Cancer And COVID-19

The sooner it is found it is less likely to have spread to other parts of the body. Early cancer can be cured.

Any delay is dangerous. Go at once to a doctor and ask for a thorough examination.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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