.
  • Make sure each day involves some pleasure (example: take a bath, enjoy food, watch your favorite TV show, talk with a friend).
  • Practice “belly breathing” to reduce stress. Breathe deep into your abdomen. Watch your belly rise and fall.
  • Take a moment to notice how you feel right now. Don’t judge your emotions or try to change them. Just observe them and see how much your current stress levels are reduced.
  • Visualize yourself coping with current problems. See yourself facing these challenges. You have overcome challenges before.
  • Encourage yourself through tough times. Repeat statements like I can do this, this won’t last forever, I’m doing my best.
  • Acknowledge how strong you are to have made it here. You are important, you are brave, and you are resillent.

Cancer Patients in the Time of COVID-19

As a cancer survivor, I’m able to experience the growing global pandemic from a unique perspective. During these extraordinary times my thoughts are often with the ovarian cancer community and the women who I consider to be my teal sisters. I recognize that each of us in this community faces new challenges and I worry for my fellow survivors that I have met in person or online. Are they able to obtain the prescriptions and groceries they need? Are they getting to their treatments? Are they able to have appointments with their oncologists? How are they dealing with the anxiety of facing this terrible situation in an immunocompromised state? Are they exasperated or outraged when they hear reports of some people disregarding the directives given by government officials and health authorities, the unbelievably selfish individuals who are still refusing to stay home or practice social distancing? 

Naturally, as the world is being swallowed by a pandemic many health care systems are working at full capacity and some are courageously trying not to buckle under the strain. How do cancer patients or those struggling with other life-threatening conditions or illnesses get the care they need? Furthermore, the question about whether to continue immune system-suppressing cancer treatments during the Covid-19 pandemic appears to have no clear-cut answers. “Oncologists are in a very particular predicament right now,” says Dr. Siddhartha Mukherjee, a hematologist and oncologist at Columbia University Medical Center and Pulitzer Prize-winning author of The Emperor of All Maladies. “Because on the one hand, you don’t want to delay treatment, but you also don’t want to expose patients to risk.” 

Meanwhile, The American Society of Clinical Oncology (ASCO) has put out a series of general guidelines during this crisis. But the organization has also written that, “At this time, no specific recommendations can be made … for delay in therapy or choosing alternate therapy in the context of Covid-19 infection.” Consequently, in the United States and Canada, oncologists, nurses, care teams, and hospital administrators have been working hard to address each patient’s situation individually.

I like to believe that those of us in the cancer community might actually have some advantages during this terrible global pandemic. Under normal circumstances, oncologists give patients undergoing chemotherapy a list of recommendations that echo the advice we’ve all been hearing for weeks: wash your hands as often as possible, stay away from crowds, dine at home, don’t touch your face, don’t shake hands. For individuals with cancer, these behaviors are often already a way of life. Obviously, individuals living with cancer are used to uncertainty; in addition, we routinely practice social distancing during periods when we’re immunocompromised by chemotherapy drugs. We have become experts at depending on others to help us, spending lots of time alone and learning to use that time productively. Such experience can be useful to help us cope with the demands of protecting ourselves and others during the pandemic

Experts say that some of the psychological issues associated with the COVID-19 pandemic, are similar to the psychology of receiving a cancer diagnosis. There is much that all of us and each of us have already experienced in the past few weeks that is shocking, unexpected, unpredictable, unknowable, new; much that we have not felt before and not seen. Ovarian cancer patients are familiar with this type of uncertainty. We suddenly find that we must try our best to live today while we do not know what tomorrow and the day after will bring. Before I was diagnosed with cancer, I had no true sense of how precarious human existence is or of how uncertain my future had probably always been. Then, on November 3, 2011, I received a phone call from gynecologist’s office, he wanted to see me in person immediately. With that meeting I learned that the course of my entire life could change in just a single day, all at once I was forced to acknowledge my own mortality and how fragile life is.