May 05, 2020 11:00 AM

Author: Jake Rex Erickson

From time to time, HCI invites guest commentary from our community. The views reflected in these commentaries are those of the author and do not necessarily represent the official views of HCI.

As a third year medical student, I was about to start work with the Huntsman Cancer Institute (HCI) breast cancer team when coronavirus cancellations began. All University of Utah School of Medicine clinical learning was suspended to protect the health of patients and students. And though the cancellation was necessary, I felt disappointed—I had been counting down the days until my rotation at HCI. I’d heard only rave reviews from my classmates who’d worked there.

Soon, however, Kirstyn E. Brownson, MD, the physician I was scheduled to work with on my rotation, contacted me. Even as HCI quickly converted care to online platforms, Dr. Brownson made time to go above and beyond to bring me an HCI learning opportunity, physical-distancing style. We talked shop and she shared insights about treating breast cancer. Aside from these lessons, she gave me a challenge: research something I’m interested in and its connection with breast cancer.

Currently, I’m hoping to become a psychiatrist, so I’m interested in people’s mental wellbeing. I took the challenge and started looking into the literature.

I learned there are years of research linking social isolation with poorer breast cancer outcomes. In fact, social isolation impacts the health of all sorts of people.

While we don’t completely understand how social isolation impacts the body’s processes, a few systems seem to be involved. Most of them have to do with stress. Psychologically, people who experience loneliness tend to perceive day-to-day activities as more stressful. They also experience fewer stress-relieving moments.

This stress both directly and indirectly translates to increased tumor growth. Studies with mice show certain breast tumors directly respond to stress. The tumor responds by building the machinery it needs to grow faster and spread farther.[1]

The indirect response has to do with the immune system. Stress can weaken the immune system, which makes it harder for the body to fight off all kinds of diseases, including cancer. One of the arms of the immune system is generated by what researchers call the natural killer cell.[2] This type of cell directly attacks cancer cells. Animal and human studies show that isolation lowers the number of natural killer cells in the body.

There is good news, however. The negative effects of isolation depend on the person’s internal experience of that isolation, rather than the actual time spent away from others. In other words, it is the feeling of loneliness and disconnection that really make a difference. This means patients, their loved ones, and their care team can take action.

Despite physical distancing, we are not doomed to live lonely lives. We can fight the effects of feeling lonely with our unique, creative gifts. We can find ways to connect, engage, and support each other. We can use new and old technology to feel one another’s presence while being physically separate. Patients have used strategies ranging from family video calls to letter writing, from online support groups to motor parades where friends inside cars drive through the streets displaying signs of support and connection.

Just as each of us has the opportunity to adapt at this challenging time, HCI is working on creative ways to support its community. COVID-19 has made it unsafe for visitors to be in the hospital. So HCI is rolling out patient care cards for loved ones to write down ways they would care for the patient if they were there. For example, the loved one can tell the care team that the patient won’t ask for an extra blanket or a snack but to bring it anyway.

The coronavirus has affected all of us—and that impact may be more severe for people with diseases like cancer. Those of us who have experienced the sting of loneliness know how important it is to get emotional support by reaching out to others. Though COVID-19 has physically separated us, we must not leave each other, especially those battling cancer, feeling isolated and alone.

[1] Sloan EK, Priceman SJ, Cox BF, et al. The sympathetic nervous system induces a metastatic switch in primary breast cancer. Cancer Res. 2010;70(18):7042-7052. doi:10.1158/0008-5472.CAN-10-0522

[2] Levy M S, Herberman B R, Whiteside B T, Sanzo B K, Lee B J, Kirkwood B J. Perceived social support and tumor estrogen/progesterone receptor status as predictors of natural killer cell activity in breast cancer patients. Psychosom Med. 1990;52(1):73-85

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