key: cord-0970148-fqiz9l7w authors: Ratnasekera, Nadisha; Perera, Irosha; Kandapolaarachchige, Pushpakumara; Surendra, Gayan; Dantanarayana, Ajith title: Supportive Care For Oral Cancer Survivors In Covid‐ 19 Lock Down date: 2020-07-06 journal: Psychooncology DOI: 10.1002/pon.5463 sha: c24ce4acebc3b703cc8864ea6510a5d5e9f22362 doc_id: 970148 cord_uid: fqiz9l7w OBJECTIVE Availability and accessibility to routine health care services for cancer patients were a cause of concern during the COVID-19 pandemic, which induced stringent enforcement of lockdown and social distancing in Sri Lanka. Oral cancer patients who have undergone surgery recently encountered problems such as pain, difficulty in swallowing. However, accessing routine treatment and obtaining medication emerged as the most pressing concerns among them. Therefore, we aimed to provide supportive care for affected oral cancer patients. METHODS A rapid situational analysis was conducted among 25-randomly selected oral cancer patients of an ongoing interventional study aimed at improving life situation of oral cancer patients. RESULTS Over-the-phone supportive care tailored to the needs of oral cancer patients, provided by a health professional, deemed a simple but helpful intervention. CONCLUSIONS Facilitating patients to navigate the health care system to ensure that they can continue in receiving timely treatment was the most critical aspect of the intervention. Interventions tailored to patients' needs could offer better supportive care for cancer patients in COVID-19 pandemic scenario. • Availability and accessibility to routine health care services for cancer patients was a cause of concern during COVID-19 pandemic induced stringent enforcement of lock down and social distancing in Sri Lanka. • Oral cancer patients who have undergone surgery recently encountered problems such as pain, difficulty in swallowing. However, accessing routine treatment and obtaining medication emerged as the most pressing concerns among them. • Over the phone supportive care tailored to needs of oral cancer patients provided by a health professional deemed a simple but a helpful intervention. • Facilitating patients to navigate the health care system to ensure that they can continue in receiving timely treatment was the most critical aspect of the intervention. • Interventions tailored to patients' needs could offer better supportive care for cancer patients in COVID-19 pandemic scenario. Sri Lanka, is a lower-middle-income-developing country, possessing one of the best efficiently pro-poor public health care delivery models across the globe underpinned by simultaneous achievement of strong health outcomes, good financial protection and low cost 1 In January 2020, we introduced an innovative, self-sustainable intervention as a component of an ongoing research study aimed at improving the psychological well-being of the oral cancer patients treated with surgery. They were approached at 3-time points:1) soon after diagnosis This article is protected by copyright. All rights reserved. when they visit hospital 2) At home 1-week after discharge 3) At home 2-weeks after first visit. This intervention was developed by a comprehensive triangulation method of an extensive literature search followed by gaining inputs from patients, caregivers and experts through a qualitative exploration 7 . Furthermore, the health literacy status of oral cancer patients was meticulously considered as the majority had less optimal levels of education 8 This article is protected by copyright. All rights reserved. possible. Similar capacity enhancement of oncology nurses to deliver supportive care to parents with advanced cancer had been reported from developed countries 10 . The ongoing intervention garnered preliminary encouraging responses from oral cancer patients and their care-giving family members. Patients started feeling the benefits "we are no more worried as we know what to do". However, the COVID-19 pandemic and strictly imposed quarantine curfew and lock down of the country especially the high risk districts, resulted in temporary restrictions in access to the intervention. People were strictly instructed to stay home except for accessing emergency medical care providers of essential services; defaulters were arrested by the police. Accordingly, an extension/modification to the intervention was needed. Moreover, oral cancer patients had emerging information needs which were different from the pre-COVID-19 era. The present modified intervention was deemed a blessing in disguise during the enforcement of lock down in Sri Lanka. Many patients who participated in the intervention have contacted the first author who is the Principal Investigator (NR) for the ongoing research and the PHNOs to seek assistance especially pertaining to acute problems eg. pain, clinic dates, availability of drugs etc. The contact details were available for the participants and vice-versa thereby ensuring accessibility of the target population to the investigators. An attempt was made to deliver the same or slightly modified intervention over the phone since visiting the patients was not possible during the lockdown period. Furthermore, the PHNOs were temporarily recruited for the field work on COVID-19 prevention and control and were no longer available. Hence, the study PI had to deliver the over-the-phone intervention which yielded even more encouraging responses from the patients. Patients admitted that just talking to a health professional relieved their tension. This article is protected by copyright. All rights reserved. A rapid standardized situational analysis was conducted among by the first author among 25 randomly selected oral cancer patients from the intervention group. It was clearly evident that the patients were in a miserable status mainly due to the lack of information on how to access the routine drugs they were using obtained from respective public health care facilities free of charge The singular fact that medical personnel were inquiring about their well-being over the phone uplifted their spirits during this difficult period. This was the comment made by almost all patients whom were contacted. Furthermore, the main issue of drug availability and clinic dates This article is protected by copyright. All rights reserved. was rectified after coordinating with the relevant clinics and specific guidance was provided to the patients. It was evident that lack of awareness on how to access hospital clinics to get the medicine was the predominant cause for an array of problems cancer survivors encountered. Therefore, adequate time was spent to provide satisfactory information to the patients. . The COVID-19 pandemic had an unprecedented impact on societies and health care systems as stringent lock down enforcement and social distancing was needed to curtail the community spread of infection. Sri Lanka as a developing country faced the challenge well but availability and accessibility to routine treatment was the most pressing concern for cancer patients. Accordingly, many oral cancer patients who underwent recent surgeries were facing problems with pain and swallowing while the majority did not know how to access routine services under constraints posed by COVID-19 pandemic. Hence, the most critical aspect in the intervention was to facilitate patients to navigate the health care system to ensure that they can continue in receiving timely treatment. This was complimented by advice on practicing 'mindfulness therapy' to maintain psychological well-being during difficult times. Sri Lanka: Achieving Pro-Poor Universal Health Coverage without Health Financing Reforms Delivery of cancer care in Sri Lanka Cancer incidence data Sri Lanka Cancer incidence data Sri Lanka 2011-National Cancer Control Programme Psychosocial Interventions for Patients with Head and Neck Cancer Past, Present, and Future Psychosocial interventions for patients with head and neck cancer (Protocol). The Cochrane Library How patients of oral cancer cope up with impact of the disease? A qualitative study in Central India Oral hygiene and periodontal disease in male patients with oral cancer. Letters to the Editor Mindfulness-based stress reduction for women diagnosed with breast cancer Enhancing the capacity of oncology nurses to provide supportive care for parents with advanced cancer: Evaluation of an educational intervention Authors wish to declare that no funding involved in this clinical correspondence.The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. This article is protected by copyright. All rights reserved.