Relatives of cancer patients in the terminal stages of the disease can request an exemption letter from cancer charity Pals so they can say goodbye to loved ones in person.Dr Sharon Alikhani, the Pals medical director, said: “If patients are in the last few days or week of life, police are recognising a Pals exemption letter.“It allows a named member of a family who doesn’t live with the patient to make a visit to their loved one.”She added: “We have used it in a couple of families to date. It is very nice for a relative to see a loved one and say goodbye.”Dr Alikhani said that the Covid-19 lockdown has left some patients without the normal level of support given by family and friends.She said: “I feel very sad for patients and the families of individuals in their dying phase who rely on their family and friends for personal support.“With the current shelter-in-place, it means that families are isolated and friends are lost because they can’t support their friends in a physical sense.”Dr Alikhani added that cancer patients faced the additional threat of contracting Covid-19 because of their weakened state and were particularly worried about the risk of coronavirus infection. She said: “The community at large is very anxious and scared and I would say that patients are not exempt from that and are even more anxious about anyone coming to their house, or even things like groceries potentially being contaminated.”Colleen English DeGrilla, the Pals executive director, Dr Alikhani and the organisation’s five oncology care nurses supported 180 cancer patients at any one time.Dr Alikhani said nurses continued to make daily house visits to patients, during the state of emergency to change dressings, take blood, or disconnect a patient’s chemotherapy.She added that nurses, at first, wore surgical masks when taking blood samples, but now wore masks and gloves for every home visit, and a gown, if needed.But Dr Alikhani said supplies were short, so a risk assessment was conducted to decide what level of protection was used.She added that deliveries of extra equipment were expected.Dr Alikhani said a nurse in a mask was a problem because their facial expressions could not be seen.She explained: “With a mask in place, especially for those patients who are hard of hearing, communication can be difficult.”Dr Alikhani said some patients were contacted by phone, or by using telemedicine, rather than being visited in person.Dr Alikhani revealed: “Patients who are more isolated and need more psychological support, those visits are not happening face-to-face, because they are not deemed essential.“We are doing more consults on the phone, or by using a telemedicine app, where I can see them online via my iPad or computer, if they have a smart phone. But many patients are elderly and don’t have access to technology.”She added: “I am very concerned about the mental wellbeing of patients because some of them rely on nurses for their weekly interaction with the outside world.”Dr Alikhani said Pals staff made regular phone calls to patients and, where possible, made WhatsApp video calls or contacted patients using FaceTime “so that they can see us, and we can see them”.She added: “I called someone last week and they said ‘this is the third call I have received from Pals this week’.“I thought she might say not to call as much, but instead, she said ‘it is so nice to get a phone call and see that you’re looking out for us’.“A nurse, a social worker and I had called her, and she was so happy.”Ms English DeGrilla, Dr Alikhani, and the Pals nurses started to work remotely using the Zoom app about three weeks ago.The organisation’s office on Point Finger Road, Paget is staffed by one employee, who provides access to supplies of Ensure, a nutritional supplement, as well as incontinence products and wound dressing materials. Pals also assists with supplies for patients discharged from hospital, including hospital beds, wheelchairs, commodes, and walkers.Patients are not able to travel for overseas treatment during the worldwide lockdown and one Pals patient is stranded in the United States.Ms English DeGrilla said: “She only went for a two-day visit for minor surgery, and now she is stuck there because there are no flights.”She added that Pals, which does not get a grant from the Government, had an annual budget of just over $1.87 million and 78 per cent of its income went to patient care.