19.05.2020
Covid–19 pandemic and treatment of cancer

People who have been recently diagnosed with cancer or are on treatment have concerns regarding continuing treatment of cancer and balancing the risk of getting covid infection versus delay in treatment. We present some of the frequently asked questions related to cancer treatment in Covid times.

If I am suffering from cancer, do I have a higher risk of getting COVID-19 infection?

Cancer by itself and some cancer treatments such as chemotherapy can weaken the immune system and increase the risk for severe illness from COVID-19. Other associated risk factors include old age, presence of long standing coexisting diseases such as asthma, chronic lung infections, heart, liver, or kidney disease, diabetes, other immune deficiencies, history of smoking, previous bone marrow or organ transplantation and prolonged use of corticosteroids or other medications which can weaken the immune system. Patients who are suffering from cancer and are currently on treatment do not have a higher chance of getting infection but they have a higher chance of developing more severe disease if covid infection sets in.

If I have cancer now or had it in the past, how can I protect myself?

Currently there is no vaccine to prevent COVID-19 nor there is any specific treatment for it. The best way to prevent illness is to avoid being exposed to the infection and follow all precautions as is true for anyone.

  • Avoid touching your eyes, nose, and mouth
  • Maintain social distancing at home, hospital and everywhere.
  • Wear face mask; preferably three ply or N95 mask. If you do not have these masks then even tight fitting cloth mask is better then no mask at all. Replace/change mask after every few days. Store mask in paper bag after use. Avoid touching mask once its worn.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; after blowing your nose, coughing and sneezing, as well as before and after coming in contact with others. Coughing and sneezing should be done in elbows. Use disposable tissues in place of handkerchiefs.
  • Stay home as much as possible, even if you have to go out maintain social distancing, stay at least 6 feet away from other people, avoid crowded places and always wear a mask or cloth to cover your face.
  • Clean and disinfect frequently touched surfaces, including doorknobs, light switches, keyboards, counter tops, phones, handles, faucets, sinks, and toilets.
  • Avoid hospital visits unless there is an emergency
  • If I am under treatment for cancer, should I delay my chemotherapy or radiotherapy?

    It’s likely that covid infection is going to persist for next few months.So, if you are have been recently diagnosed with cancer or are on treatment for cancer, please discuss with your doctor/oncologist regarding available treatment options and time lines for executing the same. In general chemotherapy or radiation therapy should not be delayed if delaying it would adversely impact disease outcome. Treatment of early stage cancers should go as planned as these are the cancers with best chance of cure with chemotherapy and radiotherapy. The treatment regimens may be adapted in some cases with administration of oral drugs instead of intravenous chemotherapy, institution of shorter chemotherapy schedules and larger intervals between doses to avoid frequent and longer hospital visits. Radiotherapy schedule may be altered in order to shorten total duration of treatment. Every cancer patient and his/her disease is different, so all patients need individual discussion with treating oncologist in order to understand their likely benefit/risk of continuing cancer treatment in covid times.

    Should cancer surgery be delayed or deferred at this time of corona pandemic?

    Corona virus pandemic is behaving like a marathon race; it means it is not going to go away for at least next 3-6 months. We have to therefore learn to live with this new ‘normal’. Treatment of cancers is almost a semi emergency and we cannot wait for the pandemic to get over before going ahead with cancer treatment. Most cancers need immediate and urgent treatment surgery, chemotherapy or radiotherapy except for some low grade tumors which may be left alone for a couple of months e.g. ductal carcinoma in situ of breast, verrucous carcinoma in head and neck region and other in-situ cancers.

    The treatment schedule of most cancers is decided as per standard guidelines or with some modifications in view of covid outbreak. Depending on the severity of corona illness in a geographic area and available resources, the choice of treatment or sequence may have to be altered to best avoid any complications and adverse outcomes. Any decision about surgery would be based on how urgent it is and the level of risk if surgery isdelayed at this particular time. We, at Jaypee hospital, encourage shared decision making with patient and attendants along with multidisciplinary tumor board discussions either physically or through virtual platforms.

    In case surgery is planned, the complexity and timing of surgery needs to be balanced. We consider surgery for tumors when the surgical procedure will be curative and delay or postponement of surgerycould significantly deter the outcome. We consider upfront surgery without delay for early stage breast cancer, operable oral cancers, localized colon cancer and early stage ovarian cancers. Most locally advanced rectal and esophageal cancers would go for preoperative chemoradiation and gastric cancers for preoperative chemotherapy followed by surgery at a later time point.Cancer with equivalent outcomes with surgery and radiation therapy such as cervical and prostatic cancer might be referred for radical radiation therapy.

    What precautions do I need to take as a cancer patient during hospital visits?

    Preferably patient should come to hospital alone or with only one attendant. You should carry minimum essential documents, files, or scans with you. Avoid common places in hospital, pharmacy or canteen and unnecessary contact with other patients and their relatives. Maintain social distancing from hospital staff and other patients.Always wear face mask, gloves and face shield if necessary. Practice frequent hand washing and hand sanitization. We all have to be collectively responsible and s do not hide any symptoms from your doctor.

    As a cancer survivor, am I at a higher risk of developing COVID-19 infection?

    People who have been treated for cancer in the past may have weakened immune systems, which can increase the risk for severe illness from COVID-19. However after treatment for cancer, the immune system usually recovers over some time especially if chemotherapy or radiotherapy was competed 6- 12 months back. Patients who have suffered from lymphoma, leukemia, myeloma or had been on immunotherapy or underwent bone marrow transplantation need to be most cautious as they are more vulnerable to catch viral infections.

    As oncologist it is our responsibility to balance risks versus benefits while planning cancer treatment considering the type and stage of cancer, available treatment options, other existing diseases such as diabetes, hypertension, heart ailmentsand stage of coronavirus transmission in the community.

    The author Dr Ashish Goel is Associate Director Surgical Oncology at Jaypee Hospital, Noida, a unit of Jaypee Healthcare Pvt. Ltd. Dr Goel is an accomplished cancer surgeon with over 20 years’ experience in oncology and oncosurgery. He has been extensively trained in surgical oncology from several institutes of repute both in India and abroad.

    Doctor
    Dr. Ashish Goel
    Associate Director
    Department of Surgical Oncology
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