By Robert A. Poarch
If you’re a cancer patient in this time of social distancing due to COVID-19, you’re probably feeling particularly susceptible and have a lot of questions surrounding your care. Here to help, Albert Quiery, MD, a board-certified physician who serves as the Medical Director of Mission Medical Oncology, talks about how you can be your healthiest.
If I have cancer, am I at higher risk of getting or dying from COVID-19?
At present, there is no conclusive evidence that patients who have a diagnosis of cancer are at greater risk of becoming infected with COVID-19. Patients with cancer, however, are more likely to develop severe COVID-19-related disease and, therefore, have poorer clinical outcomes. Like patients with other underlying health conditions, such as heart disease, lung disease and diabetes, patients with cancer when infected with COVID-19 are more likely to require hospitalization and develop severe pneumonia requiring ventilator support. The risk of dying from COVID-19, therefore, is greater for patients with cancer. Cancer patients who are at the greatest risk are those on active treatment, particularly patients with lung cancer who may have compromised lung function at baseline, those with blood cancers and those who have undergone a stem-cell transplantation.
If I have cancer, how can I protect myself?
We all need to be vigilant and faithful in our practice of social distancing during this pandemic. This is particularly important for patients with cancer. Here are a few tips for reducing your risk of exposure to COVID-19:
- Familiarize yourself with the symptoms of COVID-19 infection and contact your physician if you develop symptoms suggestive of COVID-19 infection.
- Practice social distancing. Stay at home and avoid person-to-person contact as much as possible. Avoid travel, social gatherings, handshakes and contact with those who may be ill.
- Avoid touching your eyes, nose and mouth.
- Wash your hands with soap and water for at least 20 seconds before eating or touching your face and after coming into contact with others.
What should I do about cancer treatment during COVID-19?
There is no simple, one-size-fits-all answer to this question. I would strongly recommend that you discuss the unique circumstances of your care with your surgical oncologist, radiation oncologist and/or hematologist/oncologist. Some general principles being utilized to inform these decisions include:
- The CDC has recommended that elective surgery be postponed. Cancer surgery, however, is not typically considered elective. Considerations include whether the surgery can be safely delayed without a negative impact on the patient’s cancer outcome. Consideration must also be given to whether the planned surgery will likely require intensive care resources and, if so, whether these resources are available in the midst of this pandemic.
- Similarly, patients in the midst or radiation or those in need of emergent radiation for cancer control should discuss the timing and potential changes to the radiation schedule with their radiation oncologist.
- Chemotherapy, which commonly suppresses a patient’s immune system, may increase a patient’s risk for complications to COVID-19 infection. The decision to proceed with chemotherapy or immunotherapy needs to be assessed on a case-by-case basis. Based on available data, the American Society of Clinical Oncology has not yet recommended the routine withholding of chemotherapy. Patients in consultation with his/her medical oncologist must assess the risks associated with delaying or interrupting treatment on cancer control, the risk for disease recurrence and the overall goals of their cancer care. For patients in remission, stopping maintenance chemotherapy may be an option. Home infusion or transition to an oral therapy may be considered, if feasible, to reduce risk for COVID-19 exposure. The use of Neupogen/Neulasta and prophylactic antibiotics may reduce the risk of some COVID-19 complications.
- In cases where a patient’s cancer is well controlled, delaying a planned stem-cell transplant may be reasonable. Visitation post-transplant should be limited, and visitors should be screened for symptoms and potential exposure to COVID-19.
- Although there is no data on the safety of immunotherapy in the COVID-19 era, the treatment-related lung inflammation (pneumonitis) seen with the use of these therapies may place these patients at higher risk for the complications associated with COVID-19 infection.
- Port flushes can be transitioned to every 12 weeks, and imaging (CT, PET and echocardiograms) for patients who are doing well can be delayed.
When should I see/call a doctor or go to the hospital?
During this pandemic, it is important that patients with cancer remain in communication with their treating cancer specialist. If you develop fever, cough or shortness of breath, if feasible, you should contact your physician immediately for recommendations. For serious symptoms, you may directed to the emergency department for immediate evaluation and treatment.
How can I avoid panicking and feel better during social distancing?
The loss of control we are all experiencing as a result of COVID-19 has been disturbing for most people. You are not alone. This pandemic is not only frightening, but it has disrupted our routine, our social interactions and separated us from our support systems. Although we are unable to control many of the restrictions placed on us by the COVID-19 mitigation planning, it is helpful to focus on the things we can continue to control in our lives. As stated above, it is essential that we all remain informed during this pandemic, but it is also important that we not allow the news to consume our days, thoughts and emotions. Social media can allow us to remain connected to family and friends. Exercise is a great way to reduce stress and anxiety. Listening to music, reading, meditation, journaling or writing an old fashion letter can help us process our current reality and keep the flood of information in perspective. There are many APPs available online for meditation and many houses of worship have set up virtual religious services, particularly important for many people as we approach Easter, Passover and Ramadan.
Should I stockpile medications?
I would recommend that all cancer patients have access to several weeks of medication and supplies in case you need to stay home for a prolonged period of time.
If I am a cancer survivor, should I be worried or take extra precautions to avoid getting COVID-19?
Regardless of our individual medical history, we all need to heed the recommended precautions to avoid infection with COVID-19. Any potential increased risk for cancer survivors for developing a serious complication of COVID-19 infection is likely based on length of time that has transpired from cancer treatment, the intensity of prior treatment, other medical conditions, age and overall health.