Is it safe to continue with cancer treatment during the pandemic? Balancing the benefits of cancer-related care with risks related to COVID-19 calls for personalised solutions, writes Dr. Anthony Pais.

All my patients have one question: Is it safe to continue their cancer treatments during the pandemic? The answer, of course, differs from case to case. Nonetheless, as a general rule, unless one has fever or flu symptoms, or is under quarantine, due to recent travel, patients are advised not to suspend their cancer treatment. It needs to be continued as per schedule.

The coronavirus disease 2019 or COVID-19 presents a unique challenge. As countries across the globe attempt to find solutions and lockdowns become mandatory, lives are affected in ways that we cannot possibly fathom. These are difficult times for everybody, but my heart goes out to people with cancer. The disease works in tenacious ways on one’s body and mind – add to that the stress of the current pandemic and uncertainty about one’s ability to battle it!

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Issue of immunity

People with cancer are more vulnerable to any kind of infection, including COVID-19, because of the systemic immunosuppressive state caused by the disease. We also know that cancer treatments, such as chemotherapy and radiation, can further suppress the body’s immune system.

The greatest immune deficits, studies show, are found in patients with haematological malignancies (certain leukaemias or lymphomas) as well as bone marrow transplant recipients and people undergoing chemotherapy, or taking medicines that lower the white blood count.

According to recent research from China, published in The Lancet Oncology, people with cancer have more than triple the risk for severe health events in case they develop COVID-19. An analysis of the data of 2,007 patients in China hospitalised with COVID-19 showed that the incidence of severe events – death or ICU admission requiring invasive ventilation – was significantly higher among individuals with a cancer history (39 per cent) than those without (eight per cent).

Another paper, published recently in the journal JAMA Oncology, focused on cancer patients treated at the Zhongnan Hospital of Wuhan University in January and February. The researchers emphasised the need for making informed decisions on curtailing cancer care during the pandemic. Also, the need for “proper isolation protocols” to ensure that patients do not contract the coronavirus while undergoing treatment at the hospital.

Better safe

Immunosuppression, other co-morbidities and age make COVID-19 a major concern for cancer patients. It’s important for patients as well as their caregivers to take adequate precautions to lower their risk of getting infected.

It is pertinent to have a dedicated COVID-19 exposure risk screening at every hospital entrance. Proactive measures to move certain procedures to outpatient as well as reschedule non-urgent visits can go a long way in keeping the hospital environment safe for patients.

At our hospital, we have introduced home-based nursing services to reduce hospital footfalls and patient/attender travel. Telemedicine is another promising alternative that is worth exploring. If a person with cancer is feeling sick, it’s advisable to call the hospital and check whether s/he should stay home and monitor their symptoms or visit the doctor. The hospital needs to be prepared to handle the situation, in case it’s a suspected case of coronavirus, to avoid placing other patients at risk.

Communication is the key. We need to encourage open and transparent conversations between patients and their care teams, comprising nurses and oncologists. Balancing the benefits of cancer-related care with the risks related to COVID-19 calls for personalised discussions with each patient. It’s important to address patient concerns, especially if they have been exposed to someone who is ill, or are experiencing any new symptoms.

Early studies have shown that patients with cancer who have COVID-19 may present with different symptoms than the general population. For instance, they may not have fever, but sore throat. In some cases, patients may complain of diarrhoea before they develop respiratory symptoms.
In the current scenario where travel is restricted and healthcare facilities are limited to emergencies, making early diagnosis and providing timely treatment can become bigger challenges. In cancer treatment, delay of any kind can be detrimental. However, hospitals also have to take into account the potential risk to other patients and it’s staff, in case the person with cancer has an asymptomatic viral infection.

Being humane

People with cancer often live with pain, fatigue, and restrictions regarding things they can do on an everyday basis. Emotional distress can become an integral part of their lives, even without the COVID-19 pandemic pushing them over the edge. Baseless social media messages are promoting panic, especially among the immunocompromised and most vulnerable populations.
As the world fights the current outbreak, let’s not forget our humanity. It’s important for each one of us to work together in this epic battle, not only against the virus but also against the panic and widespread medical misinformation. Even as we practise social distancing, we can help each other through this crisis.

How about helping elderly neighbours get their monthly stock of medications, or helping them with transport to and from the hospital for treatment? How about talking to patients in palliative care and reassuring them? How about supporting children with cancer? How about volunteering to help provide the vulnerable population with some freshly cooked food? How about giving someone a reason to smile in these trying times? How about simply being humane?

(The author is Senior Consultant – Oncoplastic Breast Surgery, Co-founder & Clinical Director at Cytecare Cancer Hospitals in Bengaluru, India)