Cancer, COVID-19 and Isolation

A widespread and profound consequence of social isolation has been loneliness, boredom, FOMO ("fear of missing out" is a social anxiety that an exciting or interesting event may currently be happening elsewhere, often aroused by posts seen on a social media website), and a general feeling of disconnectedness. This has always been an issue for cancer patients and others living with poor health or diminished energy.

Now that the world has been told to stay home, to socially distance from others, and to basically behave in ways that are opposite to our human instincts, we are noticing an unhappy spike of these feelings. Cancer patients are likely to have had some experience dealing with these feelings and situations, but the double whammy of cancer and COVID-19 is very tough.

As the world is beginning to re-open and many people are starting to be more active outside their homes, people with cancer continue to feel appropriately anxious about these changes. We know that people who are immunosuppressed are at a higher risk of becoming seriously ill if infected with the virus, so it is wise to continue to curtail exposure to others. In addition to the daily decisions about what feels safe, we must live each day with the consequences of social isolation.

There has been an explosion of possible virtual activities and endless suggestions about what to listen to, watch, or participate in. Museums around the world offer virtual tours; symphonies and bands offer online concerts, and there are many invitations to join online exercise groups. Whatever your interests, there are options online.

However, partaking in an online ballet class or even listening to an interesting lecture is not at all the same experience as being there in person. Many of us, myself included, have developed Zoom fatigue and are less enthusiastic about clicking on the invitation link.

Since mid-March, my clinical practice has been entirely virtual. This has been a steep learning curve for both me and my clients, but we are improving. There are certainly differences in the experience. It is harder to sit with silences, and I have noted fewer tears. One client suggested to me yesterday that, in spite of our long relationship and tight connection, it is harder to feel held over the computer, so she is aware that she is restricting her reactions and feelings. It has been especially challenging to establish relationships with new patients. I am now working with four people whom I have never met in person, and I suspect there will be surprises at both ends when we can be together in the same room.

It is tough to know what to recommend to people who are experiencing discordant and lonely feelings about being so long at home. The standard suggestions of getting out for daily walks, Netflix binges, puzzles and lots of Zoom connections just don't cut it. Many of us are beginning to realize this is likely to be a long haul, and we must find ways to manage ourselves and our shrunken lives over time.

People who live alone have had especially lonely days, while people living with family or friends or roommates have discovered every possible tension in those relationships. Most of us have never spent so much time together as we have since March. We continue to be separated from others whom we love; grandparents can't care for their grandchildren, and we can't visit family or friends who live at a distance.

I have read a few articles that make a distinction between happiness activities and meaning activities. The latter are always harder and particularly so now. We can't volunteer in the community or door knock for a political campaign or reach out to help others in the ways that provide lasting gratification. On a simpler level, think about the difference between having a virtual dinner with friends vs. sitting around a table to break bread together. One is infinitely more satisfying than the other.

We will continue to figure this out and to get through it together, but it continues to feel important to acknowledge how tough this is.