Trapped in a double cage: Building resilience in cancer caregivers endangered by the COVID-19 pandemic.

Sophie Opsomer

Keywords: Resilience, advanced cancer, palliative care, cancer caregiving, COVID-19

Background:

When confronting a potentially traumatic event (PTE) such as a partner’s diagnosis of advanced cancer, caregivers seem often protected against severe psychological illness by resilience. However, during the COVID-19 pandemic, these caregiving partners were expected to deal concurrently with a second PTE characterized by a threat of exposure to the contagion, viral transmission, isolation, and fear of impending death.

Research questions:

What are the experiences of partners taking care of a person with advanced cancer during the COVID-19 pandemic?

Method:

An interview study with interpretative phenomenological approach of nine partners’ lived experiences.

Results:

Dealing with two PTEs at a time was experienced as ‘living in a double cage’. The partners talked about how they no longer managed to escape from the cancer and how their lives came to a halt as the patient’s life raced toward death. On the other hand, the quality time with the partner, resulting indirectly from the imposed measures was much appreciated.
The pandemic emphasized the dynamic features of resilience. The vulnerability of the resilience resources, both the individual characteristics and the availability of professional and personal support, was magnified, whereas the pandemic seemed to be a catalyst for moderating coping strategies such as maintaining normality, assuming responsibility and managing or mastering the situation. Overall, a resilience process seemed promoted and a new equilibrium was established.

Conclusions:

In dealing with major stressors, partners seem to employ an array of inventive and balanced coping strategies. These strategies, predominantly personal in nature, seem to set the stage for a resilient outcome, even in the presence of extreme environmental constraints. However balanced and creative, the coping strategies are also close related to fight and flight reactions. Hence, the risk for exhaustion should be considered Nevertheless, permanent support by HCPs should be guaranteed, albeit technology-driven whenever face-to-face contact is not possible.

Points for discussion:

How can we, HCPs, guide partners of patients with advanced cancer in developing a resilience process throughout cancer caregiving?

What is the impact of any second PTE on existing resilience promoting characteristics and context features?

How can HCPs detect and bring to the forefront those resilience-supporting characteristics and features that are still intact?