Life as a cancer patient, caregiver during COVID-19

April 16, 2020
Dawn Brazell with her mother Sara Cutler on vacation in North Carolina
Dawn Brazell (left), and her mother, Sara Cutler (right), vacation in North Carolina last fall. Some of Cutler's cancer treatment appointments have transitioned to telehealth visits to reduce her potential exposure to COVID-19. Photo provided

Usually my mom, Sara Cutler, greets her oncologist Antonio Giordano, M.D., Ph.D., in a clinical room at Hollings Cancer Center at the Medical University of South Carolina. Today, though, she’s pulling up a text that has a link for a telehealth visit.

This is life in an era of COVID-19, when we’re all hunkered down, waiting to be able to go outside. My mom, who’s 81 and battling stage 4 metastatic breast cancer, rarely goes out. She no longer does the volunteering she loves. Fortunately, I work remotely, but every time I leave the house, I worry what I might be bringing back in. We all just do the best we can.

That she can do this visit via telehealth, though, relieves me as it does her. It’s yet another way the pandemic is shaping our lifestyles and the delivery of health care.

The visits are part of a social lifeline for mom, who is the type often seen as the life of the party—the type that people call a “hoot.” I know how much seeing her oncologist will cheer her up. Cancer treatment often binds doctor and patient, a medical boot camp of sorts, in a way not always seen in other specialties.

As the telehealth link loads, Giordano’s smiling face appears, and the lilting tones of his Italian accent fill the living room. Her face lights up. The two have built a rapport over the past three years that she’s battled the return of her cancer. It was a shock. She was eight years out from her prior surgery to treat her cancer and well past the five-year mark. She thought she was in the clear. That battle won. One morning she woke and couldn’t walk. She had a break in a small bone in her leg. It had returned, and this time, it had spread to her bones and other sites.

Referred to Hollings Cancer Center, my mom began her second round of battling breast cancer. Giordano, a researcher as well as physician, keeps changing up her chemotherapy as her cancer finds ways to outsmart it. This is life with metastatic cancer.

As the telehealth call continues, they catch up on family a bit. Giordano’s extended family lives in Italy, some in the Northern region that has been hit hard. The last time his mother went outside her house was March 9. Even though his parents are safe and still in lockdown, his uncle has been hospitalized for three weeks in a COVID-19 hospital in Naples. His uncle is improving and requires less oxygen, but it’s a scary time.

Giordano agrees that mom should be staying home. Given how aggressive COVID-19 is, he thinks "flattening the curve" is the best thing the nation can do right now to avoid what happened in most of the countries in Europe, like Italy and Spain. In Italy, a country that is about four weeks ahead of the U.S. in terms of the pandemic, about 16% of COVID-19-related deaths occurred in patients who have had active cancer within the past five years, he says. This is a vulnerable population.

Sara Cutler uses her cell phone for a telehealth appointment 
Sara Cutler uses her cell phone for a telehealth check up with Dr. Giordano. Their friendly rapport has not changed, even though some of their visits are virtual now. Photo by Dawn Brazell

They switch topics to her care and how’s she handling her new chemotherapy. “How are your side effects?” he asks.

“Fine,” she answers, cheery, and I shake my head internally because I’ve seen her suffer. It’s a relative fine, one that relates to the courage that it takes her to push through and stay strong as she hopes to hold the disease at bay.

“Hold up your hands for me?” he asks.

She balances her phone and shows him the redness of her palms. They decide to keep her dosage the same. Then the conversation goes back to general topics. I ask him what I can do to keep her safe. She lives with me and my children. (See his tips here).

He’s glad to hear she’s staying home and explains that is why Hollings is expanding its telemedicine services where appropriate. It reduces the time of exposure to COVID-19 and the risk of infection. Patients get to stay in their safe environments and don't have to travel, which eliminates waiting rooms, checking in and out and interactions with multiple health professionals.

“You have just removed at least five person-to-person interactions that present potential risks of infection,” he says.

That telehealth oncology visits are part of her care now makes me feel relieved. Some cancer treatments require going into the cancer center but not all. There’s no way to avoid all risks. It’s a dangerous time for all cancer and immune-suppressed patients. It’s yet one more stressor to an already anxiety-filled world of scans, bloodwork, chemotherapy and radiation.

As we look forward to life returning to somewhat normal, I worry what impact that will have on her. At some point, I will have to head back into the office. She’ll want to meet with friends. Now we have COVID-19 and the isolation and fears that adds to the equation.

This pandemic has us weighing risks and postponing health visits. I wonder when people can return to their regular doctor’s visits and get their routine cancer screenings. Based on one modeling projection, the estimated upper range of COVID-19 fatalities still will not surpass the lives that cancer takes each year. I keep this in mind as I temporarily postpone my cancer screenings. I watched my brother die of melanoma, and it’s tough witnessing my mom’s journey with it now.

We take it a day at time, the fears of cancer and stress of COVID-19 all jumbled together in a kaleidoscope of uncertainty.   

We take proper safeguards, and then we let go of the anxiety, which can kill in its own way. Instead, we celebrate the unintended good consequence that the pandemic has brought us more time to spend together right now.

As my mom signs off her telehealth call, she teases with Giordano. It’s good to hear her laugh as she hangs up. I treasure the moments when she’s happy.

“He blew me a kiss,” she says, grinning as if she’s 20 instead of 81. I shake my head at their antics, and I bless him quietly in my heart, grateful for how he brings a touch of joy to this last part of my mom’s journey.

Not everyone can be saved. Not from cancer and not from COVID-19. As a caregiver, I try not to let the anxiety of juggling both of them weigh down the joy to be found. I focus on the caring that shines through and how this global crisis makes us all ironically interconnected in our isolation. In the end, all we can do is find the value in our shelter at home and be present in the moment for the gifts it has to offer.