Liver Cancer Care During a Pandemic: Nurses Weigh In

The novel coronavirus (COVID-19) pandemic has drastically affected the way that hepatocellular carcinoma (HCC) is treated, making nurse adaptability crucial in recent months.

In an Oncology Nursing News webinar, Abigail Smith, CRNP, a nurse practitioner at the University of Pennsylvania Perelman Center for Advanced Medicine and Amy Hillsman, CRNP, a nurse practitioner at Georgetown Lombardi Comprehensive Cancer Center discussed how the outbreak has switched up HCC care, as well as some of the changes that could be long-lasting.

Changes in Liver Cancer Care

Like the rest of the country, most patients with cancer are encouraged to avoid public places (including hospitals) to limit their potential exposure to COVID-19. “The more comorbidities a patient has, along with the treatment that they’re on, stratifies their risk category and affects how we’re treating them, and if we want them in clinic at all, or if we want them to stay home as much as possible,” Smith said.

To decrease clinic visits, both nurses’ institutions are utilizing telehealth and home healthcare, where nurses go to patients’ houses to conduct lab work and check on their status. Hillsman noted that her institution is operating at about 60% telehealth, meaning visits are being conducted via video or phone conferencing of some kind.

But the actual type of treatment that a patient is given could change as well.

“For treatment changes, [one of] a few things we’ve seen is possible deferment of treatment. That’s across the board,” Hillsman said. “We may decide on liver-directed treatment over surgery, and we might decide on oral therapy instead of IV, because patients won’t have to come into clinic as often. But patient preference comes into play there, too, and we’re trying to manage that.”

Adverse Events of Treatment … and Isolation

Since patients are not seeing their providers as often, it is crucial that they have an open line of communication regarding adverse events and any symptoms that they are having — be it from the treatment or potentially COVID-related.

“One thing that we really try to push is education of side effects and to let us know sooner rather than later,” Hillsman said. “I always tell patients we don’t want you to go to urgent care or the emergency room if we can prevent it, so always tell us [about symptoms], even if it’s really minor. And patients don’t want to go to the ER now with COVID-19, either.”

The toll of staying home has been affecting how many patients feel, too, Smith mentioned.

“What I’m seeing more and more of is that patients are really lonely. So, it’s now not just the physical angle of this, but the emotional angle of this as well,” she said. “Because of the lack of activity, patients are saying that they’re feeling more weak and more symptomatic, and that might not necessarily be from the cancer.”

To combat these maladies, Smith recommends patients get out of bed, exercise, and will refer them to social workers if needed.

Telehealth for COVID-19 and Beyond

Both nurses agreed that telehealth has been monumental in helping assess patients’ adverse events, as well as continuing to monitor them through their care. Whenever possible, they try to video call patients instead of voice-only phone call.

“Prior to COVID-19, we, as a department didn’t do any telehealth or telemedicine. Now we’re switching to mostly telehealth for our oral patients. We really try to do video, so we can asses the hand-foot syndrome or other side effects they may be experiencing,” Smith said. “Telehealth is here, and it’s going to stay. That’s for the benefit of the patient.”