The COVID-19 pandemic has put millions of Americans already battling some form of cancer at added risk and has complicated decisions for both doctors and patients.
“During a pandemic, the potential benefit with chemotherapy would be unchanged, but the risk of harm would be increased by a degree that cannot be readily quantified,” according to a paper published Friday in the journal The Oncologist.
Cancer treatments are designed to attack rapidly dividing cells, a category that includes both cancer cells and vital immune system cells. As a result, patients have a far weaker immune system with which to fight off viruses like the one that causes COVID-19.
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The World Health Organization has estimated that cancer patients face twice as high a risk as the general population of contracting the new coronavirus.
An Italian study examining 355 patients who died of COVID-19 found that 20% had active cancer.
As with the treatment of other chronic illnesses like heart disease, cancer therapy has changed in the COVID-19-focused world. Simply going to the hospital to receive treatment comes with an added risk.
The cancer patient enters a building where the virus is active in other patients, is likely active in some of the medical staff who come in contact with them and is lingering on countertops and surfaces.
Yet authors of the paper stressed that “diagnosis and timely treatment of cancer patients should not be compromised during an infectious disease pandemic.” They added that the risk of any procedure must now be balanced against the increased risk of the pandemic and assessed one patient at a time.
“Radiation therapy during a pandemic has unique challenges,” they wrote. “Unlike medical or surgical therapies, radiotherapy patients need to attend daily, and the nature of the treatment is such that an interruption of therapy is clinically unacceptable.”
The paper offered recommendations to reduce the risk to cancer patients:
- Attendance at clinics where cancer patients are being treated should be limited to one visitor or none at all.
- Chemotherapy infusion units “must have strict screening and be prepared to identify and transfer potential (COVID-19) cases safely without risking disease transmission.”
- Patients should be called a day before a scheduled appointment and asked about their recent travel history, symptoms and possible contacts with people who may have been exposed to the virus.
- Patients should consult with their doctors to determine whether it may be safer or more appropriate to take a break from chemotherapy.
- Doctors should consider telephone visits — so-called “telemedicine” — to treat patients remotely and reduce in-person hospital visits.
- Routine screening and genetics appointments can be put off until this wave of the pandemic is over.
- Hospitals should try to separate COVID-19 patients and the staff who treat them from all other patients.
“Health care authorities in cancer care should immediately start planning for cancer care delivery during a pandemic,” authors of the paper concluded. “The limited, but accumulating, evidence suggest that patients with cancer are at higher risk of COVID-19 infection than individuals without cancer.”
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