COVID-19: Cancer Care During the Pandemic

Are we ready for summer? (Dr. Noorali Bharwani)
Are we ready for summer? (Dr. Noorali Bharwani)

An article published in JAMA Oncology (online March 25, 2020) the authors report incidence and outcomes of COVID-19 in cancer patients who were treated at a tertiary cancer institution in Wuhan, China.

They found patients with cancer harbored a higher risk of COVID-19 compared with the community.

This increased risk of infection and death among cancer patients creates high psychological pressure of uncertainty. These patients and their families need guidance and support. Moreover, cancer treatments such as surgery, chemotherapy and radiotherapy suppress the immune system. This makes cancer patients more vulnerable to complications like infection.

Physicians and cancer patients have to decide: Does cancer treatment priority outweigh the risk of contracting infection with coronavirus?

An article in Lancet Oncology (Summary of international recommendations in 23 languages for patients with cancer during the COVID-19 pandemic – May 13, 2020), provides professional guidance to promote patients’ safety, treatment, and compliance, and ameliorating patients’ stress.

The authors identified six main areas of recommendations.

The first area concerns general considerations for patients with cancer during the COVID-19 pandemic.

Generally speaking, cancer patients’ immune system is not very strong. Especially the ones who are awaiting or undergoing treatment. The degree of immunosuppression depends on the type of cancer, the patient’s age, fitness, comorbidities, the type of therapy, and the time since last therapy.

Patients should familiarise themselves with COVID-19 symptoms. Early symptoms can be managed at home by way of self-isolation. Immediate medical attention should be sought for more severe symptoms, such as high fever, difficulty breathing, chest pain, confusion, and blue lips or face.

The second area of recommendation regards specific special measures that people with cancer should take to avoid COVID-19 infection. The best way to prevent infection is to avoid exposure to the virus by implementing strict hygienic and behavioural measures.

Hygienic measures include frequent hand washing, disinfecting objects, avoiding handling objects in public places, and washing fruits and vegetables.

Behavioural modifications include staying at home, not gathering in public places, and not touching other people. The use of a face mask is recommended.

The third area – patients with cancer should avoid people with a known exposure, infected asymptomatic people, and infected symptomatic people for at least 14 days and until their symptoms have resolved.

The fourth area of recommendation is related to mental health: guidance on managing anxiety and stress.

Some recommendations include breathing fresh air, engaging in physical exercise and creative activities, and having quality time with their families. Rest, sleep, and healthy eating are important. Talk to your friends and family frequently, engaging in pleasant activities, meditation, yoga and physical exercise. Patients who feel that they cannot cope with their stress should talk to their doctor.

The fifth area of concern is to maintain trust between physicians and patients to enhance patients’ confidence in medical staff decisions and improve their compliance with medical advice.

This may not be very easy. There has been a significant delay in continuity of care. Most patients understand the reasons for delay. But it is not easy.

As things improve with COVID-19 pandemic, cancer centers will be going through painful and difficult process of prioritising patients for treatment. Patients will be evaluated on a case-by-case basis, according to the overall clinical picture, the aggressiveness of the cancer, and the potential health risks from COVID-19.

Finally, the sixth area is the importance of containing spread of COVID-19 to vulnerable people. This can be done by keeping patients and visitors who have symptoms or have been exposed to an infected person not visit their cancer centre, but should first call their doctor’s office for further instruction.

We hope all patients and especially cancer patients get the treatment they need soon.

Take care. Be safe.

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