Combating patient isolation: Breast cancer treatment during the COVID-19 pandemic

As a health care system, we have united during the COVID-19 public health threat to embrace social distancing and “flatten the curve.”  In order to conserve scarce resources and limit viral transmission, we health care providers have canceled elective surgeries, postponed health screenings, and moved patient encounters to online platforms.  While we are fighting to save critically ill patients affected by the virus inside the hospital, we are attempting to keep nonurgent and nonemergent patient concerns out of the hospital confines. We are working hard to address our patients’ health concerns from the safety of their own homes for both the public and the individual good.  However, in our efforts to combat the coronavirus through tactics of isolation, we must not forget about the detrimental role that isolation plays in many human diseases.

Social isolation is implicated as a major risk factor for all-cause mortality, and one of the many disease states it has been shown to negatively impact is breast cancer.  While there are numerous scientific studies correlating isolation with worsened breast cancer outcomes, the mechanism through which social isolation negatively impacts breast cancer outcomes is not fully understood.  Most studies suggest that isolation ultimately inhibits the body’s ability to respond to and fight off cancer. Isolation induced changes in tumor microenvironments, including increased transcription of pro-metastatic genes, changes in inflammatory cell infiltration, and elevated levels of stress hormones, have been noted in experimental models.  Studies of mice infected with human breast cancer cells revealed that isolation leads to changes in breast tumor growth pathways, which allowed the tumor cells to travel through the body more quickly and grow more rapidly.  Human studies have found correlations between isolation and weakening of the body’s immune system in the form of decreased natural killer cell activity.

The good news is that the deleterious effects of social isolation seem to be tied to the individual’s interpretation of isolation. Thus, loneliness, rather than the physical distance between an individual and others, is likely the driving force behind these poor health outcomes.  Furthermore, increased stress experienced by those who are socially isolated is thought to be heavily influenced by an increased perception of stress and a decreased experience of stress relief.  This message is critical because it reveals an opportunity that we, as health care providers, have to intervene during the COVID-19 pandemic to positively impact the health of our patients.  While we must continue to encourage social distancing, we must not let the physical barriers of social isolation become a place for loneliness to take root.

We are fortunate to live in a world where we have technologies at our disposal to make the human connection possible even when we are physically far apart.  We must leverage this technology to check-in and ensure that our patients still feel heard.  While the healing power of the human touch is absent in a virtual physical examination, virtual visits are excellent vehicles for physicians to investigate psychosocial stressors affecting patients.  By recognizing distress, we can help our patients cope with this distress and combat its effect on patient disease.  Because of the complex nature of COVID-19 induced isolation, the overall impact of this risk factor on human disease is difficult to predict.  What is certain, however, is that the physical separation imposed by this virus does not need to drive a wedge between the doctor-patient relationship and that this relationship must be utilized to address the isolation experienced by patients during this time in order to safeguard patient health.

Jake R. Erickson is a medical student. Kirstyn E. Brownson is a surgical breast oncologist.

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