Dear Editor
Since December 2019, the coronavirus has affected all aspects of our lives worldwide. This deadly crisis, for which no health care system was fully prepared, has created enormous pressures on health care delivery and has directly and indirectly affected the treatment of many common diseases. Cancer patients are a vulnerable group in the current epidemic due to their immunodeficiency status due to cancer and various anti-cancer therapies [1]. Research shows that cancer patients are at greater risk for more severe infections and subsequent complications, especially if surgery or chemotherapy is given in the month before the coronavirus infection [2]. These conditions have led to a significant increase in coronavirus mortality in cancer patients [3].
Under the new circumstances, the community of cancer patients is going through a difficult path, the constant challenge of which is to balance the risk of hospitalization with the risk of coronavirus, which has an emotional impact not only on patients but also on the medical staff. Anxiety and distress from coronavirus can be more severe in vulnerable groups such as cancer patients. In this situation, cancer patients feel isolated; even if their family helps them with their daily activities, it can make them feel guilty, leading to non-compliance with health protocols [4].
Quarantine is common during the coronavirus epidemic and accelerates anxiety, irritability, and depression, mainly when performed for long periods [3]. Although attention to the consequences of the coronavirus epidemic is primarily focused on adult patients, children, especially those in high-risk groups such as immunodeficiency, are also affected psychologically and physically. Following the closure of schools due to the outbreak of coronavirus and home quarantine and its combination with other factors such as lack of opportunities for play and entertainment, domestic violence, low socioeconomic status, mental illness, and substance abuse of parents severely threatens the mental health of children and as a result, creates more behavioral and emotional problems for them [5].
Oncologists were quick to announce cancer care guidelines during the coronavirus epidemic. Strategies such as reducing the number of clinical visits and shortening radiation therapy sessions have now been implemented in most oncology clinics. Prioritization in the provision of cancer therapies is strongly influenced by the extent of the benefits of therapeutic goals. At the same time, factors such as the patient’s age, comorbidities, and preferences should also be considered in a general context [6]. Addressing patients’ concerns poses another challenge for cancer clinics. During this crisis, ensuring the well-being of patients and caregivers, creating a safe environment, and providing effective and compassionate care are more important than ever. Patients are encouraged to explore creative ways to deal with stress, including physical activity, a balanced diet, adequate sleep, mindset-based strategies, and social communication skills [7].
In this crisis, better and more efficient communication between oncologists and their patients is a priority. Telemedicine has been positively experienced by oncologists and patients [8]. Interacting with patients through telemedicine and providing helpful physical and mental counseling can prevent unnecessary hospital admissions. Today, telemedicine is also used by psychologists and psychiatrists to ensure psychological support for patients, and this has led to a reduction in referrals to medical centers. In response to the increasing need for efficient and helpful communication between cancer patients, most oncology clinics have designed a coronavirus question-and-answer section on their websites that explicitly uses social media to help overcome the barriers to the coronavirus epidemic.
Overall, the coronavirus has severely affected the daily lives of people around the world. In the meantime, cancer patients must be physically safe, and their mental and emotional health be taken care of. The use of psychotherapy techniques in these patients facilitates exposure to the disease. It has significant compensatory effects on their psychological problems such as rejection and isolation, social isolation, distrust, and emotional deprivation. In fact, due to the close links and interactions between the psychotherapist and the patient, the possibility of actual encounters and linking the initial experiences in a supportive environment increases, and on the other hand, by increasing the patient’s sense of self-efficacy and risk, new behaviors are strengthened. The patient also learns to express empathy and satisfy emotional needs instead of giving up on emotions. Therefore, recognizing the problems of cancer patients during the coronavirus outbreak can provide the basis for effective prevention, education, intervention, and treatment for these patients.

Ethical Considerations
Compliance with ethical guidelines
All methods used in the study of human participants are by the criteria of the Ethics Committee.

Funding
This article is a letter to the editor and has not received financial support from the government or academic organizations.

Authors’ contributions
All authors have contributed equally to the design of this article, the presentation of scientific material, the preparation of the manuscript, and the revision of the final version.

Conflicts of interest
The authors declared no conflict of interest.


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