Going through chemotherapy is tough enough for cancer patients at the best of times.

There’s the sickness caused by the drugs; the hair loss; the feelings of exhaustion; the worry and strain.

Image what it’s like, then, to undergo chemo during a pandemic - and to have to wear a mask while the toxic cocktail of drugs designed to kill your cancer is trickled into your veins.

That’s what between 30 and 40 cancer patients have to go through at the Magnolia Centre at York Hospital every day. And yet in many ways it is a miracle that hospital staff have been able to keep up these vital treatments through not one but two waves of the coronavirus.

During the first wave, the entire chemotherapy team decamped to the Nuffield Hospital to continue providing treatments there. There was a simple reason for that, says York Hospital Trust’s lead chemotherapy nurse Lizzie Walker: cancer patients are vulnerable to infection, because the drugs used to treat them suppress the body’s immune system.

With the number Covid patients rising at York Hospital, they felt it was important to treat cancer patients away from what they referred to as the ‘hot zone’.

They moved the entire chemotherapy unit to the Nuffield over the course of a weekend, Lizzie says. That included not only treatment chairs, but also equipment, patient records - and even IT. “Everybody just kind of mucked in to help,” she says. “We’re a really close team.”

A similar approach was taken in Scarborough, where cancer patients were given their chemo in the trust’s mobile chemotherapy unit rather than in the hospital.

During the second wave of the pandemic, however, it has been different. Surgery and chemotherapy has moved back to York Hospital. Cancer diagnosis has also resumed.

Treatment is at the Magnolia Centre, which since the first wave of the pandemic has been been upgraded so that it is now Covid secure. The centre, on the hospital’s first floor, has its own separate entrance, so that there is no need for patients coming for chemotherapy to go through any other areas of the hospital. All patients are given a swab test before they come for their first cycle of treatment. Thereafter, they are screened each time they come for another cycle, to check their temperature and for any other signs that they may be infected.

A ‘one way system’ has been introduced at the Magnolia Centre, and screens have been put up in waiting areas and consulting rooms and offices.

The treatment area has been expanded into another department next door, so that treatment chairs are further apart for social distancing reasons, and the centre has been split into two ‘zones’ to reduce the need for unnecessary contact.

Consultations with a doctor, meanwhile, are often now done by telephone or video, so a patient doesn’t need to come in at all unless for treatment.

Perhaps the toughest thing of all, for patients and staff alike, is the need to wear PPE. Patients have to wear masks, Lizzie says - not ideal when you are feeling ill already, and especially when a cycle of treatment can last for up to eight hours. But it is for their own safety.

Staff, meanwhile, have to wear full PPE - surgical masks, eye protectors, gloves and aprons. “That’s a real challenge for everybody,” Lizzie says. “It is particularly difficult for the patients, because a lot of communication is non-verbal. It is difficult for that to happen when you are wearing a mask! But everybody has adapted to it.”

The other really tough thing, as far as patients are concerned, is the fact that no visitors are allowed. Depending on a patient’s condition and treatment, they may have to attend for treatment two or three times a week, perhaps for several months or even longer. Treatment involves sitting in a chair while a cocktail of drugs is dripped into your arm. It can last for up to eight hours.

Patients can choose to sit in a room on their own, or in a communal area where they can at least chat to other patients - from a carefully-observed social distance, of course.

But the comfort of having a loved one to keep you company has gone.

That is hard, Lizzie admits. “But our patients are extremely vulnerable. We have to protect them.”

If a cancer patient were to get coronavirus, Lizzie says, they would be at a much higher risk of complications. Clinicians would also face tough choices about how or whether to continue their cancer treatment.

Fortunately, those are decisions that have so far had to be taken only very rarely. “We have done very well with patient shielding,” Lizzie says.

One thing the hospital has noticed, however, is a fall in the number of new cancer patients being referred. That was particularly true at the height of the first wave of the pandemic, the hospital says, and was ‘most likely as a result of patients not going to their GP to seek advice about their symptoms’.

So it is absolutely vital that, pandemic or not, patients who have symptoms that could possibly be caused by cancer - a lump in the breast, say, or unusual constipation, diarrhoea or blood in the poo - should consult their GP.

“We don’t want people sitting at home suffering,” says Lizzie.

The same applies for patients undergoing chemotherapy who suffer unpleasant side effects - such as nausea - when they are at home. They should always call a member of the chemotherapy team, Lizzie says - every cancer patient has an ‘alert card’ with the number they should call written on it.

The Covid pandemic, of course, has taken a toll on chemotherapy staff as well as patients.

Administering chemotherapy takes special training, Lizzie says. Staff also have to be able to monitor patients carefully as they undergo their treatment.

So when staff are off, it is not easy to get extra staff in to replace them.

And of course there have been times when some members of the chemotherapy team - about 50 staff across the two hospital sites - have had to take time off.

That’s not necessarily because they have coronavirus themselves, Lizzie says. Staff have families, like everyone else. And it may be that they have to look after a child sent home from school - or they may have to isolate or form part of a ‘bubble’.

When that happens, other staff have to take up the slack.

Lizzie, 34, only returned to work herself at the start of the first wave of the pandemic straight from maternity leave - her daughter is now approaching two years old.

“My husband worked from home and looked after her during the first lockdown so I think I had the easy job!” she jokes.

She admits there is a constant worry about exposing family members to the virus,.

“But we have been provided with the appropriate PPE and there are safe systems in place,” she says. “So we just have to do everything we can to follow the procedures to protect ourselves, patients and our families.”

Yes, staff do get tired, she says. “But we have to stay focussed, and take things day by day. And I can’t stress enough how amazing the team is!”

The encouraging news on vaccines offers some hope that there will one day be an end to the pandemic, she says. “So we’ve just got to try to get through to the end of this year - and be hopeful for next year!”