Cancer and COVID-19

COVID-19 Questions from Cancer Patients and Their Caretakers

1. What should I do if I suspect I have cancer during COVID-19?

  • DO NOT go to the emergency room
  • Call your primary care physician and request a telemedicine appointment
    • If they do not offer remote, virtual appointments, either
      • Speak with your doctor by phone and ask them how to proceed, or
      • Download and sign up for a telemedicine service on your phone so you can been evaluated immediately
  • While laws are rapidly changing to encourage healthcare professionals and patients to use telemedicine during the pandemic, insurance coverage, both public and private, varies by company/institution and state
    • DO NOT go into a hospital, clinic, or office until it is absolutely necessary and tests/scans have been ordered

2. What should I do if I suspect I have COVID-19 and am undergoing treatment?

  • All patients undergoing cancer treatment including: chemo, radiation, immunotherapy, and/or surgery, are considered at HIGH RISK for COVID-19
  • If you suspect you have COVID-19 call your oncologist immediately
  • DO NOT go directly to the emergency room or to a testing facility without a plan made with your care team because if you do not have COVID-19, you are likely to contract it at those sites
  • According to the recently passed Families First Coronavirus Response Act if you need to visit your healthcare provider for coronavirus testing your insurance, public or private, should cover both the test and the visit
    • ***NOTE***
      • Some patients who were tested received bills from the hospitals where they were tested because they were out of network
      • HOWEVER, on Friday, April 3rd, the President announced that his administration will use money from the recent stimulus bills to pay hospitals for treatment of uninsured coronavirus patients
      • It is UNCLEAR exactly how privately or publicly insured patients will be billed by hospitals
      • Please contact me if you need assistance with this issue!

3. I am scared to go to the hospital for treatment, do I have to go?

  • One would hope that your oncology team is acutely aware of not only your individual risk, but the risk that is posed by having multiple patients in a treatment center at this time. However it is critical to find out what protocols they have in place. Contact them and ask how they plan to modify the clinical procedure.
    • DO NOT ASSUME THAT ANY PERSONAL PROTECTIVE EQUIPMENT (PPE) WILL BE PROVIDED TO YOU! Procure your own!
  • While it is important to stay on your treatment schedule to complete your individual protocol, many treatments can be administered from home
    • Your oncologist, nurse practitioner, and social worker may be able to work with you to have your treatment administered at home
    • You, and your caregivers, can be trained to administer certain treatments, and a home healthcare aide can come to your home to administer those that need to be done by a professional
  • To minimize your potential exposure to COVID-19, you should ask your oncologist about delaying any/all in and out-patient, elective, preventative, and adjuvant treatments/procedures
    • Dr. Len Lichtenfeld, Deputy Chief Medical Officer of The American Cancer Society, stated “We’re headed for a time when there will be significant disruptions in the care for patients with cancer. For some it may mean a delay in having elective surgery. For others it may be delaying preventative care or adjuvant chemotherapy that is meant to keep the cancer from returning.” These appointments will need to be rescheduled once the peak of the pandemic has passed.
  • ASK YOUR ONCOLOGIST THE FOLLOWING QUESTIONS
    • Why do you want to delay my treatment?
    • Is it exposure to COVID-19 or a medical staff and supply issue?
    • Can I keep my appointments through telemedicine?
    • Can I get my treatment from home so it is not delayed?
    • If you insist my treatment must be delayed, then when will my treatment resume and what impact will that have on the success of my treatment and the overall treatment timeline?
  • Asking your oncologist hard questions is not only your right, according to The Patient Bill of Rights, but it makes you a better advocate for yourself and the decisions you make about your own health. Any physician who does not welcome your questions may not be the right physician for you.

4. What happens if my oncologist/hospital wants to delay my treatment?

  • Protocols are called protocols for a reason, it is a general set of treatment guidelines that have to be modified for EACH INDIVIDUAL PATIENT. Your doctor may want to delay your in and/or out-patient treatment to minimize your exposure to COVID-19.
    • Dr. Len Lichtenfeld, Deputy Chief Medical Officer of The American Cancer Society, stated “We’re headed for a time when there will be significant disruptions in the care for patients with cancer. For some it may mean a delay in having elective surgery. For others it may be delaying preventative care or adjuvant chemotherapy that is meant to keep the cancer from returning.” These appointments will need to be rescheduled once the peak of the pandemic has passed.
  • ASK YOUR ONCOLOGIST THE FOLLOWING QUESTIONS
    • Why do you want to delay my treatment?
    • Is it exposure to COVID-19 or a medical staff and supply issue?
    • Can I keep my appointments through telemedicine?
    • Can I get my treatment from home so it is not delayed?
    • If you insist my treatment must be delayed, then when will my treatment resume and what impact will that have on the success of my treatment and the overall treatment timeline?
  • Asking your oncologist hard questions is not only your right, according to The Patient Bill of Rights, but it makes you a better advocate for yourself and the decisions you make about your own health. Any physician who does not welcome your questions may not be the right physician for you.

5. I am in the midst of treatment, should I delay or stop?

  • EACH AND EVERY CASE IS DIFFERENT
  • If your oncologist recommends a delay in treatment, then it is wise to listen
    • The American Cancer Society, the National Cancer Institute, and multiple medical journal publications advocate for the delay of adjuvant chemotherapy and elective surgery for stable cancer patients
    • Proactively boost your immunity and monitor yourself, you know yourself better than anyone else (See question 7!)
  • If your doctor recommends you continue your treatment, then continue, AND proactively boost your immunity (See question 7!)

6. I know I am considered high risk because I am immunosuppressed, so what steps can I take to protect myself?

  • STAY HOME
  • WASH YOUR HANDS REGULARLY
  • DO NOT TOUCH YOUR FACE (This is really hard!)
  • PRINT, READ, AND POST THIS ON YOUR FRIDGE:
  • Clean Your Home with EPA and CDC Approved Products that kill COVID-19
  • Quarantine yourself from
    • Family members/roommates who still have to work outside the home on a regular basis
    • Family members/roommates who have travelled or attended a large public gathering in the last 14 days
    • Children who have not been home or isolated for 14 days
  • Groceries/Takeout Food/Packages/Mail
    • WATCH THE FOLLOWING:
    • HAVE ALL GROCERIES, TAKEOUT FOOD, PACKAGES, AND MAIL DELIVERED TO YOUR DOOR, PORCH, OR GARAGE, do not allow the delivery man or woman come into your COVID-19 free home
    • Groceries
      • Use a delivery service or have a someone, preferably outside the home, shop for you
      • If you cannot get delivery, call your local grocery store and tell them that you are immunocompromised, they will with either deliver them to you or assist you with curbside pickup
      • Leave items not needed for immediate use to sit on you porch or in your garage for 72 hours
      • Otherwise decontaminate all items in accordance with the above video
    • Takeout Food
      • If you order takeout, order a dish that can be heated so that you can microwave it to assure it is not contaminated
      • Remove packaging and serve in accordance with the above video
    • Packages/Mail
      • Leave packages and mail on porch or in garage for 72 hours unless it is necessary to open immediately
      • Otherwise decontaminate outside of package and potential contents according to the above video
    • Laundry
      • Wash clothes, towels, and linens regularly and the warmest setting possible
      • Disinfect your laundry hamper
      • Don’t shake dirty laundry
      • WEAR GLOVES if you are laundering anything that has been out in public
    • Pets
      • Dogs and Cats cannot get sick from COVID-19
      • That said, they may get it and test positive for it, but unlike humans, they will not fall ill
      • FOR THAT REASON, AND BECAUSE THEY ARE FURRY CARRIERS of COVID-19 MOLECULES
        • Supervise your pet in your backyard
        • It is okay to play with them outside of your home, JUST KEEP YOUR, AND YOUR PET’S 6ft DISTANCE FROM OTHER HUMANS
    • Guests
      • ONLY VIRTUAL ONES PLEASE!

7. I know I am considered high risk because I am immunosuppressed, but is there anything I can do to boost what immunity I do have?

  • Sleep Well
  • Eat Immune Boosting Meals and Snacks
  • Move!
  • Monitor Your Mental Health
    • It is extremely difficult not to feel isolated when undergoing cancer treatment, COVID-19 only makes that isolation more profound (See question 8.)
  • Self-Care
    • WASH YOUR HANDS
    • MOISTURIZE your hands, so that that the COVID-19 molecules cannot hide in microcracks in the skin
    • KEEP YOUR NAILS SHORT so that the COVID-19 molecules do not hide under them
    • DO NOT TOUCH YOUR FACE (This is really hard!)
  • Supplements
    • Consult your oncologist before taking them as they may interact with your treatment
    • High-dose Vitamin C and Zinc
      • This combination is a known combatant of cold and flu viruses, as together they have shown an increased the rate of recovery in patients who are already infected
      • Individually, both Vitamin C and Zinc play important roles in immune defense
      • Recommended Dose
        • 1000mg/day Vitamin C (ascorbic acid) 1000mg/day
        • 15-30mg/day Zinc (acetate, gluconate, or picolinate)
    • Vitamin D
      • Modulates the innate and adaptive immune responses
      • Can often get depleted for patients undergoing treatment and avoiding sun exposure
      • Recommended Dose
        • 5000IU/day D3

8. Having cancer already makes me feel isolated, the pandemic has only exacerbated that, what can I do?

9. My partner/spouse is my caretaker and he/she has to work through the current quarantine, what do we do?

  • Never fear, if you have a door and disinfectant, YOU CAN DO THIS!
    • Decontaminate your home, see Question 6
    • Isolate him/her in another room and, if possible, ask them to use a separate bathroom
    • Be aware of all HIGH TOUCH SURFACES and be ready to be constantly wiping them down multiple times a day
    • Do not share items with them
      • Designate specific plates, cups, and cutlery for your partner/spouse and have them clean them
      • Have your partner/spouse remove the clothes they wore in public and launder them immediately on warmest setting
      • Have separate sets of toothpaste, shampoo, conditioner, and body wash/ soap
    • WEAR GLOVES if/ when you are doing communal dish/ clothes washing
    • WASH YOUR HANDS FREQUENTLY
    • Ask your partner/ spouse to WEAR A MASK in your presence as it will severely decrease the amount of potential viral particles in their air

10. Cancer is stressful enough on my family, what can we do now that we are all home together for the foreseeable future?

  • DON’T PANIC. No parent or child, regardless of age, was ready to be home, indefinitely, full-time, TOGETHER
  • Contact your oncologist and let them know that you now have family home that was not only unexpected, but may have been exposed to COVID-19
  • Make a plan with your family about how you are going to handle quarantine
    • Designate one person to interact with the public to be the errand-runner
    • Set up a disinfecting station outside or in a low traffic area for all packages, groceries, and goods entering the home
  • At present, almost all public and private universities, high schools, and elementary schools have successfully transitioned to online classes
    • Everyone needs a place to work and think, you may need to put a card table up in the laundry room, basement, or garage, but make sure everyone has a private/semi-private workspace…for your sanity and theirs.
    • Headphones may be a solid investment right now
  • BE KIND TO YOURSELF. NO ONE is doing this perfectly, so do not make that your goal

11. Is there any data yet on cancer patients and COVID-19?

  • Preliminary published data out of Asia shows the following:
    • Cancer patients are at higher risk of contracting COVID-19
    • Cancer patients, as a population, have poorer outcomes from COVID-19
    • Among cancer patients with COVID-19 age is the only risk factor
      • Lung-cancer patients did not have a higher probability of severe events compared with patients being treated for other types of cancer
    • A possible risk factor that needs to be further studied in cancer patients who contract COVID-19 is time between of immunosuppressive treatment and/or surgery and contraction of the virus
  • Recommendations
    • Intentionally postpone adjuvant chemotherapy and elective surgery for stable cancer patients in endemic areas
    • Stronger personal protection provisions should be made for cancer patients
    • More intensive surveillance and treatment should be considered for cancer patients infected with COVID-19

The information contained in this post was sourced from the following: