Eliza Paris was 25 years old when she was diagnosed with stage four appendix cancer, requiring 12 rounds of chemotherapy and an 18-hour surgery to remove her ovaries, gallbladder, spleen, appendix and part of her colon.
She relearned how to walk in the halls of New York's Memorial Sloan Kettering Cancer Center. When she finished treatment and left, she hoped the cancer was gone and she would never have to come back. But a few months later, the disease returned, requiring chemotherapy that drips for 48 hours every other week — a regimen she'll likely need in some form for the rest of her life.
"I thought I'd tackled everything I could tackle in my lifetime, and then comes a pandemic where I live in New York City, in the epicenter," said Paris, now 27.
Much of the day-to-day cancer treatment at Sloan Kettering paused when COVID-19 hit, and Paris drove to Atlanta to work from home with her family. Twenty-five days into her quarantine there, after family dinner and Jeopardy!, she began feeling sick to her stomach. Later that night, she fainted. She recalls being asked if she had a living will, and whether she wanted to be resuscitated.
After emergency kidney surgery, she woke up in the ICU. She had sepsis, coronavirus and cancer.
"I hit the trifecta," Paris said. "I was also trying to advocate for myself, to say, 'Listen, I'm not your normal 27-year-old woman. I have cancer.'"
"It was a very overwhelming experience," Paris continued. "But, you know, when I think back to it, I don't think about all of that. All I think about was how hard I was trying to catch my breath."
For cancer patients in the age of COVID-19, the road to recovery has taken a tumultuous turn. Cancer hospitals like Sloan Kettering have been forced to reimagine how to care — or how to safely postpone care — for tens of thousands of patients, including many like Paris who battled cancer and coronavirus simultaneously. Cancer surgeries have been postponed, treatments interrupted and screenings practically halted; operating rooms had to morph into ICUs, as the world's oldest and largest private cancer center joined the frontline of a global pandemic.
"We were all feeling scared," said Dr. Jeffrey Drebin, the chair of surgery at Sloan Kettering. "But there was a sort of a sense of mission, a sense of trying to continue our cancer care and to do COVID care for our patients, and to be part of the greater community."
Paris, like the majority of Sloan Kettering's patients with COVID-19, has now recovered from the virus, the hospital said. A longer term challenge lies ahead; patients must feel safe enough to return to Sloan Kettering to resume their cancer treatments, even if it means braving the coronavirus crisis outside. Nationwide, preventive screenings have dropped by roughly 90 percent compared to the same period in each of the past three years, according to a recent analysis of 2.7 million patient records. And as coronavirus continues to consume news cycles, Sloan Kettering's leaders worry that cancer patients may feel safer at home even after that is no longer the case.
"Cancer has not taken a vacation," said Dr. Lisa DeAngelis, the chief medical officer at Sloan Kettering. "It hasn't been sheltering in place. It's been doing what it does, which is develop and, unfortunately, grow."
But while Sloan Kettering is a specialized cancer center, it too was consumed by coronavirus's descent on New York City hospitals. The hospital says it had 25,000 patients in active cancer treatment at the time, in addition to serving hundreds of thousands more who continue to seek health care there after their treatment finishes. "Many hundred" of Sloan Kettering's patients contracted coronavirus, DeAngelis said, and looked to the cancer center for help.
Cancer patients are high-risk for coronavirus complications, as both the disease and its treatments tend to weaken the immune system, according to the American Cancer Society. In a recent study of 218 coronavirus patients with cancer in New York City, roughly one in four patients died. A similar study involving 14 hospitals in China found the coronavirus's death rate was three times higher for cancer patients.
The faces behind those statistics can be younger than most coronavirus victims. David Behrbom, a Bronx elementary school teacher, passed away at age 47 after being diagnosed with both leukemia and coronavirus within the span of a few days. Jeffrey Ghazarian, who reportedly beat testicular cancer four years ago, passed away in Pasadena at age 34. Ron Golden, a Marine in the Reagan White House turned truck driver in Tennessee, had just started chemotherapy for lung cancer when he contracted COVID-19 and passed away at age 56, said his wife, Josie Keaton.
"It's like a nightmare," said Keaton. "We knew he had maybe a year, but we knew we had time together. We had things we were going to try and do."
This heightened risk is part of the reason why many cancer hospitals like Sloan Kettering tried to reduce patient volume as much as possible, moving oncologists meetings onto iPads, for example, and postponing surgeries in favor of chemotherapy and radiation. In the toughest weeks, Sloan Kettering went from roughly 110 surgeries a day to about 20 to 25, Drebin said.
Triage decisions are not easy at the U.S.'s largest cancer surgery program; there are very few optional surgeries. A multi-departmental committee met twice a day on matters like these — a series of risk-benefit calculations that pitted a global pandemic against America's deadliest disease for adults under 65.
"We worked very hard to try to get everyone cared for as quickly as possible," said Drebin. "But I would say ties always went to kids."
Surgeries decreased in part because of Sloan Kettering's preparations for an influx of coronavirus patients. It repurposed operating rooms and converted an additional floor into ICU beds, promising coronavirus care to their patients, employees and employees' families. Aside from early restrictions on N95 masks, Sloan Kettering had enough resources to offer help to the rest of the city; they say they sent out 35 ventilators and offered to take in cancer patients from more crowded hospitals.
They now believe, cautiously, that the worst is behind them.
"There've been many moments when I sort of can't believe that this is happening in the United States of America" said DeAngelis. "We, along with others, are really now turning our attention to the fact that, you know, we've got to take care of people. They have other illnesses, other problems that haven't gone away."
Cancer is the devil they know, and they are increasingly shifting resources back to that original mission. Testing is a big part of that; DeAngelis said patients are screened the day before their appointment, tested upon admission and tested again every three days afterward. All patient-facing employees have been tested at least once, and staff on high-risk units are tested weekly.
But the once-bustling hospital, much like the Upper East Side Manhattan neighborhood where it sits, still feels empty. When Paris, now back in New York, goes in for treatment, she is the only person allowed in the waiting room. The halls are less crowded, and visitors are restricted; her mother must wait in the car as she undergoes procedures like CT scans, chemotherapy and blood work taken through a port in her chest.
"Sloan's doing an amazing job of keeping all the patients comfortable and isolated from one another, but making sure that they're also attended at the same time," said Paris, who has filmed a series of video diaries for NBC News about her return to treatment. "I cannot say enough amazing things about the staff here right now."
Paris drove 14 hours from Georgia to resume chemotherapy at Sloan Kettering, but many other patients still have cancer treatment on pause. One in four cancer patients surveyed by the American Cancer Society as of April 8 reported a delay in their treatment, and half of those patients didn't know when treatment will be rescheduled. Thirty-eight percent of survivors and patients said the pandemic had affected their ability to pay for health care.
A cancer treatment backlog is troubling, DeAngelis said, because an early-stage disease is much easier to treat. The current situation could become even more serious if another wave of COVID-19 comes, DeAngelis said, especially because some patients appear more scared of coronavirus than cancer.
"They're going to want to wait for the virus to get quieter, if you will, which hopefully that's coming," said DeAngelis. "In the next month or so, maybe they will start coming back. But...if screening has been delayed, there might be yet another wave of people who need care just at the point in time when the virus may reemerge as a more prevalent public health problem."
"If those things coincide, we can't just shut everything down," DeAngelis continued. "I think we would be doing a real disservice to our patients with cancer."
It's a concern echoed by the deputy chief medical officer of the American Cancer Society in a recent interview with NPR. Last year, investigators found that lung cancer patients who experienced a hurricane disaster during radiotherapy had worse overall survival rates. For natural disasters lasting just under a month, risk of death increased 27 percent.
With data like this in mind, experts fear the coronavirus pandemic, officially over two months old, could spike an already somber estimate out of the American Cancer Society; 600,000 people will die of cancer in 2020.
One of the greatest challenges for cancer care will be restoring patient confidence, DeAngelis said. To this end, Drebin and DeAngelis said Sloan Kettering has taken every possible precaution to be able to protect patients from coronavirus.
"We have to be able to reassure them that we can get them through their course of treatment and take care of them," said DeAngelis, adding, "It is a huge amount to ask, because people are feeling vulnerable in many ways right now, right? Health is only one of them."
Experts like DeAngelis and Drebin say it is crucial to return to identifying and healing the melanomas, leukemias, carcinomas, lymphomas and sarcomas that have been claiming Americans young and old for decades. They will continue to do so, pandemic or not.
"We have to all figure out how to coexist with it, to take care of people who are affected by the coronavirus, but also take care of their cancer," said DeAngelis. "That's the mantra right now."