COVID 19 and Cancer

April 20, 2020
8:29 pm

What cancer patients need to know during the COVID 19 pandemic??

The COVID-19 pandemic is caused by the novel corona virus first isolated in the Chinese
province Wuhan in December 2019. The pandemic has become overwhelming with several
thousands infected and close to 10000 deaths globally.Majority of the individuals infected
with the COVID-19 virus will experience mild to moderate flu like symptoms and recover
without treatment. 

Older people, and those with underlying medical problems like cardiovascular disease,
diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.
Cancer patients are more susceptible to COVID-19 infection and also have increased
incidence of severe events (death or ICU admissions).

  1. Please try not to get in close contact with patients/family members with a positive travel history and symptoms of possible COVID infection like fever, cough, running nose and shortness of breath. The idea is to avoid unnecessary hospital visits and home quarantine yourself.
  2. Most hospitals have COVID screening questionnaires and screening at the entrance. Please co-operate and go through the screening for the benefit of yourself and your fellow human beings.
  3. If you need to consult your oncologist, request for telephonic/wats app or video consultations. Follow social distancing if face to face consultation is required. Try to minimize time spent in the hospital and restrict number of family members accompanying you for chemotherapy to maximum of one. Please use a mask, preferably N95 to avoid exposure to asymptomatic COVID carriers/ COVID infection.
  4. In case you are on chemotherapy and feel sick (fever, shortness of breath) and/or fever with low WBC counts, got to your emergency room where COVID testing/immediate care will be given.
  5. I am getting several phone calls/whats app messages from patients regarding delaying chemotherapy or not at this critical time. Several oncologists globally believe that there is no consensus/guidelines for the management of patients with cancer receiving systemic chemotherapy during COVID -19 crisis. Moreover, the evidence to delay/administer is lacking at this time. We have to discuss this with the patient and come to a reasonable answer. A few pointers below may be useful. These are mainly my thoughts based on discussion with my colleagues and not necessarily the single best option.

Hence it is important for our cancer patients to follow certain “Dos” and “Don’ts”.

  • If you are having a cancer which is largely curable like germ cell tumors, it should be continued.
  • Similarly, if you have a blood cancer (leukemia / lymphoma or myeloma), treatment should should not be interrupted. Request your doctor if hospital visits can be reduced and oral medications can be used till the crisis settles down, example myeloma.
  • Chemotherapy for early stage cancers post-surgery has to be decided by your doctor based on your age, stage, risk of recurrence, history of diabetes, lung disease, smoking history and aggressiveness of disease. So, your oncologist will have to sit with you and explore the best option.
  • If you are suffering from a stage IV cancer and you are on palliative chemotherapy; your life expectancy, co-morbidities like diabetes, lung disease and benefit from chemo/targeted therapy have to be considered before continuing /initiating treatment. Please discuss with your doctor if chemotherapy can be delayed.
  • If you are on maintenance chemotherapy/targeted therapy, your doctor may consider postponing treatment for a period of 3-4 weeks.
  • If your disease requires down-staging prior to surgery, it is advisable to initiate chemotherapy especially for aggressive malignancies like triple negative breast cancer.
  • Discuss with your doctor and have your stem cell transplantation postponed.
  • Most doctors will continue your oral chemotherapy and hormonal therapy.
  • Immunotherapy drugs are relatively new and it has to be individualized by your doctor taking into consideration various factors.
  • Please avoid routine follow up visits at this time.