COVID: An Unexpected Barrier to Care

November 2020 Vol 11, No 11
Roberta Sales, MPH, BSN, RN, OCN
Memorial Sloan Kettering Cancer Center,
New York, NY

Background: A 21-year-old with carcinoma of the nasopharynx was first evaluated by the Head and Neck Oncology Service at Memorial Sloan Kettering Cancer Center (MSKCC) in April 2020. This patient had 14 out of 20 barriers listed on the National Cancer Institute Data Elements in Navigator Tracking log. The coronavirus (COVID-19) added a 15th barrier. The patient required daily proton therapy at an outside facility and weekly chemotherapy at MSKCC. The patient and her mother arrived in New York City (NYC) at the height of the coronavirus pandemic and were extremely anxious. Oncology nurse navigators (ONNs) reduce barriers to care, which reduces time to treatment. Due to COVID-19 guidelines and changes in staffing and available resources, the ONN role was critical.

Objective: This patient’s cancer care could not be delayed. The ONN had to ensure that the patient received the same level of care she would have received before COVID-19. Care coordination between the proton therapy team at a non-MSKCC facility and MSKCC’s medical oncology team could not be affected.

Methods: Prioritization of interventions to overcome barriers was immediately begun by the ONN, with housing and financial support the primary concerns. Education was paramount. There were limited housing options and COVID-19 exposure concerns with Airbnbs and public transportation in NYC. The ONN increased outreach to more community resources because many had closed and discovered new ones. The patient’s mother could not accompany her daughter to her visits, but she participated via telehealth and audioconferencing. To decrease anxieties, already high and worsened because of COVID-19, the ONN increased the number of “check-in” calls and e-messages to the patient and her mother. This ensured they were always in the loop and addressed any concerns they might have regarding the non-MSKCC facility. Staffing changes required vigilant navigation.

Results: The biopsy resulted on May 14, and concurrent proton/chemotherapy treatment was initiated on June 10. There was no delay in treatment. The ONN used telehealth, developed new resources, and increased communication with her colleagues within and outside MSKCC. Prior to COVID-19, relationships were usually established during an in-person meeting with a patient. An increase in the communication between the ONN and the patient and family allayed fears about COVID-19. Logistical and emotional support maintained a trusting relationship even with the implementation of telehealth, a less personal mode of communicating. The level of anxiety decreased once the patient’s housing for the entire period of treatment was confirmed and financial support was obtained to cover daily living expenses. Navigating with the non-MSKCC facility ensured that scheduled visits were coordinated, and rescheduling, which would have created confusion and problems, was avoided.

Conclusion: ONNs must adjust their interventions to ensure that cancer treatments and outcomes are not negatively impacted by the various effects of the COVID-19 virus. This requires more than just adapting to the technologies of telehealth. Attention to resources and the altered relationship with our patients must be addressed as well.


Lee T, Ko I, Lee I, et al. Effects of nurse navigators on health outcomes of cancer patients. Cancer Nurs. 2011;34:376-384.

National Cancer Institute. Patient Navigation Research Program page. Updated April 14, 2008. Accessed July 17, 2020.

Rowett KE, Christensen D. Oncology nurse navigation: expansion of the navigator role through telehealth. Clin J Oncol Nurs. 2020;24:24-31.

Weiderholt PA, Connor NP, Hartig GK, Harari PM. Bridging gaps in multidisciplinary head and neck cancer care: nursing coordination and case management. Int J Radiat Oncol Biol Phys. 2007;69:S88-S91.

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