Cancer and COVID-19: Navigating Re-entry

For better or for worse, the world is slowly beginning to re-open. In Massachusetts, many shops are now allowed to open their doors, and restaurants can serve food inside and outside. I actually had my first haircut since February today, and I feel like a new woman. If you have not yet taken this leap and want some reassurance, I am happy to give it. As others had told me, the scene at the beauty salon was very different than normal: one customer only, the same set of questions asked at medical visits, temperature taking, and the staff wearing gloves, masks, and face shields. It felt completely safe.

Having said that I felt fine about being there, it is also very important to acknowledge that we must all make our own choices, and they will differ. Hopefully none of us are crowding bars or beaches as we have seen on the news, but each of us must decide what feels comfortable. We also know that what feels comfortable today may be very different from what feels comfortable next week or next month.

For example, it is impossible for me, right now, to envision getting on a plane. I very much want to visit my daughter and her family in Minnesota, so my resistance may weaken over time. Or not. I have a patient, living with recurrent cancer, whose first grandchild was born last week in another state. She is desperate to visit, but feels especially vulnerable since she is receiving chemotherapy. She and her husband are exploring all possible options, but it is a long way to drive and that would involve restaurants and hotels. Most of us cannot afford to charter a private jet, the solution offered by some articles that I have read.

There are many decisions that fall between a haircut and a plane trip:

• Will you take your child or grandchild to the playground?
• If a child in your life returns to some kind of group care, does that change your willingness to be around her, even outside?
• Are you comfortable getting together with friends in the backyard or a park for a picnic or drinks?
• What about taking walks or going for bike rides?

We have had the recommendations drummed into us: wear masks and try to stay 6 feet apart. Sometimes that is easier than others. Have you seen the ads for face masks that have a Velcro flap over the mouth so you can eat at a restaurant? And, to complicate every decision, each has to be made in parallel with our house mates or family members at home. If someone is eager to return to the gym, s/he is also exposing everyone at home to anything that is picked up there.

Many of my patients are telling me that this beginning of our new normal feels even scarier than the past months. When we were all, except for essential workers, told to stay home, there really weren't many decisions to be made. We had to figure out groceries, but otherwise were occupied with childcare and house chores and trying to keep ourselves busy. Now we are being told that it is time, or almost time, to think about going ahead with our lives.

There are no easy answers here, and it is infinitely more complicated and difficult for people on active cancer therapy. Clearly anyone who is currently receiving chemotherapy, radiation therapy, or immunotherapy has a compromised immune system and needs to be careful. The studies have indicated that those who have completed therapy, for the most part, are pretty quickly back in the same risk pool, regarding the chances of becoming seriously ill if infected, with everyone else. Exceptions are usually listed as being people with lung cancer, hematological cancers, or any type of Stage IV cancer. Within those groups, of course, there are great variations, and different people are going to feel more or less anxious about exposure.

It seems to me that there are two summary recommendations: Talk to your doctor about your concerns and pay attention to your own instincts. It is going to be easy, as more people are moving out and about, to feel social pressure to participate in activities that may not feel right to you. Going through cancer treatment has taught many of us a few standard responses to unwanted advice, which may be helpful now.

If someone pushes you to go somewhere or do something that does not feel right, you can say something like: My doctor has recommended that I be more careful for a while or that just does not feel OK to me right now. Remember: You are the boss of you, and these are your decisions to make. There clearly is no right and no wrong, and we are all figuring out how to manage these challenging times.