COVID, Chemotherapy and Caring for Patients

An Interview with Clinical Nurse Specialist Maria Ashworth

How does your role fit in to the patient’s journey/treatment pathway? 

My role as a Clinical Nurse Specialist (CNS) is to ensure an effective and smooth pathway for gynae oncology patients, from the diagnosis through treatment and to the follow up process.  I do this by providing support, guidance, and information and by liaising with other professionals and agencies involved in the patient’s care. As CNSs our role is not only to co-ordinate patient’s pathways and focus on their clinical needs, but also to be there for the patients, to support their physical as well as emotional needs. Psychological wellbeing is so important when patients are faced with cancer and the worry that brings. To ensure that patients receive the best care, we are often privileged to work not only with the patients but also their families and friends.  

Have the needs of the women you care for changed during this past year? 

COVID-19 has brought lots of anxiety and uncertainty for all of us, but more so for our patients, who either have been diagnosed with a cancer or are currently going through cancer treatment. 

Many of our ladies who were already limiting contact with their friends due to being immunosuppressed (weak immune system due to chemotherapy) had to resolve to completely isolate due to COVID-19, losing very valuable support networks.  To make things more difficult and despite most of us having to quickly become more skilled with technology, not all our patients were able to continue with virtual support due to a lack of access and challenges understanding how to use it (especially with some of elderly patients).  This has only added to feelings of isolation and loneliness.    

Some of our mums with school-age children made the decision to move out from their family home to decrease their risk of catching COVID-19 while being on treatment.  Not seeing your children or being able to give them a hug for seven weeks of chemo radiotherapy treatment, when you feel very vulnerable, is not easy for any of the family.  I have so much admiration for those ladies and the sacrifices they and their families had to make to see them well on the other side.  

Some of our patients have been faced with anxieties of treatment being stopped or delayed. It has undoubtedly put a strain on my patients and their families. Some of our phone calls that would normally take 5-10 mins are now 45 mins as we deal with the increasing worry, uncertainty, and general questions the new situations have thrown up. 

We also had more patients enquiring about financial help due to the economic impact COVID-19 had on their family incomes, only adding to the worry. 

Beyond PPE and the more obvious restrictions, what have been the greatest impacts on your work?  

The lack of human contact has a huge impact! COVID -19 forces us all to practice social distancing.  Physical contact, such as a hand on the shoulder or hug, is such a large part of how we show empathy, provide reassurances, or just show we care when we don’t always have the words.   

In these situations, I struggle to see some of my patients going through what is very often the most difficult time in their life.  The tears, anxiety, and distress so clear to their family, friends, and their care team, for us all it can be so difficult to not be able to squeeze their hands or give them a quick hug.   

On the clinical side of oncology, we all had to adapt very quickly to how we were assessing our patients. To reduce their risk of contracting COVID-19 we have reduced the number of patient visits to the hospital by running more reviews via telephone clinics rather than face to face. That meant that nurses and doctors were suddenly missing very important visual cues from the patients we usually gain lots of information from just by seeing them walking into the clinic.  Many of us had to get more in tune with our phone call communication skills, the questions we are asking and auditory clues we are picking up to ensure we are getting the full picture for the patient at home. I’m a very visual person, I definitely recognise my ladies more by their face, whereas at the moment with everyone wearing masks, I probably know my ladies more by voice. We had to adapt very quicky to protect our patients, but everyone worked incredibly hard to continue our services despite the changes, and our phone clinics have been well received by the patients.  Like many technological and working changes brought about by the pandemic, I believe these online consultations may be here to stay.  

If you could give one piece of advice to women going through an experience of gynaecological cancer at this time, what would it be? 

During the first wave we saw a decrease in the referrals of suspected cancers coming through due to the disruption in the screening services and services offered by some of the GP surgeries.  

Even though some of the services started to recover we know that many patients are still very frightened to seek help for fear of contracting COVID-19 or generally delaying checks due to the current situation. My advice for any lady who has got symptoms of abnormal bleeding or an abnormal smear test is to please not delay seeking help.  Speak to your GP or specialist clinics. We are making all efforts to reduce the risk to all our patients of contracting the virus while being seen in the hospital.  Seeing appropriate help and not delaying diagnosis and treatment is essential to getting patients the best possible outcome and, in many cases, will be lifesaving. 

Is there anything women often say they wish they’d known before receiving their diagnosis?  

Awareness of symptoms and the importance of not delaying seeking medical advice, even when in their heart, they knew something was not right. 

Do you have any tips for how friends and family can support their loved ones, especially at this time when they are more likely to be apart? 

Going through cancer and its treatment can be very emotional, with many ups and downs on the way, especially when you need to face much of it on your own due to isolation during this time. 

My advice would be even if the current situation forces you to stay apart, try to stay connected use the phone, FaceTime, Skype, or Zoom, etc.  There are many things you can continue doing virtually as a group (Friday movie night, book clubs).   Send them an email, a text or even go back to writing a letter or a postcard they can read when they need something to cheer them up.  Maybe even draw a supportive message on their driveway with chalk! 

Treatment can be very draining for patients and sometimes they might not be up to certain things, not because they don’t want to but because of the treatment-induced fatigue.  Give them time to recover and talk with them about the best time to keep in touch.   

It is also important you look after your own wellbeing, don’t ignore your own feelings for too long. Looking after someone with cancer can be physically and emotionally very challenging. Many charities are still providing support via the internet and phone calls, so do get in touch or talk to the nurses if you need some advice on where to get support. You can only look after a person well if you are first looking after yourself. 

What has this past year taught you?

That people have much more resilience and strength inside of them than they realize.  Our patients have been through so much and yet I am still blown away by the positivity, kindness, and selflessness they show in the hardest of times.  The same goes for our amazing gynae–oncology team, who have moved heaven and earth to continue providing the best possible care they can in these difficult times.