Caring for loved ones with cancer during the COVID‐19 pandemic: A double hit risk for social isolation and need for action

“I'm having a lot of trouble with the family for Mr. S. Any advice would be appreciated! ” This was the urgent page I received from a medical intern asking for help with communication for a distraught caregiver. The caregiver's husband had been re-admitted for treatment complications related to his bone marrow transplant. The wife, his primary caregiver, played a critical role as his advocate, always by his side, and helping him manage his symptoms and stress following treatment. On this day, admission into the hospital felt more fraught with distress than prior hospitalizations. The COVID-19 pandemic led the hospital to impose a no-visitors policy in an effort to curb the potential spread of the virus. The medical teams communicated their support to families through telephone and video conferencing. As I talked to the caregiver about how hard it was to be apart from her husband, I gently asked, “Who is supporting you through this? ” And she broke down, crying out “I have no one. I am alone in this! ”. Her anguish was compounded by her fear that he might die in the hospital alone. The patient had told his wife that his biggest fear was dying without her present and she felt helpless in preventing this. The current COVID-19 pandemic and the related containment measures—namely quarantine, social distancing and self-isolation—can have detrimental effects on one's mental health and well-being. Social distancing has become a part of our everyday lexicon in the era of the COVID-19 pandemic and heightens the risk for individuals to experience social isolation, and potentially, loneliness. Under normal circumstances, cancer patients rely heavily on family caregivers (ie, family or friends; hereafter referred to as “caregivers”) for care and support. Even before the current pandemic, the standard precautions to mitigate the risk of infection for cancer patients also affect the caregivers who often socially isolate from extended family and avoid public gatherings. Unfortunately, the added effects of the current pandemic further isolate cancer caregivers not just from important social connections such as close family and friends but also their loved one with cancer. Thus, while the COVID-19 pandemic may “doubly hit” cancer patients in terms of their risk of infection, we must not forget that caregivers in parallel may also be “doubly hit” in their risk for social isolation. As our society faces the devastating illness of COVID-19 and the shared experience of isolation, the inherent resilience of cancer caregivers may offer some valuable lessons in coping during COVID-19. Finding positive meaning as a caregiver engenders resilience and has the potential to increase over the course of illness trajectory. At Dana-Farber Cancer Institute, patients have demonstrated increased resilience during treatments—such as bone marrow transplant—which have forced them to face isolation and adhere to a routine. Caregivers have the potential to emerge from their caregiving experience with similar lessons of resilience. Within the caregiving relationship, for example, adjusting to changing roles and having social support outside of that patient– caregiver relationship can increase resilience which, not surprisingly, is inversely related to caregiving burden. Encouraging reflection of shared experiences within patients and their caregivers may also promote resilience and growth. In a review of 24 studies on mitigating the loneliness associated with quarantine, a sense of mutual altruism was found to potentially increase resilience. Coming together for a shared mission can alleviate suffering during isolation—a skill at which many caregivers are likely already adept. Reminders about the shared mission of protecting the patient—irrespective of contact precautions interfering with their ability to be physically present—can foster resilience and serve as a reminder that isolation is temporary. Received: 1 June 2020 Revised: 25 June 2020 Accepted: 30 June 2020