Coronavirus and the Cancer Patient

Patients with cancer, survivors and particularly those who have compromised immune systems are reasonably concerned about the potential effect of the newly described coronavirus (COVID-19) on their health and care.  There has been a worldwide spread of the virus and increasing numbers seen in the United States.

The Coronavirus
This virus (which has been termed COVID-19 and sometimes SARS-CoV-2) was first recognized in Wuhan, China in December, 2019.  Coronaviruses are a very large family of RNA viruses most commonly associated with the common cold and other mild illnesses, but sometimes with severe diseases such as SARS (Severe Acute Respiratory Syndrome primarily in 2002-3) and MERS (Middle East Respiratory Syndrome in 2013-14).  This COVID-19 is genetically related to the SARS virus.  These viruses also cause a large variety of diseases in animals and livestock such as pigs, cows, chickens, dogs, and cats as well as wild animals such as bats.  Hundreds of these types of viruses have been identified in the last decade.  Research data suggests that this virus was able to jump from probably a bat to man around last December.  Ever since, the disease has spread rapidly with some areas heavily and severely affected.  As the virus has spread, national, regional and local efforts and guidelines to slow the spread have been instituted including here in Florida.  The situation is rapidly evolving and may be different in different areas of the country.

Fortunately, most of the cases of COVID-19 are mild.   The main symptoms of a significant infection are high fever (>101 degrees), a deep dry cough, excess fatigue and shortness of breath, sometimes loss of smell, aches and pains, nasal congestion or runny nose.  It appears that some infected people do not develop symptoms at all, but some develop major breathing issues.  Older people (particularly over 70), and those run down with chronic illnesses, or with compromised immune symptoms have a more difficult time with the illness and are a higher risk of developing an acute respiratory syndrome. Weakened immune systems can result from intensive chemotherapy or bone marrow transplantation but localized radiation therapy or hormonal therapy usually does not severely alter the immune function.  It appears that patients in active chemotherapy treatment or shortly after are more at risk than patients who have completed therapy and recovered.

Based upon the first study of affected patients, about 1% of the coronavirus patients also had a history of cancer, suggesting that having cancer increases the risk of getting COVID-19 by 3 fold compared to with no risk factors.  This is similar to other respiratory illnesses such as the avian flu. Co-morbidities also affected the fatality rate as well.  People with no other health conditions had a fatality rate of 1.4% while those with cancer had a fatality rate of around 5-7%.  There was no evidence that any specific type of cancer (e.g. breast, lung, prostate) was more at risk and unfortunately, no detailed information on type of treatments.  However, it did appear that cancer patients were at risk to progress more rapidly to severe lung illness and recommended timely attention to breathing problems.  There is a lot of uncertainty about the risk numbers because testing was not previously widely available and reliable, and since some people have minor symptoms, it seems plausible that ultimately the risk will be lower than these numbers – but until then we need to be vigilant.

So, what does this mean for the patient with cancer?

• First, the message that is very clear is that those who have cancer, particularly if they are over 70 years are at an increased risk from this infection and should be extra cautious. Social distancing is an important part of reducing the risk of getting infected and minimizing the spread
• Cancer patients under active treatment with scheduled appointments should keep them unless they’re experiencing coronavirus symptoms. The Ackerman cancer center is making special procedures available for protecting and managing patients and staff during this time.
• At this time, there is no direct evidence to support changing or delaying critical anti-cancer therapy. The decision in each individual patient needs to consider factors such as the risk of cancer recurrence if the therapy is stopped or delayed, as well as the patient’s tolerance of the treatment.  Also, there may be limitations on testing, radiologic studies, and treatment which result from limitations of the health system.  To conserve resources of the health system and minimize contacts, and weighing the risks and benefits will result in screening mammograms and some follow-ups being postponed.
• If you get sick, let someone know. Call your provider and let them know you have respiratory symptoms.  Sometimes, they may advise you to stay home.  If you’re feeling very sick and think you need to go to the ER, call ahead and let them know and they will provide guidelines and protect you when you walk in the door.
• Wash your hands often with soap and water, for at least 20 seconds.
• If someone in the household gets sick, use social distancing to reduce the risk of spreading. Older people are more susceptible so if young people are sick, try to minimize the exposure.
• If possible, try to avoid using public transportation, and when in public use social distancing. Stay at home unless necessary.
• Try to get good sleep and good nutrition – it’s very important to helping maintain a good immune system.
• Make sure your vaccinations are up to date.
• Stay up to date with the recommendations from public health officials as the situation is changing rapidly.

The good news is that coronaviruses tend to go away when the weather warms up and people are not crowding inside, so it is likely that this virus will pass.  Let’s hope it does so soon and until then continue with the social distancing to help minimize spread. Lots of research and clinical studies are underway for new treatments and vaccines and hopefully, these will be able to control this and other similar viruses.  We will get through it.