Just because the world is tackling a pandemic, doesn’t mean other illnesses and diseases stop. This is one of the key reasons for social distancing measures as governments and public health authorities don’t want already overburdened health care systems to be swamped with an uncontrolled flood of COVID-19 cases. And, of course, they want to protect those who are immunocompromised from becoming seriously ill.
But treatment of diseases such as cancer must continue and those with such conditions are understandably anxious about COVID-19’s impact on their treatment, as well as the risk of contracting the virus.
In a recent survey of 1,300 patients with chronic illnesses, including cancer, 73 percent reported feeling that their condition makes them more vulnerable to SARS-CoV-2, the virus that causes COVID-19. Among cancer patients, 50 percent reported they were skipping events, 57 percent said they were going to public places less often, and 59 percent said they were avoiding public places when possible to prevent infection with the novel coronavirus.
Some recommendations for cancer patients during COVID-19
While those receiving chemotherapy have a weakened immune response and should definitely take the preventive measures mentioned above to minimize COVID-19 infection risk, there are some questions around those receiving newer immunotherapies for cancer, according to a University of Colorado Cancer Center press release. Such treatments use a patient’s own immune response to fight cancer, leading some to wonder if these therapies may prevent COVID-19 infection.
“As far as we know, immunotherapy on its own would not make patients more susceptible to COVID-19,” says Ryan Weight, DO, MS, investigator at University of Colorado Cancer Center and medical oncologist at the UCHealth Highlands Ranch campus. However, Weight adds that people receiving such therapies that include checkpoint inhibitors are likely to be more susceptible to COVID-19 due to other factors such as age.
He adds that there is currently no evidence to suggest that anti-cancer immunotherapies provide extra protection against viruses such as COVID-19, so those receiving such treatment should take similar protective measures to those receiving chemotherapy. Immunotherapies are still fairly new, so there is not as much research on them, Weight points out.
“We don’t have any data to support that immunotherapies could reduce a person’s susceptibility to infection,” he says. “It just hasn’t been studied yet.”
Cancer care in the COVID-19 era
As for how cancer treatments will continue during the pandemic, a recent peer-reviewed article by Seattle Cancer Care Alliance (SCCA) experts provides advice on how health care institutions can continue a high standard of care going forward. Seattle is expected to be one of the areas hardest hit by COVID-19 in the US.
“Our overarching goal is to keep our cancer patients and staff safe while continuing to provide compassionate, high-quality care under circumstances we’ve never had to face before,” said co-lead author F. Marc Stewart, MD, medical director, SCCA, in a press release. “We are working around the clock to develop new guidelines and policies to address situations that we couldn’t have imagined several weeks ago. When the pandemic ends, we will all be proud of what we did for our patients and each other in this critical moment for humanity.”
Some key tips for health care institutions:
- Keep communication open between all stakeholders—the general public, caregivers, patients, staff, and administrators
- Form an Incident Command Structure to respond quickly to changing information and coordinate hospital-wide efforts
- Be flexible as new challenges are likely to arise day by day
In addition to COVID-19 putting added strain on many health care providers, some of the expected challenges pointed out by the article include the effect on treatment from travel bans “including reduced access to international donors for allogeneic stem cell transplantation.”
They suggest handling these issues through measures many hospitals are already taking such as rescheduling elective surgeries and “well” visits, ensuring staff are following strict hygiene measures such as handwashing, limiting the number of staff in a patient’s room at any one time, and ensuring sick staff stay home.
For cancer patients in particular, they say it’s important to have “upfront, proactive palliative and end-of-life conversations with cancer patients who may become infected with COVID-19.”
As for cancer related surgeries, while some obviously cannot be postponed or rescheduled, The Society of Thoracic Surgeons (STS) recently published a press release by Robbin G. Cohen, MD, MMM, and Elizabeth A. David, MD, MAS, from the University of Southern California's Keck School of Medicine, on some procedures that can likely be delayed due to COVID-19.
Patients with early stage lung cancer can expect to have conversations with their health care team about the pros and cons of waiting to do their surgeries, the release says.
“Smaller tumors or ground glass tumors without solid parts can likely wait to be removed until the pandemic subsides,” Cohen and David say, adding that the health care team of those with larger tumors or tumors that involve structures such as lymph nodes “will consider timing of treatments in the setting of COVID-19.”
Most esophageal cancer surgeries can be safely postponed to minimize the risk of COVID-19 infection, the Cohen and David add, stating that “patients may need small procedures that can be performed in the outpatient setting, such as feeding tube placement, but most esophageal cancer resections likely will wait until the pandemic subsides.”
As for preventing health care workers from becoming burned out, the SCCA experts had a few strategies:
- Create a back-up labor pool
- Reassign staff who are at greater risk of infection (those with chronic illnesses, etc.) to administrative roles
- Compensation policies
A list of helpful COVID-19-related resources from key cancer care institutions can be found on the National Comprehensive Cancer Network’s website. These include documents for recommended visitor policies, appointment scheduling and rescheduling, handouts on COVID-19 for cancer patients, and self-care tips for oncology professionals.