Coronavirus & Cancer Patients
As the Coronavirus Pandemic unfolds in the United States and Americans work to adjust their daily lives around changes in their routines, many questions arise. Among them, questions from the cancer community about their immunity and susceptability to the COVID-19 virus. We’ve addressed some of the most frequently asked questions here with help from Dr. Steve Pergam, a clinical and infectious disease researcher at the Fred Hutchinson Cancer Research Center.
You can read the related article here: https://www.fredhutch.org/en/news/center-news/2020/03/coronavirus-what-cancer-patients-need-to-know.html
Frequently Asked Questions
I’m currently in active treatment. Is my immunity compromised?
Yes – According to Dr. Steve Pergam, a clinical and infectious disease researcher at Fred Hutchinson Cancer Research Center, “People over 70 & those with underlying health conditions, like cardiovascular disease, lung disease, diabetes, kidney disease and a history of cancer appear to be at higher risk for major complications if they contract COVID-19. People with hematoligic (blood) malignancies (like non-Hodkin Lymphoma, CLL, AML, ALL, and Multiple Myeloma) and those who’ve received bone marrow transplants seem to be at the greatest risk.
I’ve finished active treatment, but don’t feel like my old self yet. Is my immunity compromised?
Yes – According to Dr. Steve Pergam, a clinical and infectious disease researcher at Fred Hutchinson Cancer Research Center, while everyone is different (some may recover immunity faster than others), even those out of treatment need to be extra cautious. “The risk extends beyond the period of active treatment. The after effects of cancer and the immunosuppressive effects of treatment can be long-term.” Check with your doctor if you are concerned about being at an elevated risk or if your work requires you to be in contact with people that may have been exposed.
I’m on long-term hormonal therapy (like Tamoxifen, Arimidex, etc). Is my immunity compromised?
Probably not. Or, at least not because of the hormonal therapy. Tamoxifen and Arimidex and other long-term hormonal treatments are not known to have specific impacts on your immunity. Though, if you have other underlying conditions or tend to get sick often, there may be something else impacting your immunity. Check with your healthcare professional for specifics about your individual circumstances.
I’m scheduled to have a surgery to remove my breast cancer soon. Will my surgery be cancelled? Is breast cancer-related surgery considered elective?
There is no clear answer on this yet. Some facilities are continuing to schedule and perform lumpectomies, mastectomies, port placement surgeries and other surgical procedures related to breast cancer treatment while others are suspending these operations temporarily. Your best bet is to check in with your surgical team to see how they are handling surgical scheduling in your area.
COVID-19 brought its own set of challenges to those with breast cancer while finding best practices.
Breastcancer.org tell us that:
Most people infected with the COVID-19 virus will have mild to moderate respiratory symptoms and recover without requiring special treatment or hospitalization. Some will have no symptoms at all.
According to the CDC, currently having cancer increases your risk of having serious complications if you do become infected with COVID-19. At this time, it's not known if having a history of cancer increases your risk of serious complications.
This higher risk for serious complications from COVID-19 for people currently diagnosed with cancer likely is because having cancer puts a strain on the body and also because certain treatments can cause people to become immunocompromised (have a weakened immune system) or have lung problems.
The following breast cancer treatments can weaken the immune system:
all standard chemotherapy drugs, such as Taxol (chemical name: paclitaxel), Taxotere (chemical name: docetaxel), Cytoxan (chemical name: cyclophosphamide), and carboplatin
certain targeted therapies, such as Ibrance (chemical name: palbociclib), Kisqali (chemical name: ribociclib), Verzenio (chemical name: abemaciclib), and Piqray (chemical name: alpelisib)
Typically, the immune system recovers within a couple of months after you stop receiving chemotherapy or targeted therapy. But your immune system’s recovery time can vary and depends on several factors. If you received those treatments in the past, it's not clear if you are at higher risk for serious complications from COVID-19. If you’re receiving ongoing treatment with these medicines for metastatic breast cancer, it’s likely that your immune system is weakened.
Some chemotherapy medicines and targeted therapies can also cause lung problems, which could put people at higher risk for serious COVID-19 complications.
People with metastatic breast cancer in the lungs also can have lung problems that may get worse if they develop COVID-19.
Some people with breast cancer may have other risk factors for developing serious complications from COVID-19. For example, you are at greater risk if you:
are age 65 or older; though the risk for serious complications increases with age, so people in their 50s are at higher risk than people in their 40s and people in their 60s and 70s are at higher risk than people in their 50s; the greatest risk for serious complications is among people age 85 and older
have chronic obstructive pulmonary disease (COPD)
have a serious heart condition
have type 2 diabetes, chronic kidney disease, or sickle cell disease
are obese
smoke
Research on COVID-19 and cancer is very limited, so it’s not clear how COVID-19 may affect people diagnosed with cancer. It’s also not clear how different types of cancer may affect COVID-19 outcomes. Research will take time to be further developed.
From April 28 through June 7, more than 600 people shared how COVID-19 affected their breast cancer care in an online survey conducted by Breastcancer.org.
From these respondents (83% of whom live in the United States, and 42% of whom were in active treatment), we learned:
There were delays in many aspects of breast cancer care, including routine clinical visits (32%), surveillance imaging (14%), routine mammograms (11%), reconstruction (10%), radiation therapy (5%), hormonal therapy (5%), mastectomy (5%), and chemotherapy (4%). About 30% reported no delays.
About 30% reported they chose or considered delaying or changing their own treatment plans due to concerns about contracting COVID-19.
About 11% reported that COVID-19 affected their desire or ability to get a second opinion.
Other health conditions linked to a higher risk of complications from COVID-19 were common: 30% reported obesity, 28% had asthma, 15% had a heart condition, and 14% had diabetes.
About 80% reported feeling some level of anxiety about their care being affected by the pandemic.
More than half (58%) have used telemedicine, and about 45% found virtual appointments to be helpful and effective.
About 67% reported being satisfied or very satisfied with the quality of care they were receiving.
About 26% reported they or a family member had lost their job, and about 42% reported they or a family member had their hours cut.
Tips for Getting the Care You Need:
Don't put off getting treatment. If you're nervous about seeking care, talk with your treatment team about the precautions they're taking.
Ask about receiving treatment elsewhere. It may be possible to receive treatment separately from where COVID-19 patients are being treated.
Have a family member, friend, or caregiver join you virtually at medical appointments. You may not be able to bring a trusted individual along with you, so try connecting with them via a phone call, Zoom, or Facetime. An extra set of ears may help you in the long run with breast cancer care.
Get a second opinion. If you don't feel like you're getting the care you need, seek answers from someone else that may help you feel more comfortable and confident.
Take care of your mental health. Talk with a trusted individual or therapist, join an online support group, or pick up a new hobby to help free your mind.
With help from breastcancer.org, here are our tips to help you protect yourself in the fight against COVID-19:
The best way to avoid getting COVID-19? Try to avoid being exposed to it. There is not yet a vaccine to prevent COVID-19, and the FDA approved remdesivir (brand name: Veklury) to treat people hospitalized with COVID-19, but this medicine is only for people with symptoms serious enough to require hospitalization.
Taking precautions will help you lower your risk of getting sick, especially if you are immunocompromised or have a serious health problem. Social distancing or physical distancing practices are strongly recommended to reduce the spread of COVID-19.
Social distancing means limiting close contact with other people — even if they appear to be healthy — to reduce your own risk of infection and prevent the virus from spreading. Staying at home and not seeing your loved ones can be difficult, but it’s important to do right now for your own safety and for the greater good.
Social distancing practices include the following, when possible:
stay at home
avoid public spaces
avoid public transportation and unnecessary travel
avoid social gatherings
work from home
stay at least 6 feet away from people when out in public
avoid physical contact such as handshakes, hugs, and kisses in social situations
avoid contact with people who are or may be sick
reschedule non-urgent medical appointments or complete them virtually by phone or internet video.
In addition to limiting contact with other people, here are some steps you can take to help protect yourself and others against this virus or any harmful germs:
Wash your hands frequently using soap and water for at least 20 seconds, especially after being out in public, coughing, sneezing, or blowing your nose.
Use alcohol-based hand sanitizer with at least 60% alcohol when soap and water aren’t available.
Don't touch your face when your hands aren’t clean, and make it a habit to not touch your face when you're outside your home.
Wear a mask.
Clean and disinfect surfaces you touch daily, including things you might not think of such as doorknobs, light switches, faucet handles, and phones. Make sure you use a cleaning agent that the Environmental Protection Agency says is effective for killing this virus.
Practice healthy habits: eat well, exercise, avoid or limit alcohol, don't smoke or vape, and get enough sleep.
Switch to glasses if you wear contact lenses to avoid touching your eyes more than necessary.
If you are receiving treatment for breast cancer, or if you are living with breast cancer that has metastasized to the lungs, the following extra precautions may help you protect yourself:
be extra vigilant about hand hygiene and not touching your face
avoid close contact with friends and family and take precautions if you depend on them for medical care
make a plan with your doctor to monitor for symptoms
make a plan with your caregiver or other loved ones in case you or they get sick
make a plan with your employer to work from home if you’re not already doing so
stock up on medications
ask a friend or family member to shop for groceries or pick up medications for you.
For more information, check out:
Cancer.net: What People with Cancer Need to Know
Common Questions About COVID-19 and Cancer: Answers for Patients and Survivors