How to Navigate Cancer in the Wake of the COVID-19 Pandemic

March 20, 2020

Patients with cancer who have routine follow up appointments are being asked to reschedule to help combat the spread of COVID-19.

People who have either recently received an earth-shattering cancer diagnosis and are preparing to undergo the necessary treatments or have been in remission for any amount of time, constantly face an uphill battle. Whether it’s the potentially crippling treatments or concerns of the disease returning or spreading, the anxiety likely never goes away.

The ever-changing developments during the last several weeks as the novel coronavirus — a respiratory illness — has spread across the world has surely added to that anxiety.

However, Dr. Harold Burstein, a senior physician at Dana-Farber Cancer Institute in Boston, noted that there’s still a lot of unknowns in terms of how COVID-19 affects people with cancer.

“Patients with hematological malignancies, or those getting chemotherapy, bone marrow transplantation, or taking other medicines that lower the white blood count or otherwise depress the immune system should be considered more vulnerable to infection in general,” Burstein told CURE®. “We don’t really know how that affects COVID-19 but it is reasonable to assume that such patients are more susceptible to serious infection. They should take special care to isolate themselves and reduce infection risk.”

Dr. Steven Pergam, medical director of the infection prevention program at Seattle Cancer Care Alliance, agreed and said that although they don’t want to be alarmist, they want to be truthful.

“All cancer patients should be concerned about COVID-19 because they are at higher risk,” said Pergam. “I also consider any cancer patient in active treatment — this includes surgery, radiation, chemotherapy and/or immunotherapy — at risk, particularly those who are told by their doctors that they are immunosuppressed because of their treatment. Many cancer patients also have additional complications, such as diabetes, lung complications or heart disease that might put them at increased risk. The combination of immunosuppression, other health problems and age make COVID-19 a major concern for many cancer patients.”

Coronavirus Guidelines

Patients should abide by all the guidelines being widely distributed through public health channels, which include meticulous handwashing, steering clear of those who are sick, staying home if fever or respiratory symptoms develop and disinfecting high-touch areas, according to Pergam. Additionally, Pergam recommended having a few extra months’ worth of prescription medications on hand just in case.

“Basically, my advice is to take seriously all the precautions advised for everyone but be even more vigilant,” Pergam said.

Both Pergam and Burstein heavily stressed the importance of adhering to social distancing.

“Given the risk of infection from close contact, it seems prudent that most people should avoid large gatherings, airports and air travel,” Burstein said. “There are growing restrictions around the world on air travel. Cruise ships are cancelling their voyages. There are going to be more cases. First, we want patients to take care of themselves.”

As for if a patient with cancer starts feeling sick, Pergam recommended they call their provider team, let them know their symptoms and ask whether they should come into the clinic and be seen right away or if they should stay home and monitor their symptoms.

“Those who have severe symptoms and are struggling to breathe should call ahead before they go to the ER (emergency room) or clinic and let them know about their symptoms,” he said. “As a matter of caution, patients should always call the clinic ahead of time if they develop a cough or experience shortness of breath. It’s important to ensure that the care team is prepared to handle the situation with a separate room to avoid placing other patients at risk.”

COVID-19’s Impact on Care

Institutions across the country have implemented precautionary measures. For instance, Dana-Farber had modified its chemotherapy programs where appropriate or is using growth factor support to prevent neutropenia as much as possible in patients, Burstein explained.

“Many cancer patients are probably at ‘average’ risk, the same as the general public,” Burstein said. “Patients with histories of early stage colon, breast or prostate cancer; patients who have had surgery and/or radiation but not chemotherapy; or patients who are many years out from treatment and doing well are likely at more-or-less the typical risk profile. There is no reason to think that the hormonal treatments used in breast and prostate cancer would put patients at jeopardy.”

In addition, Dana-Farber has opened discussions as to how to best reduce procedures and tests to try and preserve health care resources.

“We are encouraging patients to push off ‘routine’ follow up appointments,” Burstein said. “We have stopped performing screening mammograms in asymptomatic patients. We expect that there will be staffing challenges in the weeks and months ahead and are planning for that.” One way that’s happening is through telemedicine.Health care systems are being stretched to the max,” he said. “Hopefully we can marshal the resources to give good care to everyone still, even if the care looks a bit different.”

As for operations at Seattle Cancer Care Alliance, Pergam said there has been constant coordination across its various departments and partner institutions, including Fred Hutchinson Cancer Research Center, University of Washington Medicine and Seattle Children’s, on best practices to support the community.

“As the U.S. community hit hardest by COVID-19, we have had a head start in formulating and communicating guidelines and recommendations to our patients,” Pergam said. “We have compiled an extensive list of frequently asked questions that offer advice and support to our patients, and we update it regularly.”

Seattle Cancer Care Alliance is still operating under normal business hours and continuing to provide care to patients but is asking patients who are experiencing symptoms such as fever, cough, congestion, sore throat, runny nose or shortness of breath to call a newly established nurse triage line before arriving at the clinic.

“We are not turning away any patients, but we are taking different precautions if they are symptomatic,” Pergam said. “We’ve also made the difficult decision to reschedule non-essential patient visits for the time being out of concern for our patients’ health and to make sure that we are well-positioned to care for our patients in active treatment and prepare as the number of COVID-19 cases in our area continues to grow.”

Pergam and Burstein agreed that patients must be in constant and close communication with their care teams, nurses and oncologists if they are concerned about potential exposure to the virus as well as to what care is essential and what may be safely postponed.

“Having cancer and being concerned about the coronavirus can feel overwhelming,” Pergam said. “Patients should be vigilant about their health and not hesitate to reach out to their providers if they’re experiencing any symptoms or need support. Finally, patients should turn to reliable sources such as CDC.gov and their local health departments to get up-to-date information on COVID-19, while avoiding websites that promise a quick fix or treatment to protect them from the virus.”

As for Burstein, the news and plans are changing daily. He said he hopes that society can learn how to best test, treat and care for those with COVID-19 infections, but in the meantime to “do what you can to keep yourself and your family healthy.”


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