Cancer Care in the Era of COVID-19 Pandemic
Cancer patients are at increased risk of COVID-19 infection as per the Centers for Disease Control and Prevention (CDC) guidelines. Thus, there is a lot of valid anxiety among patients undergoing cancer treatments or other immunocompromised therapies which may put them at risk of this infection. In order to shed some light on recent revelations, we asked Dr. Nancy Sharma (Medical Oncologist and Hematologist at Swedish Cancer Institute at Issaquah) to address questions and concerns of our patients. Dr. Sharma has been practicing oncology for eleven years working with cutting edge research and delivering the newest cancer treatments including immunotherapy.
Q: Is it true that cancer patients are at increased risk for COVID-19 infection?
A: Yes. As per the report of the World Health Organization (WHO)/China joint mission on corona virus disease published on February 28, 2020, the case fatality rate for patients with cancer as a comorbid condition was 7.6%. This is compared to the overall COVID-19 case fatality rate of 3.8%. Patients with a history of cancer have also been found to have a higher incidence of severe events such as admission to the intensive care unit compared with other patients.
Q: What steps can cancer patients take to minimize the risk of infection?
A: Patients starting anticancer therapies should be made aware of the symptoms of COVID-19. They should be trained on proper handwashing, hygiene and minimizing exposure to sick contacts and large crowds. Use of a mask should be encouraged as per CDC guidelines. Any symptoms of infection and fever in cancer patients should be evaluated comprehensively.
Q: Is it safe for cancer patients to have pets at home?
A: Data on virus transmission to household pets is still evolving. As per a recent study published in New England Journal of Medicine (NEJM), cats may be silent intermediate hosts of the virus. Infected cats may not show any appreciable symptoms that might be recognized by their owners. While it is not recommended that cancer patients remove pets from their homes, it is recommended that other family members manage litter boxes. If living alone with cats, patients should wear masks and gloves to dispose of litter.
Q: Should all cancer patients be tested for the virus?
A: The CDC has not provided any specific guidance with respect to COVID-19 testing in patients with cancer. Thus, most cancer centers are following the same guidelines as the general population. As per the American Society of Clinical Oncology (ASCO), it may be reasonable to test asymptomatic patients who will be receiving immunosuppressive anticancer therapy. This might inform doctors to delay anticancer therapy and guide decisions around protection of healthcare providers and other patients.
Q: How should one get an antibody test?
A: At this point, antibody tests are still being developed and implemented. You should check with your healthcare provider to see if they offer antibody tests at their facility. However, the results of the antibody tests should be evaluated carefully.
A positive antibody test, does not mean that you are immune to the virus. It only tells you that you have recently been infected by the coronavirus. Similarly, a negative test may be falsely reassuring, since antibodies do not show up for 1 to 3 weeks after infection.
Q. What are the recommendations regarding activity for cancer patients who have positive COVID-19 results?
A. Among the recommendations by general cardiology, asymptomatic people should not exercise for 2 weeks after a positive COVID-19 results in those with mild symptoms should not exercise until 2 weeks after symptom resolution. Similar recommendations apply for cancer patients.
Q Should cancer patients be given hydroxychloroquine prophylactically?
A. As per the recent data, hydroxychloroquine has not been found to be useful in treatment or prophylaxis of COVID-19 infection.
Two retrospective studies in COVID -19 patients in New York found no impact of hydroxychloroquine with or without azithromycin on risk of intubation or death.
In another double blind randomized trial, 821 asymptomatic persons with exposure to COVID 19 were given hydoxychloroquine or placebo within 4 days after the exposure without any evidence of preventing illness. Thus, WHO has stopped clinical trials on hydroxychloroquine.
Q. Should cancer patients with COVID-19 be on home isolation?
A. As per the ASCO guidelines, patients with cancer and COVID-19 should maintain home isolation until resolution of fever without the use of fever reducing medications, improvement of respiratory symptoms and 2 consecutive negative results of COVID-19 tests done 24 hours apart.
If readers have any further questions about cancer care during COVID-19 era, please send them to us and we will try to answer them with as much evidence as possible.
Stay safe everyone.
References:
Cohen Myron S (2020) Hydroxychloroquine for the Prevention of Covid-19 — Searching for Evidence. N Engl J Med DOI: 10.1056/NEJMe2020388.
Boulware David et al. (2020) A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med DOI: 10.1056/NEJMe2016638
ASCO guidelines (2020) A guide to cancer care delivery during the pandemic.
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
Weinstein Milton et al. (2020) Waiting for Certainty on Covid-19 Antibody Tests — At What Cost? N Engl J Med DOI: 10.1056/NEJMp2017739