Alexea Gaffney battles health issues every day on multiple fronts. As an infectious disease doctor in Stony Brook, N.Y., she treats patients who have COVID-19. And two years ago, at age 37, she was diagnosed with stage 3 breast cancer.
As a result, the physician and single mom, who is also home-schooling her 8-year-old daughter these days, is still under medical treatment for the cancer. And that makes her more vulnerable to the virus.
Gaffney says navigating life from minute to minute feels like a minefield of risks — ones she mitigates with face masks, protective gowns and lots of hand-washing.
"It doesn't stop me from getting nervous every single day: 'Is this the day that it gets me?' I anticipate living with this kind of fear for a very long time to come," Gaffney says.
The health threat posed by the coronavirus pandemic is particularly intense for people fighting cancer. Medication weakens the immune system. Cancer treatments are often delayed. And many have lost their jobs and, along with that, their health insurance benefits.
A recent survey by the American Cancer Society found that nearly half of cancer patients say the pandemic has affected their mental health and their ability to pay for cancer treatment. An even greater share — 67% — say they worry about the impact that relaxed rules around social distancing in their state or community will have on their health.
"Insurance is a major predictor of whether someone can stay in treatment, and so we know it's a risk factor," says Dr. Laura Makaroff, senior vice president for prevention and early detection at the American Cancer Society. "As the pandemic continues, the number of people who are worried about their ability to get care that they need or continue in treatment is going up."
For some cancer patients and their families, daily life can feel like a string of life-or-death choices that pit the risks of catching the virus against other dire downsides: Should I brave the hospital for cancer treatment — or delay it and risk relapse? Should I continue going to work, or looking for work — or stay home and risk the financial fallout? Do I send the kids to school — or try to home-school and keep them isolated from their friends?
Even Gaffney, a physician and expert in infection, says she agonizes over these decisions and then torments herself worrying about the consequences.
"It's so hard navigating all of this as both a physician and as a patient — it's hard on both sides of it," she says.
Her nephew's high school graduation was one recent example. He completed his studies online, graduating with honors, Gaffney says — a particularly notable accomplishment this year.
"He did all of that with all the stress and turmoil of everything that's happening in the world around him: COVID, racial inequality and protests," says Gaffney, her voice swelling with pride. "He defied the odds, and it's like, we're going to celebrate that — it's too important not to celebrate."
But first, her extended family had to weigh many risks because they live in New York City, the early epicenter of the virus, and many of them work in essential jobs where social distancing is difficult.
They settled on a barbecue in Gaffney's backyard. Everyone took special precautions — serving separate trays of food and pitchers of drinks on tables set far apart and repeatedly sanitizing the bathroom door and faucet.
"It was such a big to-do," she recounts. "And when it was done, I was just freaking the hell out the whole time," fretting over whether all the sanitizing and social distancing measures were sufficient.
Four days later, her mother called to report that her stepfather — who'd had kidney cancer and other underlying health problems — had come down with symptoms of COVID-19.
Gaffney assumed the worst and berated herself, until his test for the coronavirus came back negative.
Marlee Kiel is an oncology social worker for CancerCare, an organization that offers patients counseling and support, and says she often hears stories like Gaffney's from her clients. The level of persistent anxiety among cancer patients is staggering, Kiel says. "All of the stressors that have already existed for cancer patients — and now they're managing everything all at once on triple the scale."
Chief among their worries, Kiel says, is money. Many patients have lost jobs and, often, their health insurance coverage along with that. For many, she says, alternatives for short-term coverage, such as COBRA plans, are still too expensive, and Social Security disability payments usually aren't enough to cover rent and other basics.
So many cancer patients are pushing themselves to work — despite the risks of infection, Kiel says. Some delay treatment as they try to find emergency funds or negotiate payment with hospitals and drug companies.
The isolation from family and friends is not only an emotional burden; it also adds to the patient's financial load because those loved ones aren't available to provide free babysitting, rides to treatment or meal deliveries. "All of that support is now cut," Kiel says.
Outsourcing tasks like grocery shopping isn't an option for Roxana Guerra, a single mom living in Alexandria, Virginia. Guerra, who has metastatic breast cancer that has spread to her ovaries, lives near her father, and she worries his age also puts him at high risk of doing poorly if he catches the coronavirus.
Meanwhile, her job as a legal assistant was recently cut to part time. Though the financial hit has been difficult, she's thankful to still have health insurance. So when her boss asks, she finds ways to get to the office, doing her best to avoid crowds.
"I'll come once a week when it's not that busy in the building," she says, "or I can even come on a Saturday."
With school and camps closed, Guerra is also trying to fill her 11-year-old son Enrique's days with activities once occupied by soccer and friends — all while fighting the fatigue and other side effects of her cancer treatment.
"He's the reason I do these things, and I have to continue doing what I can, as long as I have the energy to do it," Guerra says.
Children, family, making memories are all priorities — priorities first shifted by cancer and now by the pandemic.
This year Abigail Johnston scrapped plans to take her two boys — ages 5 and 7 — on an Alaska cruise and a trip to her husband's native Jamaica. Johnston, who lives in Miami, was diagnosed with advanced metastatic breast cancer three years ago, when she was 38.
"If you look at the limited life expectancy that we are looking at already and you layer on top of that the COVID pandemic and the amount of things that have been canceled, eliminated — you're taking away the opportunity to complete a bucket list," Johnston says.
Life was already too short, she says. And now it must remain on hold.