Cancer Care During the COVID-19 Pandemic

May 11, 2020

Battling cancer under normal circumstances can be difficult and frightening. But doing so during a pandemic can be even that much more challenging.

Soheil Deshpande,MD and Vijay Sandilya,MD, Medical Oncologists/Hematologists at Shore Cancer Center, have prepared article to discuss implications of this pandemic on the care of cancer patients. Thank you to both doctors for taking the time to share this critical information.

SARS-Cov-2 is affecting people across all age groups and socioeconomic status. Cancer or its treatment might increase the susceptibility of patients to the virus. The patients need to visit the hospitals frequently for follow up and to receive treatment, which might increase the risk of exposure for the patients and the healthcare workers. This is a brief synopsis of guidelines issued by various societies about the management cancer patients. We will talk about the special precautions that need to be taken for the protection of the patients, care givers and healthcare workers who are in close contact with the patients, so as to decrease the risk of person to person spread of the virus.

From the data available to us so far from the CDC, we know that following conditions might predispose you to have a severe illness from COVID-19: (1)

  • People 65 years and older
  • People who live in a nursing home or long-term care facility

People of all ages with underlying medical conditions, particularly if not well controlled, including:

  • People with chronic lung disease or moderate to severe asthma
  • People who have serious heart conditions
  • People who are immunocompromised
    • Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
  • People with severe obesity (body mass index [BMI] of 40 or higher)
  • People with diabetes
  • People with chronic kidney disease undergoing dialysis
  • People with liver disease

Special precautions for Cancer Patients and Survivors. (1)
Current or past patients need to take special precautions in order to protect yourself from infection. Certain types of Chemotherapy might affect your immune system and make you more susceptible to viral infections.

  • Handwashing. Many diseases are spread by not cleaning your hands, which can be dangerous when you are getting chemotherapy treatment. Wash your hands thoroughly with soap and water at least for 20 seconds.
  • Know the signs and symptoms of infection. Infection during chemotherapy can lead to a severe illness. Call your doctor right away if you experience any of the signs and symptoms of an infection.
  • Check your temperature often and watch out for fever. Contact your doctor immediately if you have a temperature of 100.4ºF (38ºC) or higher.
  • Maintain social distancing. Avoid leaving your home. Try to get supplies and food delivered to your home. Maintain a distance of at least 6 feet (2m) between you and non-household members. If you must leave home, avoid crowded places. When in public wear a face covering.
  • It is essential to have a nutritious diet and to exercise regularly.

Caregivers, Family Members, and Other members of the household.
As a caregiver, it is important to care for your own health. According to studies in COVID-19 patients, most COVID-19 cases only have mild symptoms. But these patients can become a source of infection in the community and can spread the disease. 

If a caregiver develops any symptoms at all, they must immediately separate themselves from the cancer patient and self-isolate in a separate room. Arrangements can be made for someone else to care for the cancer patients. 

Prepare for Your Medical Needs in advance
Schedule appointments with your doctor in advance. Discuss your chemotherapy schedule with your doctor. Ask for additional supply of medicines from your doctor to reduce your visits to the pharmacy or the clinic.

What can doctors do for the protection of patients and healthcare staff. (2,3,4)

  • Due to current situation we need to minimize face to face contact. Try having telephonic or video consultations whenever possible. Especially in case of follow up or pretreatment visits. Doctor’s offices should consider having a dedicated telephone line for triage. Prescreening of the patients can be done 1-2 days before the actual consult.
  • If in person consult is necessary, ask patients to attend appointments without family members. Family members can be reached via teleconferencing. 
  • Minimize waiting time of the patients. Patients can be asked to wait in the vehicles and prompted to enter premises via text message when doctor is ready to see them.
  • Provide adequate PPE for healthcare staff. Reinforce a strict “stay at home when ill” policy and ensure that staff have access to testing whenever necessary.
  • Periodic disinfecting of all common areas and objects like door handles, light switches, keyboards etc. 
  • Introduce drive through pick up points for pharmacy or offer delivery services for essential medications.

If a patient is a known case of COVID-19:
These patients should be seen in an isolated setting separate from regular patients. Give systemic anticancer treatment only if it is needed for urgent control of the cancer. If it is possible, systemic anticancer treatment can be deferred until the patient has at least 1 negative test for COVID-19. 

Pandemic Planning Clinical Guideline for Patients with Cancer issued by Ontario health Cancer care (5) suggests that patients should be categorized into 3 groups (A, B, and C) based on the need of the patient and the efficacy of treatment that can be offered. Patients should be considered on a case to case basis by a multidisciplinary team and the rationale behind each decision should be clearly recorded.

  • Priority A can be defined as those who are critical (unstable, unbearable suffering, and/or whose condition is immediately life threatening) and for whom there is effective treatment. 
  • Priority B can those who are deemed to be non-life threatening who can be deferred and services that may be discontinued during a current wave of the pandemic event. Physicians will determine that these patients are not put at undue risk. If their priority changes, they will be moved to priority A and treated promptly. 
  • Priority C determines those for whom services may be discontinued during the entire pandemic event (multiple waves of 6-8 weeks). These patients are, for the most part, undergoing routine follow-up or screening and can reasonably wait until the pandemic is over. 

According to the above categories,

  • Systemic therapy should be continued in Priority A patients like those patients being treated who have aggressive tumors, patients with life-threatening situations and some patients already receiving treatment.
  • Surgery: All elective surgeries are to be postponed.
  • Screening: Is an activity that is usually carried out amongst healthy individuals to search for subclinical diseases. The current COVID-19 pandemic is putting a stress on the medical workforce and resources so screening can be temporarily suspended, and resources can be directed towards the pandemic. 

In conclusion, treatment of cancer during the current pandemic of COVID-19 poses some unique challenges in front of the healthcare system. This subject is constantly evolving as new evidence in made available from clinical trials from all around the world. We here at Shore Cancer Center assure you that we are with you in every step of your fight against cancer. We will continue to provide you with high quality healthcare services through these difficult times. Take care and stay safe.

Shore Cancer Center is located at 100 Medical Center Way in Somers Point. For more information call 609.653.3585. 

*This article is a brief overview about the practice of oncology during this pandemic. It is not meant to substitute medical advice from your doctor.

References:

  1. CDC 
  2. NICE guidelines for cancer care
  3. Cinar et al. Safety at the Time of the COVID-19 Pandemic: How to Keep our Oncology Patients and Healthcare Workers Safe. JNCCN
  4. Ueda et al. Managing Cancer Care During the COVID-19 Pandemic: Agility and Collaboration Toward a Common Goal. JNCCN
  5. Pandemic Planning Clinical Guideline for Patients with Cancer. Ontario health cancer care.