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SARS infected 1755 and killed 299 people in Hong Kong in 2003. On receiving the news of a COVID-19 outbreak in Mainland China, Hong Kong, as the closest city, was determined not to let history repeat itself. The government was quick and took major measures which included stringent border controls, health quarantine for inbound travellers, restrictions on gatherings of more than four people and so on.
In response to the pandemic threat, the hospital authority raised the emergency response level to the highest since 25 January 2020. Under this, all patient visits were suspended (with exceptional cases on compassionate grounds). Non-emergency services were deferred to prioritise resources. Clinical psychologist, social workers and pastoral services were suspended to reduce non-essential contact time.
These major measures proved effective in controlling the outbreaks. However, such strict regulations are a double-edged sword; they created issues for inpatient cancer care—especially in those who are older and require palliative care. Four clinical cases during the COVID-19 period are summarised in table 1 to illustrate the challenges.
Four clinical cases to illustrate the challanges of cancer care during the COVID-19.
These four clinical cases reflected the unanticipated impacts of the extreme measures: communication breakdown between caretakers and healthcare professionals, lack of family support causing patient complications, limited visiting with distress to both patients and relatives, and so on. At the time of writing, two hospitalised patients with cancer committed suicide in 1 month. The reasons for their suicidal ideation were under investigation and unclear if they related to social distancing. Distress screening (recommended in international oncology guidelines) has been used in our outpatient clinics but not yet for every hospitalised patient.1 2 Due to these incidents, there is a move to extend distress screening to all oncology patients.
COVID-19 highlighted the deficiencies in our existing system. Yet, it also offered an opportunity to identify our limitations and develop alternative and creative approaches to improve cancer care.The tsunami-like impact of this global pandemic also reminded us about the deepest need of our patients. We should not only focus on physical symptoms or routines, but more importantly should provide psychological support to patients and caretakers in a holistic, individualised, planned and communicated approach.
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Footnotes
Correction notice "Cambridge University Press has issued a retraction for publication of this article (Chan et al. 2020a) [https://doi.org/10.1017/S1478951521001309] . The article was simultaneously submitted and later published in BMJ Supportive & Palliative Care (Chan et al. 2020). Cambridge University Press did not have appropriate permission to publish the Accepted Manuscript version of this article. We thank Cambridge University Press for bringing this to our attention.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.