Cancer And COVID-19

Cancer And COVID-19

The whole world is struggling to cope with the COVID-19 pandemic. This deep rooted fear of infection is taking a big toll on the public and especially Cancer patients. Many patients aren't keeping up with their treatment in hospitals. This is extremely risky and could result in disease progression or relapse. We request you to understand that it is a New Normal but Same Cancer.

Steps are being taken by doctors and hospitals to allay patient concerns. Aware hospitals are minimising risks with strict sanitation and isolation measures. Many hospitals have opted for separate entry and exit points for COVID-19 patients and separate wards for patients with Cancer. Online consultation is being promoted to reduce footfalls in hospitals for minor health concerns.

While healthcare workers and hospitals are mindful, cancer patients need to be equally proactive by

  • Getting all treatment-related information from your doctor for the next few months
  • Confirm your appointment before heading to the hospital and reach on time. Check visitor policy beforehand
  • Following all safety rules at the hospital so you or other patients don't face any inconvenience
  • Carrying water, sanitiser, extra masks with you
Cancer and Covid-19

Cancer patients have to stay ahead of Cancer as well as COVID-19. That will only happen if we manage fear and practice precautions at all times. If you suspect you have cancer, don't delay a thorough examination. Immediately call a doctor when you observe signs like lumps in any part of the body, unusual bleeding, sores that don't heal, indigestion, change in bladder habits, nagging cough, hoarseness, difficulty in swallowing or obvious change in warts or moles.

FAQs on Covid and Cancer

Common Questions About COVID-19 and Cancer: Answers for Patients and Survivors

Q1.Can you briefly describe what it means to be "immune compromised"?

The term 'immune compromised' refers to individuals whose immune system is considered weaker, more impaired, or less robust than that of the average healthy adult. The primary role of the immune system is to help fight off infection. Individuals with compromised immune systems are at a higher risk of getting infections, including viral infections such as COVID-19. There are many reasons that a person might be immune compromised: health conditions such as cancer, diabetes, or heart disease, older age, or lifestyle choices such as smoking can all contribute to weakened immune systems.

Patients with cancer may be at greater risk of being immune compromised depending on the type of cancer they have, the type of treatment they receive, other health conditions, and their age. The risk of being immune compromised is typically highest during the time of active cancer treatment, such as during treatment with chemotherapy. There is no specific test to determine if a person is immune compromised, although findings such as low white blood cell counts or low levels of antibodies (also called immunoglobulins) in the blood likely indicate an immune compromised state.

Q2.Does a history of cancer raise your risk for health complications from COVID-19 (SARS-CoV-2)?

It appears that patients with cancer and survivors of cancer may be at higher risk of health complications from COVID-19. This is not surprising given that this group of individuals is often immune compromised. There is emerging evidence that patients with hematological malignancies, including leukemia, lymphoma, and multiple myeloma, have a greater risk of infection and complications than patients with other cancer diagnoses. There is also evidence that patients with progressing cancer when they are diagnosed with COVID-19 may be at higher risk of death or serious health complications compared with those with disease in remission.

Q3.Does receiving chemotherapy or radiation raise your risk for getting COVID-19 or having a more serious course of illness?

To date, limited evidence is available to suggest that any cancer treatments raise your risk for getting COVID-19 any more or less than anyone else who is exposed to the virus. There is some evidence that patients with cancer may experience more serious COVID-19 infection if they acquire it, likely because cancer and cancer treatment can contribute to weakened immune systems which can then lead to a reduced ability to fight off infections. Emerging evidence suggests that patients with lung cancer who received chemotherapy within 3 months of a COVID-19 diagnosis are at higher risk of dying from the infection.

It is not clear at this point if cancer patients who have received chemotherapy or radiation in the past are at increased risk for COVID-19. The risk of infection may depend, in part, on the specific treatment received, the type of cancer treated, and how much time has passed since the treatment was completed.

Q4.Should cancer survivors follow the general public health recommendations?

Absolutely. The general public health recommendations issued by the MoH (Ministry of Health) make good sense at any time, but more so during times such as the COVID-19 outbreak.

Q5.What advice do you have for patients who are on oral cancer therapies such as TKIs?

Cancer is a serious condition that requires treatment. Regardless of the type of treatment, the best advice is to talk with your cancer care team about whether or not any modifications to your cancer treatment regimen are necessary. In the absence of any symptoms or signs of COVID-19 infection, continuing your cancer treatment is likely to be the best course of action.

Q6.Are people who are on endocrine therapies, such as for breast or ovarian cancers, at more risk for getting COVID-19 or having a more serious illness?

There is no specific evidence to suggest that endocrine therapies can raise the risk for getting COVID-19 or having a more serious illness. Most endocrine therapies do not suppress the immune system.

Q7. If a cancer patient or cancer survivor feels some early symptoms such as fever or cough, should they contact their medical oncologist or primary care physician?

If on active cancer treatment, then patients should contact their treating oncologist and make any arrangements as needed. If not on active treatment, then cancer survivors should contact their primary care doctor and make any arrangements as needed.

Q8.If a person is about to start cancer therapy, should they consider postponing treatment due to COVID-19? What if the patient has been infected with COVID-19?

There are many factors to consider when making an important decision such as postponing cancer treatment in order to avoid a potential infection with COVID-19. Patients should talk with their treating oncologist about the risks of postponing treatment versus the potential benefit of decreasing their infection risk. Things to discuss include the goals of cancer treatment, the likelihood that the cancer will be controlled with the treatment being planned, the intensity and side effects of the cancer treatment, and the supportive care that is available to reduce the side effects of treatment.

Q9.I have a central venous catheter/port. What should I do about flushing it regularly?

There is evidence that flushing can occur at intervals of up to every 12 weeks with no increase in adverse events or harms. Speak with your oncology care team about the flushing schedule that is right for you and ask if you may be able to flush the port yourself should it become necessary.

Q10.I am a survivor of cancer who receives regular scans/imaging/tests to detect potential recurrence. Should I keep getting this testing?

In general, any clinic visits that can be postponed without risk to the patient should be postponed. This includes routine surveillance visits to detect cancer recurrence. In many cases, the recommended frequency of these visits is already considered a range (e.g. 3 to 6 months), so extending the time between evaluations may still be within the recommendations. If you develop a new symptom that might indicate cancer recurrence you should contact your cancer care team and not wait for the next scheduled evaluation.

Q11.Is there anything I can do to improve my general health and my immune system?

ThisYou should follow the recommendations of your care team and general recommendations for a healthy lifestyle. Do not use tobacco products, eat a well-balanced diet rich in fruits and vegetables, exercise regularly, get enough sleep and follow public health guidelines on social distancing and hand washing.

Q12.If I have a delay in care, or if for some reason I need to change providers to receive care, is there anything I should do with respect to my medical records?

If you need to change providers you should arrange for copy or transfer of your medical records to your new provider. Transferring a complete set of records is most desirable, but certain parts of the record are particularly important, such as the pathology report that established your cancer diagnosis, reports of any surgeries or radiation treatment performed as part of your cancer treatment, a summary of any chemotherapy treatments administered, and the results of your most recent scans, x-rays, or other cancer evaluations.

Q13.I am in the process of diagnosis and staging for cancer. What should I do?

Patients should discuss with their oncologists what diagnostic and staging tests are likely to be most informative in developing an initial treatment plan and should prioritize obtaining those tests.

Q14.I want to get a second opinion on my diagnosis or recommended therapy, but second opinions are not possible right now. What can I do?

We encourage second opinions but recognize they may be difficult to schedule at this time. If a second opinion can be obtained by telephone or telehealth consultation, then that should be considered a reasonable alternative to no second opinion at all.

Q15.I have several comorbidities as well as cancer. Am I at higher risk for COVID-19? Does it matter if those comorbidities are controlled by medication?

Patients with certain comorbidities, such as hypertension, cardiovascular disease, pulmonary disease, chronic kidney disease, obesity, and diabetes, appear to be at particularly high risk of serious complications from COVID-19. Most reports have not described the extent to which these comorbidities were controlled by medication or lifestyle change at the time of onset of COVID-19 infection. It is reasonable to assume, however, that comorbidities that are well controlled by medication are less likely to predispose a person to severe complications from COVID-19.

Q16.Does smoking and/or vaping increase the risk of COVID-19?

There is no specific data relating current or former vaping to risk of COVID-19 or risk of complications from this illness in patients with cancer. However, it is reasonable to assume that smoking, vaping, or other behaviors or exposures that cause lung injury might increase the risk of complications from COVID-19.

Q17.Do most people have long-term effects from COVID-19?

It is clear that some patients develop COVID-19 complications in multiple organ systems during their acute illness, such as neurological complications, kidney failure, heart attack or heart failure, and blood clots. These serious complications could have long-term consequences, but extended patient follow-up is needed to understand the long-term effects. It is also clear that some patients have symptoms that linger long after recovering from the acute COVID-19 illness. Some of these “long haul” symptoms include persistent fatigue, headache, difficulty concentrating, heart palpitations, and gastrointestinal disturbances. There is currently no way to determine who is at risk for long-term effects of COVID-19 or how long persistent symptoms will last.

Q18.It has been said that COVID-19 can cause lung scarring. Are there other diseases that cause lung scarring? Will this increase the chance of a person developing lung cancer in the future?

Many acute and chronic pulmonary infections can cause scarring, as can chronic lung inflammation from smoking, occupational exposure to dust or asbestos, or autoimmune disease. Whether scarring increases the risk of lung cancer is more likely related to the underlying cause of the scarring (for example, smoking or asbestos exposure) than to the scarring itself.

Q19.What are the recommendations for retesting of COVID-positive patients before restarting chemotherapy?

It is unclear how long a delay after the infection has resolved may be necessary before beginning or restarting cancer treatment. Treatment should not be resumed until the symptoms of COVID-19 have resolved and there is some certainty the virus is no longer present, specifically, a negative SARS-Cov-2 test, unless the cancer is rapidly progressing and the risk-benefit assessment favors proceeding with cancer treatment.

Q20.Should patients with cancer and survivors of cancer be vaccinated for COVID?

Generally, both patients with cancer and survivors of cancer may be offered vaccination unless there are specific contraindications.

FAQs on Vaccination

Vaccination

Many expert medical groups recommend that most people with cancer or a history of cancer get the COVID-19 vaccine once it’s available to them. Since the situation for every person is different, it is best to discuss the risks and benefits of getting one of the COVID-19 vaccines with your cancer doctor. They can advise you and tell you when you should receive it.

Tata Memorial Centre has compiled the following FAQs

Q1. Should patients with cancer receive the COVID-19 vaccine?

The data on efficacy and safety of COVID-19 vaccination in patients with cancer is limited. However, as patients with cancer are more prone to develop severe form of illness due to COVID-19 infection, the benefits of getting vaccinated are more than the risks.

Q2. Should people who have completed their treatment for cancer receive COVID-19 vaccine?

Patients who have completed their planned should receive COVID-19 vaccine as soon as it is available to them as long as there are no major allergies.

Q3. Should people who are on cancer directed therapy receive COVID-19 vaccine?

Patients who are on cancer directed therapy can receive the vaccine after discussing with their treating oncologist. The oncologist will suggest the suitable time based on the ongoing therapy (surgery, radiation, chemotherapy, immunotherapy, or stem cell transplant). Please inform the treating oncologist if you have had any drug allergies in the past.

Q4. Which COVID-19 vaccine is the best for patients with cancer?

All the approved vaccines have been shown to be effective. There are no direct comparisons between the available vaccines for efficacy or safety. Therefore, we suggest that you take any vaccine approved for use and available in your vaccination centre.

Q5. Are there any contraindication for COVID-19 vaccine in patients with cancer?

Patients who are allergic to PEG (polyethylene glycol) should not receive the COVID-19 vaccine. Individuals with a known history of polysorbate-80 allergy (used as excipient in certain chemotherapeutic drugs) should not receive covid-19 vaccine.

Q6. Should patients with a previous history of COVID-19 infection be vaccinated?

Yes, patients with cancer who had been infected and recovered from the illness should also receive the COVID-19 vaccine as it will protect from reinfection.

Q7. Should the vaccine be given to patients with positive COVID-19 antibodies?

The COVID-19 vaccine should be given to all patients with cancer irrespective of their antibody status. Serological testing should not be used to guide the decision and timing of vaccination.

Q8. What should be the gap between the first and second doses of the vaccine?

The current guidance for the normal population is to take the second dose 4 to 8 weeks after the first dose. However, for patients with cancer, it is preferable to take the second dose early, preferably at 4 weeks after the first dose.

Q9. What are the side effects that may occur after the COVID-19 vaccine?

You may expect some minor side effects like soreness of the shoulder (injection site) for a few days after the vaccination; also, you may have mild fever, tiredness for a day or two after the injection. Serious side effects are extremely rare, but we advise you to consult your doctor in case of any troublesome symptoms.