Dr. Scott Irwin

As COVID-19 has spread throughout the world, many people have likely had questions as to when the pandemic will end and what will eventually happen. Patients with cancer, according to one expert, are more familiar with those questions as they likely came up during their diagnosis.

“For the patients that are nervous about how this is going to end, or what's going to happen, I would say that that's true for them outside of the COVID crisis because that's the same question they have about their cancer,” Dr. Scott A. Irwin, director of the patient and family support program at Cedars-Sinai Medical Center, said in an interview with 

®. “How is this going to end, when is it going to end, what am I going to have to go through?”

Irwin discussed what patients should consider when wondering when the pandemic will end, as well as how patients with cancer should go about speaking to their oncologist after they receive a diagnosis.

For the patients that are nervous about how this is going to end, or what's going to happen, I would say that that's true for them outside of the COVID crisis because that's the same question they have about their cancer. How is this going to end, when is it going to end, what am I going to have to go through? Now, I'm not a virologist or immunologist but my understanding with the COVID crisis is we have examples from the past with SARS, with MERS, with Ebola, with the Spanish Flu and other flu epidemics, and these are natural cycles that come and go, I think we have done a great job mitigating those in this country, we may have started a little bit too late, but it still was effective and we have efforts going forward to help in the future.

So, this morning they were talking about antibody tests so that you know that if you have had it and are immune to it, they are talking about deploying many people from the CDC to do surveillance and tracking if a hot spot were to reoccur just like we did with Ebola in Africa. A vaccine may be around in the future, so, this may be part of our lives like the normal flu cycle, or this may go away largely like SARs and MERs and we'll just have to see, but there will be a time, just like with all the other epidemics that we will get back to a normal life.

However, I think as we discussed earlier, I think they may be some changes in our lives. How we do medicine and patient care, for the convenience for the patient especially in a place like Los Angeles to have to come in for not only your cancer treatments but then to see me as a psychiatrist, if we can't align those, that's a lot of effort. I'm hearing there's going to be a change in landscape in the retail space and the number of physical stores.

So, I think we will see life changed after this, but we will get back to a time where we feel like this is normal and it's not front and center. I think a good example is the election, which was all we could hear about on the news every day until this occurred and now, we barely hear a peep about the election and all we hear about is this. And I think that will come to an end too.

For patients that aren't sure about their futures and what's going to happen, I encourage them to talk to their oncologist. First and foremost, I encourage them to decide what they want to know and what they already understand. So, usually that's one of my first questions, what do you understand about your cancer, and what do you want to know and I have people at opposite ends of the spectrum, so some people will say 'I don't want to know anything, I'm going to live everyday like it's my last day and one day it will be' I have other patients that will say, that are very technical and scientific and they want every number and every detail and every statistic as well and most people are in between.

When patients don't feel like they are getting the information that they want or need, I often encourage them to ask the following questions, number one, what's the best case scenario for me, number two, what's the worst case scenario for me, number three, what does the literature say about people like me, and fourth ask your oncologist, 'OK, you've seen 1,000 patients like me, where do you think I fall in all of this?'

Realizing that none of us have crystal balls, that life is uncertain on any day for any of us, but in general what is your best guess. And what I want patients to avoid is getting into a situation where they didn't plan for a worse outcome than they expected and then once that happens it's hard for them to do all the things that they had wanted to do. I would rather that patients plan as if that worst-case scenario may happen and then never need those plans, than not make the plans and suddenly need them unexpectedly.

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“For the patients that are nervous about how this is going to end, or what's going to happen, I would say that that's true for them outside of the COVID crisis because that's the same question they have about their cancer,” Dr. Scott A. Irwin said.
 

How Patients With Cancer Should Approach Questions Surrounding the Final Outcome of COVID-19, Their Diagnosis

The COVID-19 pandemic has increased stress and anxiety throughout the world and, according to one expert, it is even more important now that patients with cancer focus on their mental health as there is decreased access to outlets that can help. 

“We need to make sure that we are staying healthy and doing the things that we need to do,” Dr. Scott A. Irwin, director of the patient and family support program at Cedars-Sinai Medical Center, said in an interview with CURE®.

Irwin also discussed the role a patient’s family, friends or significant other could play in helping them reduce their stress and anxiety both during and after social distancing is lifted.

I have suggested to patients that it is even more important now to focus on their mental health in a time where we don't have outlets to help with mental health.

Healthy eating, good sleeping, getting exercise are all great treatments for anxiety. We need to make sure that we are still doing those things. We need to make sure that we are staying healthy and doing the things that we need to do.

The first thing that friends, family, significant others can do to help patients with cancer, whether we are in this challenging time with COVID or any other time, is asking what the patient wants, or needs, or how they can be helpful. It's not helpful to say, tell me if you need anything or call me if you need anything, because most patients won't. Actively forming a plan and checking in with how you can be helpful is the best thing to do. For example, some patients really crave being social, being around their friends, trying to keep their life as normal as possible and find that friends fall by the wayside either because they're afraid to be around the person, or it is hard for them to see somebody that's sick or a good friend that is going through this or a lot of the times they just don't know how to talk to the person or what to say, so instead of having a normal conversation, which is what the person would want, they tend to avoid the person.

On the flip-side, there are people that have family and friends that just want to do things for them and get them food and check in once a day and it becomes overwhelming for the patients and they don't know how to say 'I need a break' or thank you for the help, but I really need some time to myself right now. Or, thank you for the help but it would be better if we checked in once a week instead of once a day because it's overwhelming or, 'I don't want to talk about this, I just want to go on as if life is normal when I'm not in the cancer center.

So, everybody is different, everybody interacts with their social support group differently and the most important thing is to talk about how the person with cancer wants to communicate, how they would like to be helped and how they would like to be asked for help.

As stress and anxiety have increased during the COVID-19 pandemic, one expert notes how it’s important for patients with cancer to pay attention to their mental health.
 

'More Important Now' For Patients with Cancer to Focus on Mental Health During COVID-19

Patients with cancer struggle with anxiety frequently. In fact, according to Dr. Scott Irwin, at least 80% of patients experience an increase in anxieties during their initial diagnosis.

Patients develop anxieties about what will happen to them in the future, how they’re going to get through treatment and much more. And although many of those anxieties disappear not long after diagnosis, there is still a percentage of patients who battle consistent anxiety. Imagine throwing an additional layer into the mix with a pandemic, the likes of which the world has not seen in a century.

®, Dr. Scott A. Irwin, director of the patient and family support program at Cedars-Sinai Medical Center, discussed the common anxieties patients with cancer experience, how the COVID-19 pandemic has added additional layers to a patient’s anxiety, as well as, how some patients have reported feeling less anxious. 

Patients with cancer have lots of anxieties and at initial diagnosis at least 80 percent if not more have heightened anxiety about what the future is going to hold, what this means, what the treatment is going to be, how they're going to get through treatment and if and how they will come out on the other side.

For most people that actually really subsides within a month, but for about 20 percent of people they continue to have heightened anxiety and it's around any of those things, treatment-related side effects, how well the treatment is working, what their prognosis is going to be and then lots of practical issues, how am I going to get to the cancer center to get my treatments, what's going to happen with work, who is going to take care of my kids, just about anything you could imagine. Very similar to how we've actually had to change our lives with COVID-19 now. Lots of little things in our lives have become big things in our lives, that we focus our attention on and may be anxious about, like how to get toilet paper.

As you know, people with medical illnesses are at higher risk for worse outcomes with COVID-19. Many cancer patients, because of their treatments, have lowered immune systems so this has really impacted our patients because they still need to come to the cancer center to get their treatments, if they're beyond treatment or on a treatment that's once every three weeks, they can stay away and we're doing our office visits by video, but if you need chemo or radiation you have to come in so anything we can do to mitigate the anxiety to demonstrate that we're being as safe and cautious as possible with them really helps. But they are afraid to leave their house, for some that's leading to a lot of loneliness, I mean we're all to some extent afraid to leave our house, but they really don't want to be around other people.

Interestingly though, I have a handful of patients that actually say their anxiety is better, and I wonder if that's because a lot of things in our lives that we have had to focus on, like commuting are no longer part of the picture. So, it's been interesting to me that some patients actually are feeling a little bit better. Maybe not having to deal with as much outside of their cancer and then protecting themselves at home.

I think number one, trying to think about what's leading to having less anxiety, what are the things that are missing now where anxiety may have been heightened before and is not now, and how do we better cope with those issues or mitigate those issues, or avoid those issues going forward, at least during the cancer experience. At least many of us, if not all of us, have stresses in our lives that we just have to we can't avoid. For example, if you have to get your kids to school on your way to work and deal with traffic and the commute, especially here in Los Angeles, that's not going to go away once we go back to work. So, how do we better cope with that reality? What things can we put in place to lower that stress?

The flip side and you asked about the impact on health, is that anxiety in general, for any of us, whether you have cancer or not, has negative consequences for our physical health. It lowers our immune system, it makes us more susceptible to illnesses, it worsens cancer care outcomes, patients sometimes struggle to make important decisions because they're anxious, which can delay care and treatment or keep them from getting the treatment that they need.

Although many patients with cancer are concerned about leaving their house during the COVID-19 pandemic, a board-certified psychiatrist highlights that some of his patients with cancer have reported a reduction in their anxieties during the pandemic.
 

Dr. Scott Irwin

How Patients With Cancer Should Approach Questions Surrounding the Final Outcome of COVID-19, Their Diagnosis

'More Important Now' For Patients with Cancer to Focus on Mental Health During COVID-19

How COVID-19 Has Impacted Anxiety, Mental Health in Patients with Cancer

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