Cancer patients and survivors are among those at high risk of contracting coronavirus disease (COVID-19). To help provide accurate information on the link between these life-threatening illnesses, below are answers to the frequently asked clinical questions about COVID-19 and cancer from the American Society of Clinical Oncology, American Cancer Society, National Coalition for Cancer Survivorship, and Centers for Disease Control and Prevention.
Q1: What does it mean to be “immune-compromised?”
The term “immune-compromised” refers to people — whether man, woman, or child — whose immune system is weaker compared to the average healthy individual. The primary function of the immune system is to fight and defend against infection. People with compromised immune systems have a higher risk of developing illnesses, including viral infections such as COVID-19, due to their immune systems being weaker as a result of cancer and its treatments. Moreover, having a personal history of other health problems, including heart disease and diabetes, can also contribute to a weakened immune system. Increasing age and certain lifestyle choices are other causes of an impaired immune system.
Q2: Does having a history of cancer raise your risk for health complications from COVID-19?
It appears that cancer patients and survivors alike may be at higher risk of health complications from COVID-19 since this group of individuals is usually immune-compromised, according to ASCO Chief Medical Officer and Executive Vice President Dr. Richard Schilsky. A recent study also reported that men and women with a personal history of cancer had a higher incidence of severe complications from COVID-19, such as needing an intensive care unit and mechanical ventilation. The researchers also noted a higher incidence of death among coronavirus patients with cancer, compared with other patients who did not have cancer. In hindsight, it is important to understand that these results came from one study with a small focus group (18 cancer patients). Therefore, the results do not apply to everyone with malignant disease.
Q3: Does undergoing chemotherapy or radiation therapy in the past raise your risk of acquiring COVID-19?
There is no evidence suggesting that chemotherapy, radiation therapy, or any cancer treatment can raise your risk of COVID-19. However, patients who are receiving treatment for cancer often interact with healthcare professionals more frequently than the general population, so increased exposure in that setting may contribute to an increased risk of COVID-19. Most medical frontliners advise patients to speak with their cancer care team about rescheduling or possibly skipping non-essential clinic visits. In consequence, keep in mind that postponing a medical check-up or cancer treatment session due to concerns about the risk of infection with COVID-19 is a serious decision that a patient should discuss with his or her oncologist.
Q4: If a patient is about to start receiving cancer treatment, should they consider postponing it due to COVID-19?
There are significant factors to consider before making the decision to delay cancer treatment to avoid a potential infection with COVID-19. “Patients should talk with their treating oncologist about the risks of postponing treatment versus the potential benefit of decreasing their infection risk,” said Dr. Schilsky. “Things to discuss include the goals of cancer treatment, the likelihood that the cancer will be controlled with the treatment being planned, the intensity and side effects of the cancer treatment, and the supportive care that is available to reduce the side effects of treatment,” he continued.
Q5: Should cancer survivors who receive regular imaging tests to detect potential recurrence put their screening appointments on pause?
The Centers for Disease Control and Prevention recommends postponing all clinic visits, with the exception of situations that are matters of life and death. These postponable clinic visits include mammograms and other evaluations for detecting cancer recurrence. In most cases, the recommended frequency of these visits is between six months to one year. Therefore, extending the time between assessments may still be within the recommendations. However, if a cancer survivor develops a new symptom that might indicate recurrence, they should contact their cancer care team immediately.
Q6: Is a cancer patient with several comorbidities at higher risk for COVID-19? Does it matter if he or she takes medication for those underlying health conditions?
Patients with comorbidities, including hypertension, pulmonary disease, cardiovascular disease, chronic kidney disease, and diabetes do have an increased risk of severe complications from COVID-19. “Most reports have not described the extent to which these comorbidities were controlled by medication or lifestyle change at the time of onset of COVID-19 infection. It is reasonable to assume, however, that comorbidities that are well controlled by medication are less likely to predispose a person to severe complications from COVID-19,” reported Dr. Schilsky.
Q7: What should a newly diagnosed cancer patient do if they want a second opinion on their diagnosis or recommended therapy?
Most oncologists recommend second opinions, but it might be difficult (and risky) to find a new cancer specialist and schedule an appointment during this time. If you can get a second opinion via telephone or telehealth consultation, then “that should be a reasonable alternative to no second opinion at all,” advised Dr. Schilsky.
Q8: Are there ways to boost the immune system?
If you are a cancer patient or survivor, ensure to follow the recommendations of your doctor, as well as the general recommendations for a healthy lifestyle. Eat a nutrient-dense diet rich in fruits and vegetables, exercise on a regular basis, aspire to get quality sleep each night, and stop smoking or do not introduce your body to tobacco products.
Q9: What can caregivers do to protect themselves and the person they are caring for from COVID-19?
Caring for someone with a malignant disorder has become even more serious because of the growing pandemic. As a cancer patient’s caregiver, you may be at higher risk yourself, especially if you are older or have an underlying health condition. The good news is that staying healthy and sanitary may protect you and the person you are caring for, which means it is essential to take precautions to keep you and your patient from developing COVID-19. Aside from following public health guidelines on strict handwashing and social distancing, it may help to read the American Cancer Society’s guide to helping someone with cancer lower their risk of infection.
If you experience symptoms of COVID-19 or have had physical contact with someone infected with coronavirus disease, please notify your doctor or cancer care team right away. They should help guide you in your next steps.