When the United States was in the early throes of the COVID-19 pandemic, hospitals and health care centers took many steps to decrease risk of COVID-19 transmission for patients who needed health care unrelated to the new coronavirus. The medical community largely cut off visitor access in hospitals and care centers, also cutting off access for friends and family members of patients who act as primary caregivers and play a critical role in communication of health information and continuity of care for patients. This issue is one that particularly affects people undergoing active cancer treatment, a group of oncologists and a patient advocate noted in a recent article in the Journal of Clinical Oncology (2021; doi: 10.1200/JCO.21.00126).
"Previously, most patients arrived to clinic with a companion or even a crew of supportive friends and family that packed the examination room and sent our staff scrambling to pillage extra chairs from adjacent rooms to accommodate everyone. Now, patients arrive alone," the authors noted in the article.
The problem is that these companions and supportive friends provide much more than a familiar face to the patient, explained coauthor, Christine Alewine, MD, PhD, Lasker Clinical Research Scholar in the Laboratory of Molecular Biology at the National Cancer Institute's Center for Cancer Research. "Caregivers are an integral part of a cancer patient's team," she told Oncology Times. "Care suffers in their absence. While there is a risk that exposure of medical staff to the caregiver could lead to an increased risk of COVID-19 transmission, maybe that risk is less critical than the loss of this care team member." Here are the lessons Alewine believes the oncology community can learn from this pandemic.
1 What led you and your colleagues to write this article now?
"The article was first submitted in December 2020. By this time, the medical community had learned enough about how COVID-19 is transmitted to understand the risks posed by allowing a caregiver from the same household to accompany a patient.
"Safety practices in hospitals regarding personal protective equipment and COVID-19 testing had become routine. Moreover, it was becoming increasingly heartbreaking to continue separating our clinical trial patients with refractory metastatic cancer from their caregivers during these last few months of their life, and more and more obvious how this new practice pattern was negatively impacting our care of these patients. It seemed like the right time to initiate a discussion about whether caregiver exclusion should continue."
2 So what lessons can be learned from this COVID-19 pandemic? How can health care systems and cancer care teams do better next time?
"Limiting exposure and spread of a deadly, easily transmissible virus is very important. Maximum precautions needed to be exercised as this new pathogen emerged when our understanding of its spread was limited.
"We now know that wearing masks, social distancing, and prophylactic testing of asymptomatic persons are important in limiting spread. Transmission from contaminated surfaces is rare. Moreover, exposures should be considered in the unit of households rather than by individual. With this understanding, we are better able to protect patients (and caregivers) from acquiring this deadly pathogen from medical staff and also protect medical staff from being exposed to COVID by patients.
"There are at least two important lessons learned from the COVID pandemic relevant to this discussion. First, virtual conversations are better than no contact, but they lack the power of in-person contact. IT solutions have limitations in this setting.
"Second, maximizing safety from virus transmission does not necessarily maximize an individual person's health and well-being. In this setting, every individual needs to make difficult choices about what is an acceptable risk to them based on their unique situation and that of their household.
"We are suggesting that caregivers who want to participate in-person for a household member's medical visits should be permitted to make that choice for themselves."
3 What are the next steps to better handle situations like this one in the future?
"Discussion is the first step-a discussion that includes not only hospital epidemiologists and oncologists and medical staff, but also patients, patient advocates, and their caregivers. Hopefully, we can make the best choices for how to remain safe and well all together.
"Our care is diminished when caregivers are excluded from in-person medical visits. It is time to consider whether the benefits of letting caregivers accompany patients on these visits do or do not outweigh the increased risk of COVID-19 transmission."