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Coronavirus and cancer: What survivors and immunocompromised patients need to know

Should patients who are now receiving chemo cancel it? And which cancers raise the risk the most?
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/ Source: TODAY
By A. Pawlowski

The coronavirus outbreak may be especially worrisome for the hundreds of thousands of Americans living with cancer.

Their immune systems are often immunocompromised — weakened by the disease and its treatments — putting them at higher risk for the severe form of COVID-19, the infection spreading around the world.

Research shows there’s reason to be concerned.

Among 44,000 confirmed cases of COVID-19 in China, 0.9% of patients who had no underlying medical conditions died as of last month, but that number rose to 6% for people with cancer, the Centers for Disease Control and Prevention reported. (The death rate was even higher for people with heart disease, at 10.5%; and diabetes, at 7%.)

Compared to others, “patients with cancer were observed to have a higher risk of severe events” like requiring a breathing machine, wrote researchers in The Lancet after analyzing the cases of 18 cancer patients sick with COVID-19 in China.

Since those patients had poorer outcomes from COVID-19, the authors urged doctors to pay “more intensive attention” to cancer patients whose condition worsened rapidly.

Dr. Halle Moore, a medical oncologist at the Cleveland Clinic Taussig Cancer Institute in Ohio, said she and her colleagues have been getting calls and messages daily from concerned patients.

“None of us have seen this before,” Moore told TODAY.

Here are answers to some of the most commonly asked questions:

Are cancer survivors immunocompromised?

Patients with a history of cancer who are not currently on therapy and don’t have active cancer are probably not at significantly increased risk compared to other people in their age group, Moore said.

Hormonal therapies for breast cancer are also not going to increase the risk of severe disease, she added.

The higher risk is for people currently receiving immune-suppressive treatment, as well as those who have active cancer and are not in remission.

Chemotherapy is going to raise risk more than radiation or surgery, “but anything that stresses the system has the potential for increasing one’s risk of infection,” Moore said.

It’s not clear how immunotherapy might impact the risk, but patients receiving it may develop symptoms and side effects that can be very difficult to distinguish from infection, she noted.

Which types of cancer may most raise the risk?

They would include hematologic malignancies, or blood cancers, such as leukemia, lymphoma and myelodysplastic syndromes.

For those patients, both the treatment and the cancer itself affect the body’s natural defenses because the blood system is part of the immune system, Moore said.

Also, cancers that are active and affecting a person’s organ function are of concern — for example, patients with lung cancer may be at high risk for respiratory complications because they have underlying lung disease.

Patients with a history of a bone marrow transplant are at higher risk, too, because their immune system would be suppressed long-term.

How long are you immunocompromised after chemo?

“The risk is probably present for some period of time after those treatments. However, it should diminish significantly,” Moore said.

For solid (non-blood cancer) tumors that are no longer active, “immune function tends to return to normal fairly quickly… within a few months.”

How to know if you are immunocompromised:

There’s not a simple test doctors can perform to measure how intact a cancer patient’s immune function is in terms of fighting viral infections, Moore noted.

But a complete blood count can reveal important information, including the level of white blood cells, which fight infection, and overall health. It can help doctors identify patients who are at high risk because of a low blood count.

Should patients who are now receiving chemo cancel it?

It may depend on how widespread the new coronavirus is in their area and what their doctor recommends.

“Most patients who are getting treatment are getting it because they need it, so we cannot tell people to just automatically cancel their treatment,” Moore said.

“Each case will need to be individualized and discussed with their physician. We give chemotherapy for different treatments. Sometimes it’s with the intent to cure; sometimes it’s to help with symptoms.”

People who are getting routine follow-up may want to delay their visit or schedule a virtual consultation with their doctor, if available.

That will help limit the amount of germs that people who really do need to come in and be treated will be exposed to.

What precautions should cancer patients take?

Social distancing is particularly important for patients with active cancer and those undergoing immune-suppressing treatment, Moore said. That means avoiding crowds, not leaving home if you don’t have to, and not flying or taking public transportation unless absolutely necessary.

The standard advice is even more important for cancer patients: Wash your hands regularly, don’t touch your face and disinfect surfaces frequently. Keep your immune system strong by getting enough sleep, eating well and exercising.

“Those who are immunosuppressed need to be particularly vigilant and make preparations for if they need to stay in their homes for prolonged periods of time,” Moore noted.

Family caregivers should treat themselves as though they were at risk, too, to protect their loved ones.

What if a cancer patient notices coronavirus symptoms?

A patient who has active cancer or is getting treatment should consider a fever a medical emergency and immediately call their provider, Moore said.

For respiratory symptoms or other signs of the virus, call ahead rather than just showing up at emergency department or the doctor’s office. It will help doctors determine the next course of action.

Everyone should be thinking of this as a societal issue, Moore noted.

"There's still a fair number of people who are saying, 'I'm healthy, I'm not worried, I would get through this virus just fine.' But we all need to think about: Do we have a parent or grandparent who is older and who might not survive? Or do we know somebody with cancer?"