Impact of COVID 19 on the delivery of palliative care for cancer patients

 Nemeh Manasrah 

PhD Student, College of Nursing 

         World Health Organization (WHO) defines palliative care (PC) as "an approach that 

improves the quality of life of patients (adults and children) and their families who are facing 

problems associated with a life-threatening illness." Its goal is to decrease and minimize the 

physical, social, and spiritual suffering associated with cancer disease signs and symptoms (1),

the WHO perceives palliative care as fundamental to human rights and as an essential aspect 

of public health. 

        The pandemic of COVID-19 brought severe suffering that negatively affected well-resourced 

countries and low-income countries, causing much harm to families, communities, 

and economic situation (2). It affected health care organizations all over the world. Low-income 

countries have a heavy load in controlling the health situation, delivering different 

health care services in a fragile health care system, decreasing readiness for the outbreak of 

the disease, shortage of medical technology, and decreased commitment to the rules and 

regulations for infection prevention protocols. (2)

         COVID-19 patients are expected to have limited access to health care services delivered at 

hospitals and to receive family care at home, with the shortage of personal protective 

equipment and decreased training. (3). The number of patients and access to health services 

providing interdisciplinary and person-centered care has decreased because of the spread of 

COVID-19. Equity issues arise in cancer patient care. (6)

         The number of patients who came to health centers for diagnosis and first treatment 

decreased because of limited access to transportation and fear of getting the disease. Many 

patients refused to come to the clinic to start their scheduled treatment. It takes a long time to 

convince patients to start their treatment or to receive palliative care. (6)

        COVID-19 arises as an obstacle and decreases the family involvement at the end of life 

care. There are many limitations, including funeral arrangements and restriction of personal 

protective supplies in some healthcare settings (3). These elements affect the psychological 

aspects of patients, their families, and healthcare workers. The burnout among healthcare 

workers, mainly nurses, increased because of their closer relationship with patients. Many 

tried to cut out their relationship with families and social relationship networks to commit to 

their work requirements (1).

         According to Buntzel et al., more than 70% of cancer patients felt unstable, and 21% 

became isolated because they were afraid of the higher incidence of the spread of COVID-19 

among this group compared to other populations. (1). The number of cancer diagnosis cases 

has been affected by COVID-19 worldwide. (1) The actual number of cancer cases in 2020 

was lower in comparison to the years before the pandemic. Screening programs were 

decreased and some treatments were also delayed or modified. The priority is to follow strict 

protocols to minimize the spread of infection.

         Rules and regulations to manage the spread of COVID-19 through closures and social 

distancing raised preeminent issues for patients and health care workers as well as the 

palliative healthcare team. Patients need to be treated without coming to hospitals or 

outpatient clinics to decrease the spread of the infection, which develops a problem in 

symptom management and time of the treatment. (1)

         COVID-19 decreases the infrastructure and staffing in the cancer services. Some 

difficulties in decision-making were taken as continuous access to the operating room for 

cancer patients who need necessary operation. Delivery of palliative care is prioritized at a 

low leading to decreased symptom management and the diminished possibility of hospital 

admission.

        According to Jane et al. 2020, a toolkit was developed by a multidisciplinary team to 

manage the situation during the pandemic. Many health care programs were also developed 

to help the clinical team to have a complete consultation. (4)

         The pandemic of COVID-19 negatively impacts the delivery of palliative care for cancer 

patients by restricting hospital visits for them, decreasing end-of-life support, and isolating 

patients at the end of life. (5)

        Health care professionals faced many challenges during the pandemic of COVID-19 as to 

how to manage the patients' emotional issues and deliver quality care for dying patients and 

their families (6). They are aware, that if they don’t follow the infection control protocol 

related to COVID-19, they will pass the infection to cancer patients. Another challenge is 

decreasing health care staffing confronted by the increasing workload in the hospitals and 

other healthcare delivery clinics due to healthcare workers testing positive for COVID-19. (6)

         In general, there is a small number of patients treated by palliative care after the spread of 

the pandemic. This can be attributed to a decreased number of referrals from the primary 

clinics, a lower number of deaths in palliative care hospitals, and diminished quality of life. 

There is a need for a palliative care network to provide optimal patient care. (1)

References:

1. Beltran-Aroca, Ruiz-Montero, R., Llergo-Muñoz, A., Rubio, L., & GirelaLópez, E. (2021). Impact of the COVID-19 Pandemic on Palliative Care in Cancer Patients in Spain. International Journal of Environmental Research and Public Health, 18(22), 11992. https://doi.org/10.3390/ijerph182211992
2. Radbruch, Knaul, F. M., de Lima, L., de Joncheere, C., & Bhadelia, A. (2020). The key role of palliative care in response to the COVID-19 tsunami of suffering. The Lancet (British Edition), 395(10235), 1467–1469. https://doi.org/10.1016/S0140-6736(20)30964-8
3. Spicer, Chamberlain, C., & Papa, S. (2020). Provision of cancer care during the COVID-19 pandemic. Nature Reviews. Clinical Oncology, 17(6), 329–331. https://doi.org/10.1038/s41571-020-0370-6
4. deLima Thomas, Leiter, R. E., Abrahm, J. L., Shameklis, J. C., Kiser, S. B., Gelfand, S. L., Sciacca, K. R., Reville, B., Siegert, C. A., Zhang, H., Lai, L., Sato, R., Smith, L. N., Kamdar, M. M., Greco, L., Lee, K. A., Tulsky, J. A., & Lawton, A. J. (2020). Development of a Palliative Care Toolkit for the COVID-19 Pandemic. Journal of Pain and Symptom Management, 60(2), e22–e25. https://doi.org/10.1016/j.jpainsymman.2020.05.021
5. Mayland, Hughes, R., Lane, S., McGlinchey, T., Donnellan, W., Bennett, K., Hanna, J., Rapa, E., Dalton, L., & Mason, S. R. (2021). Are public health measures and individualized care compatible in the face of a pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic. Palliative Medicine, 35(8), 1480–1491. https://doi.org/10.1177/02692163211019885
6. Hanna, Rapa, E., Dalton, L. J., Hughes, R., Quarmby, L. M., McGlinchey, T., Donnellan, W. J., Bennett, K. M., Mayland, C. R., & Mason, S. R. (2021). Health and social care professionals’ experiences of providing end of life care during the COVID-19 pandemic: A qualitative study. Palliative Medicine, 35(7), 1249–1257. https://doi.org/10.1177/02692163211017808
7. Motlagh, Yamrali, M., Azghandi, S., Azadeh, P., Vaezi, M., Ashrafi, F., Zendehdel, K., Mirzaei, H., Basi, A., Rakhsha, A., Seifi, S., Tabatabaeefar, M., Elahi, A., Pirjani, P., Moadab Shoar, L., Nadarkhani, F., Khoshabi, M., Bahar, M., Esfahani, F., … Malekzadeh, R. (2020). COVID19 Prevention & Care; A Cancer Specific Guideline. Archives of Iranian Medicine, 23(4), 255–264. https://doi.org/10.34172/aim.2020.07