Julie R. Gralow, MD, a clinical director of Breast Medical Oncology at Seattle Cancer Care Alliance, and a professor of medical oncology at the University of Washington School of Medicine, discusses future challenges in cancer care following the COVID-19 pandemic.

Many of the challenges that need to be addressed in the immediate future are related to the post–COVID-19 era, Gradlow says. The American Society of Clinical Oncology recently released the Road to Recovery Report, which provided a breakdown of what clinical trials and clinical care might look like following the pandemic.

The report addresses several key questions, such as whether the field has taken away any helpful lessons from the pandemic, and whether clinical trials should be conducted in the same way they were prior to the pandemic. Thus far, it does not seem necessary to bring patients into the clinic as often, and telemedicine appears to be a useful tool for conducting clinical trials, Gradlow says. Moreover, it may not be necessary to run on a tight schedule in regard to when a treatment needs to be performed, and it could be possible to perform treatments at different locations that are certified to provide such care, she concludes

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Julie R. Gralow, MD, discusses future challenges in cancer care following the COVID-19 pandemic.

Dr. Gralow on Future Challenges in Cancer Care in the Post–COVID-19 Era

1. Get specifics on your diagnosis and treatment.

	In order to maximize your time with your providers, bring your questions with you in writing to your appointments. Ask for copies of your test results and keep a notebook (see http://breastcancer.about.com/od/risk/p/health_records.htm) of all these results. Keep a list of questions that arise between visits so you don’t forget, and take notes of the answers. Above all, make informed decisions; learn as much as you can about your diagnosis and treatment.

	Breast cancer specialists who work at dedicated cancer centers offer specific expertise as well as access to the latest treatments that are part of clinical studies. Such centers can provide other specialty services, usually under one roof, such as physical  therapy, nutrition, and social work.

3. Get the support you need for talking about your diagnosis.

	Breaking the news to your friends and family that you’ve been diagnosed with breast cancer can be just as difficult as first hearing the news yourself from your doctor. You may feel concerned about upsetting your family and friends or worried about how they will react. Even after you have shared the news, at times you may find it difficult to communicate openly. Sometimes it’s uncomfortable to ask for help, answer questions about how you’re doing, or tell well-meaning relatives and friends that you need some time and space for yourself. If available at your hospital, request to meet with a social worker to discuss any emotional support or resource referrals you might need. A local support group for women with breast cancer may also help considerably. Ask your hospital or clinic to help you identify appropriate resources in your area.

4. Seek help in navigating financial issues, if necessary.

	Your hospital or clinic should have a social worker, patient navigator, or financial services department to help you manage financial issues and deal with private insurance companies, Medicare, and Medicaid. If you have concerns, request an  appointment.

5. Talk to your doctor about coping with menopause symptoms.

	Breast cancer patients who have undergone chemotherapy or ovary removal, or who have had to discontinue hormone replacement therapy upon diagnosis, may experience symptoms of menopause. Talk to your doctor about how to safely minimize menopausal symptoms.

	Your cancer treatment may influence your ability to taste and smell, and it may alter your digestion. Foods that you normally enjoy may not taste good during treatment while, paradoxically, foods that normally don’t appeal to you might taste better. You may prefer and tolerate more cooked versus raw vegetables, so a vegetable stew or soup may be more appealing than a salad. You may have more energy and less nausea if you eat smaller amounts of foods more frequently rather than eating three big meals per day. Try not to gain weight by overindulging and blowing your calorie budget. Help fight your cancer by eating more vegetables, fruits, whole grains, nuts, seeds, and legumes such as black beans and lentils. Choose a rainbow of colorful whole foods (like deep greens of spinach, deep blues of blueberries, white for onions, and so on) to ensure that you get a variety of anticancer nutrients. Alcohol is usually not preferred or recommended during treatment, but if you do drink, limit your intake to no more than three drinks per week. Recent studies have shown an association between alcohol and increased risk of breast cancer.

	Lymphedema is a side effect of breast cancer treatment that involves swelling of the soft tissues of the arm, hand, or chest wall. It isn’t life threatening, but it needs to be treated to avoid getting worse. The swelling may be accompanied by numbness,  discomfort, and infection. There’s no reliable way to assess your risk for lymphedema, but by taking proper precautions you can greatly reduce your chances of developing the condition. Ask your doctor about scheduling physical therapy if you notice symptoms, or consider seeing a physical therapist even before symptoms begin in order to minimize their chance of developing in the first place.

	Gentle exercise during treatment, such as regular walks, can help with both the mental and physical effects of treatment. After treatment is completed, increasing your exercise gradually will help improve your fatigue and rebuild muscle tone. Getting your circulation going may also help with chemobrain, the mental fogginess noticed by some patients during and after chemotherapy, and it can certainly improve your mood and your outlook on life. Try yoga, tai chi, swimming, or water aerobics. Be physically active for at least 30 minutes every day. If you are having difficulty exercising or aren’t sure what to do, request a referral to a physical therapist from your medical provider.

	Keeping your bones healthy throughout your life is important; however, if you’re a woman who’s been diagnosed with breast cancer, bone health is especially important. Research shows that some breast cancer treatments can lead to bone loss. Plus, women are about twice as likely as men to develop osteoporosis after age 50. Talk to your healthcare team about specific recommendations for keeping bones healthy, taking calcium and vitamin D, and appropriate weight-bearing exercises to help keep bones strong.

	Some people are able to work throughout their cancer treatment. Yet for some, reducing one’s work capacity or taking a break altogether may be necessary. If you take time off and then return to work shortly after your treatment ends, you may find that it helps you maintain your identity and even boosts your self-esteem, not to mention your income. You may want to talk with your employer about options such as flextime, job sharing, or working from home. Options like these may help your mind and body ease back into the demands of your job. Try to be patient and take care of yourself as you go back to your “normal” life.

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