COVID-19: diary of a cancer nurse specialist
Prostate Cancer UK specialist nurse John Robertson shares an account of a typical day working during the pandemic
- Daily work includes addressing concerns in a phone service and live chat, and responding to emails and social media enquiries
- Calls range from questions about symptoms and medication to the physical and psychological effects of a prostatectomy
- Since the pandemic started, more people have needed emotional support and the anxiety they already felt has been amplified
A year on from the start of the COVID-19 pandemic in the UK, cancer services have had to adapt and change to accommodate the challenges.
While cancer care was not paused, as routine surgery was during the first peak, services were severely disrupted and many people were deterred from seeking help because of the fear of COVID-19.
Here, Prostate Cancer UK specialist nurse John Robertson describes a typical day of pandemic working, one year on from the start of the pandemic:
7am The alarm goes off and I drag myself out of bed. It has been several weeks since I had to isolate in my bedroom for five days with COVID-19 symptoms. It was immensely frustrating that I could not get a test at that time. The cough has gone but my energy levels are still depleted.
8.30am At the computer in my study, setting up the software platforms we need to carry out different aspects of our work. This includes taking calls on our phone service, responding to emails, answering live chat and social media enquiries, and entering appropriate data.
Since March 2020 we have had to work from home, as our office – and London – has been out of bounds due to government restrictions.
This morning I’m working on our phone service from 9am to 12.30pm.
9am I take my first call of the day from a man aged 72 who has recently been diagnosed with prostate cancer. He had been told that the best treatment for him was hormone therapy followed by docetaxel chemotherapy.
He had been apprehensive about the chemotherapy, but after discussing it with his family – who were anxious that he get the best possible treatment – he had reconciled himself to starting it next week.
He calls us in a distressed state as that morning he’d found out his chemotherapy had been cancelled due to the risk of contracting COVID-19.
His emotions fluctuate between distress and anger throughout the call and I focus on his fears and concerns.
We talk about the second-line treatment, enzalutamide, which has been offered in place of the chemotherapy, and which should be just as effective at controlling his cancer. He seems calmer and more reassured by the end of the 45-minute call.
9.50am My second call of the day is from a man aged 55 who says both his brother and his father have had prostate cancer. He says he has always been afraid to go for tests but has recently become concerned about some urinary changes he has noticed.
He has been lying awake at night worrying about prostate cancer. We spend some time exploring his fears, risk factors and symptoms and he acknowledges that it would be sensible to discuss this with his GP.
He mentions that his GP has a limited service due to COVID-19 constraints, which is something we have been hearing a lot in recent weeks. Given his symptoms, and the fact that his family history puts him at higher risk of prostate cancer, our message is that he should not hesitate to ask for an appointment.
10.15am I have a two-minute gap and then the phone rings again. This caller is the partner of a man who had a radical prostatectomy six months ago.
He has recovered his bladder control but the caller is concerned that he shows little interest in any sexual intimacy. She tells me that whenever she tries to discuss this with him he closes the discussion down.
We have a lengthy call in which I outline the physical and psychological effects on men after a prostatectomy, and we talk through some strategies that may help her communicate more effectively with her partner.
I signpost her to some of our online resources as well as our newly launched sexual support service, where she can receive additional support from one of my colleagues who is trained in this area.
11am-12pm I receive four shorter calls in the next hour.
One person wants to know how to get a prostate-specific antigen (PSA) test, another is asking how to reduce the side effects from hormone treatment, and one wants to check the signs and symptoms to look out for.
In the last call, a young man says he’s found a lump on his testicle and is fearful that he may have prostate cancer. As someone who has been a specialist nurse for 13 years, these are questions I’m regularly asked.
I am thankful I can go into information mode and that these calls do not have the same highly charged emotional content of the previous ones.
12pm The phone rings and when I give my name and job title I can make out that someone is sobbing. I tell them that I’m here, it’s okay to take their time and they can speak when they feel able to.
The caller apologises and goes on to tell me that her father was diagnosed with prostate cancer five years ago, but the cancer has now progressed and he is not responding to treatment.
The family has been told that he is now in a palliative care situation where the aim is to make him comfortable and ensure his quality of life is maximised. His daughter is very distressed, a long distance away, and COVID-19 restrictions mean she is unable to be with him.
We spend time discussing support systems for her dad. I finish by stressing that she can call us as often as she needs to and that we are here to give her support.
12.40pm Time for a quick bite of lunch and I find that the last caller is still in my thoughts.
Since the pandemic started, the nature of our calls has changed considerably, with more people needing emotional support. Those diagnosed with prostate cancer, or supporting a loved one with the disease, often have significant levels of stress to begin with, and COVID-19 seems to have amplified that anxiety even more.
It has me thinking about the psychological impact COVID-19 has had on so many people, including myself and my fellow nurses, and like so many others I’m wondering when it will end.
1.10pm I’m trying to collect my thoughts and quickly read over some notes for an interview at 1.30pm.
Prostate Cancer UK has announced that urgent referrals for prostate cancer have dropped by 52,000 due to the pandemic, and a regional BBC radio station is covering the story.
1.30pm-1.40pm The interview goes well, and I’m able to get the message across that men at higher risk of prostate cancer should not wait for symptoms before speaking to their GP.
I use the opportunity to promote our 30-second risk checker, which should help more men understand their risk of the disease.
1.45pm I have 15 minutes to prepare for a working group meeting with colleagues from across the charity.
2pm I join the group meeting on Zoom. We are all becoming familiar with virtual meetings and rapidly getting to grips with the technology in a way that is unprecedented.
It’s uplifting and energising to be able to collaborate with colleagues from other parts of the charity, and formulate strategies that will help us better serve the needs of those affected by prostate cancer. These groups remind me why I love working for Prostate Cancer UK.
Despite the challenges COVID-19 has presented us with, we’re still there for men. In some cases the crisis has actually widened our scope for delivering information and support. Expanding Zoom licences for support groups, for example, has meant they can continue to run virtually – and many more people can attend.
3.30pm Time to call a man who completed our online request form indicating that he was interested in our fatigue support service. This is a phone service we provide to support men who are struggling with the impact of fatigue following diagnosis and treatment.
We go through his treatment history and assess his level of fatigue, and I explain how the service works.
4pm Just in time to join my nursing colleagues on our daily virtual session, where we discuss any issues and check in with each other. We decided early in the pandemic that as we were more isolated working from home it was important to catch up regularly to help each other maintain our resilience.
These daily meetings, alongside regular clinical supervision, have helped to keep morale high during a particularly challenging time.
4.45pm Finish off an email response to someone who asked whether their prostate cancer treatment made them more susceptible to COVID-19.
5.15pm Grab a bite to eat.
6pm I join a local support group to deliver a virtual talk via Zoom on all matters prostate cancer and COVID-19. It’s a well-attended session with men from across the UK joining us.
We discuss a wide range of topics including the latest research, clinical trials, treatments for recurrent disease, keeping well during the pandemic and reducing anxiety. It’s a stimulating session and good to hear how men are feeling during the pandemic, as well as getting feedback on the issues that are most important to them.
7.30pm The end of another busy but rewarding day. I have half an hour before my virtual book club – the perfect way to switch my focus away from work and relax.
How to get in touch
Anyone with concerns or questions about prostate cancer, including partners, friends and healthcare professionals, can contact Prostate Cancer UK's specialist nurses on 0800 074 8383 or online
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