BALTIMORE — When Oprah Martin was diagnosed with breast cancer, after already having beaten the disease 20 years ago, the terrible news was compounded by the once-in-a-lifetime pandemic threatening all those with weakened immune systems.
The 43-year-old Postal Service worker from Baltimore sanitizes everything now. “My work stations and mail truck. Anything I know I touched or could be touched. I use Clorox wipes and spray,” Martin says.
The coronavirus pandemic is causing anxiety and disruption of care for Martin and thousands of others in the Baltimore region newly diagnosed with cancer, or in mid-battle. They worry about their safety and health as they navigate a health care system that has been consumed by COVID-19.
All have seen changes in how their cancer is treated. They can’t bring family or friends along for surgery or treatments. Even some chemotherapy and bone marrow transplants have been postponed as physicians weigh the risk of cancer versus shattering a patient’s immune system while a contagious killer disease is still widespread.
Patricia Brown, who has had multiple myeloma for about nine years, switched to oral medications she can take at home rather than the intravenous drugs that have required hospital trips. The new treatment involves three kinds of medication.
The potent drug cocktails can come with such burdensome instructions that doctors have resisted sending some patients home with them. Brown, 72, made a choice to skip the hospital visits.
She lives alone in an independent living facility. And though staff has made her feel safe there, the precautions come at the expense of the social calendar, making her lonely. She finds comfort in her virtual support group for other cancer patients, and in God.
“If you sit back and worry every day, it’s not going to work for you,” she said. “God up above has the last say — it’s up to Him.”
Other patients say the pandemic exacerbated an already terrifying situation — making them feel more isolated and afraid.
Chris Dachille, a one-time sports producer for WBAL-TV who has Hodgkin lymphoma and a depleted immune system, frets more about his condition.
“I thought I was going to die multiple times during this,” said Dachille, 41, who began typing up notes about his funeral wishes but has since deleted them.
Before the pandemic, the Parkville resident sometimes would shop with his father, with whom he lives. Now, he rarely leaves home, except for occasional trips to Meadowood Regional Park for fresh air.
“There’s a real loneliness factor to my situation,” he said. “Thank God for the phone and FaceTime and all that stuff. That’s saving a lot of people’s lives.”
Dr. Kevin J. Cullen, director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, said medical staffs are working to reduce patient stress and fear, though often through video monitors and the phone.
The center sees few longtime patients in the clinic, reserving space for those on active therapy or with an urgent need. Nurses meet those patients at the door, screen them for COVID-19 symptoms and escort them directly to treatment.
“Cancer patients are very fragile in many ways, and this stress is something we’re trying to be very careful about,” he said. “We know they are more likely to have a hard time if they get COVID-19.”
Cullen said doctors, nurses and social workers are trying to address every need.
“Everyone is trying to be as reassuring and accommodating as they can,” he said. “There is no question this is a real challenge for patient and for staff.”
Dr. Zaineb Hassan Makhzoumi, a dermatologic surgeon and assistant professor at the University of Maryland School of Medicine, says she now contacts patients herself rather than via staffers when delivering news about their treatment schedule.
“It can be very emotional and exhausting and traumatic to not be operated on right away. It can be distressing,” Makhzoumi said. “A challenge is having patients with skin cancer, and having to tell them we’re not taking them immediately.”
The delays in skin cancer specifically could have profound impacts on patients and the health care system, according to researchers in the Hopkins schools of business and medicine. A recent paper found that 31 states canceled elective procedures, and other patients have avoided care out of fear. Treatment then can become far more complex, and expensive, leaving patients sicker for longer.
Surveys show fear is widely affecting patients, changing their treatments and even keeping them from getting care. Screenings designed to detect breast, colon and other kinds of cancer also have plunged, said Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society.
Almost 90% of cancer patients surveyed in May by the group said the coronavirus had affected their health care in some way, reporting lack of access to doctors and delays in imaging, surgical procedures and supportive services such as physical therapy and mental health care.
Close to half those surveyed also reported significant mental health and financial strain.
Lichtenfeld said patient safety has improved since the pandemic began and people should feel more assured about getting care.
“When this started it was kind of ad hoc, flying by the seat of our pants,” he said. “Now there are national organizations making evidence-based recommendations and frameworks about what to do in specific cases. They are doing everything they can to treat and protect patients.”
“It’s no fun, but I’m a big boy. It’s just something you got to deal with.”
Douglas Winger, 60, a multiple myeloma patient at Hopkins, who has to go through hourslong chemotherapy treatments without the comfort of his wife
Doctors are still working on some answers, such as when cancer patients who do become infected with COVID-19 can resume chemotherapy if it had to be stopped to treat the virus, or when it’s safe for such a patient to return to work, said Dr. William Nelson, director of Hopkins’ Sidney Kimmel Comprehensive Cancer Center.
But for those with cancer who do not have the virus, and those avoiding routine screenings, the offices now have procedures to keep everyone safe, he said.
If people keep delaying treatment, there could be large backlogs now that hospitals are beginning to perform elective procedures after the state-mandated shutdowns to maintain space for COVID-19 patients, he said.
Cancer has not “taken a holiday” with the coronavirus surge, he said.
Cancer patients can still avoid a doctor’s office for most appointments. About three-quarters of the appointments at Hopkins are now through telemedicine. To allay fears of those who must come in for treatment, Nelson cited work by nurses to launch a curbside clinic where patients can have blood drawn and receive injections of therapy drugs, anything but IV chemotherapy infusions.
“Patients were afraid and were canceling appointments,” said MiKaela Olsen, a clinical nurse specialist and operations chief in the Hopkins cancer center’s COVID-19 Command Center. “We had to adapt to the circumstances and come up with a way to get them the care they needed while also protecting them from becoming infected with the coronavirus.”
Some patients do have to come inside, and while there is comfort from nurses, there is no avoiding some changes. For patients like Douglas Winger, a multiple myeloma patient at Hopkins, that means hourslong chemotherapy treatments without his wife.
“It’s no fun, but I’m a big boy,” said Winger, 60. “It’s just something you got to deal with.”
Winger says he’s grateful for his access to specialized care because he lives nearby. He knows others are not as lucky. Many out-of-state patients can’t come to the hospital for specialized treatment and fewer patients can get potentially lifesaving experimental drugs through trials that are limiting patients.
As for Oprah Martin, she was able to have surgery in February and recently finished radiation therapy at Franklin Square Hospital, pushing through fatigue and other painful side effects such as sores that felt as if her skin were burning.
She continues working as a letter carrier at a time when more people depend on deliveries. She knows the mail can contain medicine, a Medicare card or a gift from a family member. She also tends to her three children, a niece and her fiance — and in recent years, a bunch of strangers.
She volunteers for the American Cancer Society and founded a small nonprofit in 2013 called Voices in Pink. It provides rides to doctor appointments, gift cards for food, classes for caregivers, and often attention.
“I’ve had ups and down, but more ups,” Martin said. Being able to help others is a blessing that “has been great for me, especially now.”
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