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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The importance of getting screened for common cancers.

An owl in the Dubai desert. (Dr. Noorali Bharwani)
An owl in the Dubai desert. (Dr. Noorali Bharwani)

“Facts do not cease to exist because they are ignored,” says Aldous Huxley.
Aldous Leonard Huxley was an English writer. By the end of his life, Huxley was widely acknowledged as one of the pre-eminent intellectuals of his time.

Generally speaking, many people ignore going through screening tests. They believe “no news is good news.” That is not good.

The fact remains early detection of cancer increases the chances for successful treatment and improves cure rate and prognosis. With this in mind the Government of Alberta has set up Alberta Cancer Screening Programs called Screeningforlife.

The Alberta program offers cancer screening to people who have no symptoms to get checked for breast, cervical and colorectal cancer.

Breast Cancer Screening

Just because no one in your family has had breast cancer does not mean you are not at risk. In fact, 80 per cent of women who develop breast cancer have no family history at all.

Having routine mammograms is the best way to find breast cancer early.

If you are between the ages of 50 and 74, you are at an age when it is important to consider having mammograms regularly. This is because the risk of breast cancer increases, as women get older.

Women who are under the age of 50 and over the age of 74 may need a screening mammogram on a regular basis if there are strong indications such as family history of breast cancer. These women should discuss their individual situation with their family doctor.

Cervical Cancer Screening

Screening is recommended for all average-risk females 25 to 69 years.

It is important to know cervical cancer can almost always be avoided with screening and vaccination. In fact, 90 per cent of cervical cancer can be prevented with regular Pap tests (the main screening test for cervical cancer) and following up on any abnormal results.

Georgios Nikolaou Papanikolaou (1883 – 1962) was a Greek pioneer in cytopathology and early cancer detection, and inventor of the “Pap smear”.

The single most important reason to have regular Pap tests is that they can save your life. About 75 per cent of sexually active Albertans will get HPV(human papillomavirus) in their lifetime. It is the main cause of cervical cancer. Good news is nine in 10 cases of cervical cancer can be prevented with regular Pap tests.

Colon and Rectal Cancer Screening

It is possible you may have colon cancer but have no symptoms. Speak to your doctor about colorectal cancer screening after you turn 50. Commonly used tests are:

Fecal Immunochemical Test (FIT) – This is a home stool test for people who have no symptoms and no family history of colon and rectal cancer.It is safe, easy to do and can be done right at home. Should be done once a year.

Colonoscopy – If your FIT is positive then you need a colonoscopy.A colonoscopy can also be recommended as your screening test instead of a FIT if you have any history that puts you at an increased risk.

Do not ignore the facts. Get yourself screened. If Albertans follow these guidelines then we can reduce the risk of cancer in Alberta by about 50 per cent. That would be wonderful!

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Exposure to Asbestos Leads to Many Health Problems

A beautiful view of the Canadian Rockies. (Dr. Noorali Bharwani)
A beautiful view of the Canadian Rockies. (Dr. Noorali Bharwani)

This is my 600th column and 19th year of writing What’s up doc? How time flies when you are having fun. So, here we are in 2015. Let me wish you a Happy New Year. It is never too late to wish happiness to anybody at any time of the year.

We will start the year discussing a condition that is not so common now. But there are people who are suffering and if we are not careful then more people will be affected. People who are working in old buildings and construction sites.

I am talking about the risks of exposure to asbestos. Exposure to asbestos leads to many health problems including cancer called mesothelioma. Mesothelioma (also called malignant mesothelioma) is cancer that affects the protective lining that covers many of the internal organs of the body.

Most people who develop mesothelioma have worked in jobs such as miners where they inhaled or ingested asbestos fibers, or were exposed to airborne asbestos dust and fibers in other ways.

Asbestos fibres are strong, durable and non-combustible. They were widely used by industry, mainly in construction and friction materials.

How much asbestos is in a product does not indicate its health risk. If the asbestos fibres are enclosed or tightly bound in a compound, there is no significant health risk. Asbestos poses health risks only when fibres are present in the air that people breathe.

One of the main problems with asbestos came from easily broken up asbestos used in buildings until the 1970s. People working in construction, maintenance or in the renovation of older buildings should be particularly careful.

Mesothelioma commonly affects the outer lining of the lungs and internal chest wall, but it can also arise in the lining of the abdominal cavity, the sac that surrounds the heart, or the sac that surrounds the testis.

The symptoms of asbestos exposer or mesothelioma are shortness of breath due to fluid between the lung and the chest wall, chest wall pain and unexplained weight loss.

The diagnosis may be suspected based on chest X-ray and CT scan findings, but must be confirmed either by chest fluid examination and biopsy. Mesothelioma carries a poor prognosis. Treatment with chemotherapy, radiation therapy or surgery is not very effective.

Health Canada has encouraged provincial occupational health authorities to adopt stringent workplace exposure limits for asbestos. Use of asbestos is strictly regulated under the Hazardous Products Act.

More information can be obtained from various sources like Wikipedia, Canadian Centre for Occupational Health and Safety, Health Canada and The support group provides patients with free resources, support, education, and referrals to experienced mesothelioma doctors. For more information contact:

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Cancer Drugs are Being Abused by Bodybuilders

Kin Coulee Park, Medicine Hat: A beautiful mild evening look in January. (Dr. Noorali Bharwani)
Kin Coulee Park, Medicine Hat: A beautiful mild evening look in January. (Dr. Noorali Bharwani)

I was surprised when my attention was drawn to an article in MedPage Today titled “Bodybuilders Bulk Up Using… Cancer Drugs.” Should I be surprised?

“The only thing that should surprise us is that there are still some things that can surprise us,” said Francois de La Rochefoucauld (1613 – 1680). He was a noted French author with a clear-eyed, worldly view of human conduct that indulges in neither condemnation nor sentimentality.

Abusing cancer drugs to muscle up your body does call for condemnation. As we know, performance-enhancing drugs are substances used by athletes to improve their performances.

The phrase has been used to refer to several distinct classes of drugs: steroids, human growth hormone, stimulants (caffeine, amphetamine, methamphetamine), painkillers (simple analgesics to narcotics), sedatives, diuretics, blood boosters and others.

What about abuse of cancer drugs?

“Arimidex, also known by its chemical name anastrozole, is an aromatase inhibitor – a breast cancer drug. While steroids and growth hormone make headlines when athletes abuse them, breast cancer drugs are a lesser-known staple of doping regimens, for athletes and ‘weekend warriors’ alike,” says the article. Even common anti-estrogen breast cancer drugs like tamoxifen and exemestane are abused.

The article says these breast cancer drugs are on the prohibited performance-enhancing drugs lists from the U.S. Anti-Doping Agency and the World Anti-Doping Agency. But somehow some athletes manage to find them. How can this be stopped? A difficult question to answer.

Those athletes who abuse performance-enhancing drugs do eventually suffer from side effects. Hopefully, they will learn early in their lives that the best way to improve your health is by exercising regularly, eating healthy and not abusing performance-enhancing drugs. I hope somebody is listening.

Talk to you again soon. Keep smiling.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!