In light of the ongoing coronavirus disease (COVID-19) pandemic, cancer patients may be wondering how their medical situation affects their vulnerability to infection and other ways the pandemic will affect their cancer care.
What is the coronavirus disease?
COVID-19 (the coronavirus disease) is a respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). SARS-CoV-2 is a novel virus detected in December 2019 that has spread all over the world. The World Health Organization (WHO) characterized the outbreak as a pandemic on March 11, 2020.
Why are cancer patients considered high risk?
- Some cancer patients have a compromised immune system due to treatment or the nature of their cancer. Patients with hematologic cancers (leukemias or lymphomas), bone marrow transplant recipients, and those actively receiving chemotherapy are at higher risk of immune inefficiency. This not only makes them more susceptible to the infection, but they could have more severe symptoms if they get infected with the virus.
- A study from China published in The Lancet reports that patients with blood cancers, lung cancers, or metastatic cancer had higher incidence of severe COVID-19 outcomes. Additionally, patients who were treated with immunotherapy or had surgery for their cancer are also at higher risk for severe outcomes.
- If you have other health issues such as heart disease, lung disease, diabetes, or asthma you may be at higher risk.
- Older adults (65 and older) are at higher risk for severe illness if infected.
How will this pandemic affect me as a cancer patient?
- Your doctor or other healthcare professional may call you before an appointment to check for COVID-19 symptoms.
- Your appointments may be rescheduled or done through telemedicine (video), especially if you have a routine follow-up appointment. Check with your healthcare team, and make sure your appointment is still scheduled before you go.
- If you need blood drawn for your regular routine lab tests (complete blood count, metabolic panel, etc.), you may be able to do this at home. Check with your healthcare team.
- You will likely not be able to bring a caregiver or anyone with you to an appointment, including for infusions. This is important to help stop the spread of the virus, but it could make patients feel lonely and more anxious, especially if they are receiving test results. You can ask your healthcare team if you can have your caregiver or family member on speaker phone or video during your appointment.
- Some clinics are limiting second-opinion visits, especially if traveling is involved. Check with the specific clinic to inquire about additional options. You may be able to receive remote second opinions, as some clinics and institutions offer these services.
- Get your medical records organized and ready in case that you need to visit a new doctor or clinic.
- If you have a surgery scheduled, it may be postponed. Guidelines about postponing non-emergency surgeries have been published by The American College of Surgeons suggesting that the decision to postpone a surgery should take into account various considerations, including logistics and any potential harm due to delay.
- If you have a procedure or surgery scheduled (and it has not been postponed), you will likely not be able to have visitors.
Treatment changes and decisions:
- You may have to make a treatment decision during this time, either as a new patient or if your current treatment is no longer working. You may feel that your treatment options are more limited because of travel restrictions. Speak with your doctor about treatment options and the risk of travel. If you need to make a treatment decision, Cancer Commons can provide you with personalized information about cancer treatment options. Click here to register.
- Your treatment may change to decrease your risk of infection with the virus. This may include stopping chemotherapy or switching from infusion therapy to oral therapy. Your oncologist should let you know if this change is right for you, as every patient is different, and this consideration should be made based on your treatment goals and other factors.
- Patients receiving maintenance treatment may be considered for interruption of treatment. For example, this could apply to patients with lymphoma who receive maintenance drugs such as rituximab (or others) that target diseased immune B or T cells for destruction. Or, care teams may consider interrupting maintenance treatment with pemetrexed (Alimta) in patients with adenocarcinoma of the lung.
- Patients scheduled for stem-cell transplants as part of treatment for blood cancers may see their transplant postponed for a later time, when their severely compromised post-transplant immune system will be at less risk of exposure to coronavirus.
- If you are currently traveling to get treatment through a clinical trial, you may not be able or want to travel, depending on your geographical location and where the clinical trial is held. The U.S. Food and Drug Administration (FDA) has published new guidelines for clinical trials in light of the pandemic. Trial sponsors are being asked to evaluate “alternative methods for assessments, like phone contacts or virtual visits, and offering additional safety monitoring for those trial participants who may no longer have access to investigational products or the investigational site.” Check with the clinical trial site and see what options they can provide.
- If you are considering starting a new clinical trial, your enrollment may be delayed as many clinical trials are not currently enrolling new patients.
How does the coronavirus disease (COVID-19) spread?
According to the Centers for Disease Control (CDC), SARS-CoV2, the virus that causes COVID-19, is thought to spread mainly from person to person. This includes people who are in close contact with one another (within 6 feet) and through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby, or they can possibly be inhaled into the lungs.
People are most contagious when they are most symptomatic, but the virus can also spread before the infected person has symptoms. Additionally, a person may be infected by touching a surface or object that has the virus on it and then touching their face.
How can I protect myself and my family?
- Wash your hands often with soap and water for at least 20 seconds.
- If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
- Don’t touch your eyes, nose, and mouth with unwashed hands.
- Practice social distancing by avoiding close contact with others (at least 6 feet).
- The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
- If you are sick, stay home, cover coughs and sneezes, wash your hands immediately after coughing or sneezing, wear a face mask if you are around other people, and clean and disinfect.
What are the symptoms of COVID-19?
Symptoms range from mild to severe, and the disease can be fatal. Symptoms include fever, cough, and shortness of breath, and may appear 2 to 14 days after exposure.
Digestive symptoms in patients treated for COVID-19 have been reported. Symptoms include lack of appetite, diarrhea, vomiting, and abdominal pain. Most patients with digestive symptoms have also had fever and respiratory symptoms.
Loss of smell has also been reported, mostly in otherwise asymptomatic patients.
If you think you may have been exposed, it is best to isolate yourself from others so you do not spread the infection. The virus may be spread when the infected person does not have symptoms.
How can I get tested?
If you think you have been exposed and have developed symptoms, call your doctor’s office, and their staff will guide you.
Are there treatments for COVID-19?
Although no FDA-approved therapies for COVID-19 yet exist, other already-approved therapies may help ease symptoms for patients who get infected.
Multiple agents are currently under investigation for COVID-19 treatment, including antiviral drugs, anti-inflammatory drugs, convalescent plasma, and various other types of agents.
Is there a vaccine to prevent COVID-19?
Currently there is no vaccine to prevent COVID-19. The National Institute of Allergy and Infectious Diseases (NIAID) has started testing a vaccine against the SARS-COV-2 virus. Other vaccines are also being developed and tested in the U.S. and other countries, including China and the U.K. However, it will take 12 to 18 months before a vaccine may become available.
For more information on how the coronavirus disease may affect cancer treatment for yourself or for a loved one, please register for our cancer treatment services and complete our survey on COVID-19. You can be part of the solution by helping us better understand how COVID-19 affects cancer patients.
Meanwhile, click here to read more articles on cancer and COVID-19.
If you are able, please also consider donating to Cancer Commons at this time. We remain steadfast, passionate, and sharply focused on our commitment to arm patients, free of charge, with an action plan to identify their best personalized treatment options and facilitate access to treatment. All of this is made possible by the generosity of our supporters, for whom we are deeply grateful.