When COVID-19 and Cancer Collide: What Nurses Should Know

There may be an increase of later-stage cancer diagnoses in coming months and years, as routine cancer screenings have been significantly slowed or stopped as a result of the coronavirus 2019 (COVID-19) pandemic.

Fewer individuals are undergoing checkups with dermatologists, mammograms, colonoscopies, and other exams that could catch cancers in earlier stages. But nurses can play a vital role in putting the public at ease for these kinds of appointments.

“[Nurses should] educate people about the safety precaution that [health care] institutions are taking, and highlight that early screening is going to be really, critically important,” said Marianne Davies, DNP, ACNP, AOCNP, in an interview with Oncology Nursing News.

Davies, an assistant professor of nursing at the Yale School of Nursing, said that her institution gives a COVID-19 test to anyone who is being admitted to the hospital.

“I think everybody in oncology is fearful of the spike in disease or diagnoses as we move into the fall and the new year because people are so afraid of coming in for procedures,” Davies said.

Additionally, nurses should be aware that patients who are already being treated for melanoma may face complications when it comes to immune-related adverse event (irAE) management in patients who contract COVID-19.

First, Davies noted, providers must rule out the possibility that the patient is experiencing an irAE, and not COVID-19. “If patients are symptomatic in any way, even if we think it’s an immune-related toxicity, we always test patients [for COVID-19]”

Then, if patients do test positive for COVID-19 and still are experiencing an irAE, treatment can become even trickier. Steroids are commonly used to treat irAEs — such as pneumonitis – though the jury is still out whether or not they are safe in patients with COVID-19.

“Some of the toxicity [treatment] is particularly challenging in this era of COVID-19, because some of the management strategies that we might use may contradict each other, so that can be really challenging for health care providers,” Davies said.

“There’s a lot of controversy about whether or not [steroids] exacerbate or decreases the ability of patients who have COVID-19 to actually clear the virus.”