COVID-19 & Cancer – Far Reaching Implications!

By Medical Expert Team

Nov 08 , 2020 | 2 min read

Despite many advances and breakthroughs, cancer still strikes fear in most of us. Every cancer patient is worried, stressed, anxious and has one question on their minds – will my treatment be compromised by the current circumstances? Very likely, it will. But given the risks associated with the COVID-19 infection in immune-compromised patients, those with co-morbidities and with advanced age, it would be sensible to delay any further treatment that will compromise the immune system further. None of us knows how long the risks are going to last, so I am going to discuss some practical considerations here.

Questions I am being askedare: If you delay my chemotherapy, will I still be cured ? Will my cancer spread if you delay surgery? Will my cure rate go down? Will my cancer come back? These are valid questions from patients who are already under tremendous stress because of their diagnosis, treatments and side-effects and multiple hospital visits.

Cancer patients on treatments do have to visit the hospital multiple times for various reasons – blood tests, physiotherapy, chemotherapy, radiotherapy, flushing of lines, removal of infusion pumps and to receive supportive care injections. Some of these can be done at home but in these trying times of limited public facilities to travel, this is near-impossible. Moreover, any contact with a healthcare worker is the biggest risk factor. These issues need to be addressed individually with a shared decision making model between the patient, family and the oncologist. These questions are affecting patients physically, psychologically, emotionally and financially. All our lives will have to be readjusted in the coming months.One size will not fit all!

It is quite possible that we may end up undertreating a few patients and may compromise outcomes in the long run but this must be weighed against the clear threat from the COVID-19which may also increase deaths short-term. To try and improve 5 or 10 year survival outcomes marginally and to ignore the real risk of dying now due to COVID-19 is impractical.

Cancer patients are particularly vulnerable to theCOVID-19 as their immune systems are compromised as a result of the cancer itself and the treatments given. Evidence from China and South Korea shows that the implications are longterm,at least for the foreseeable next 3-6 months or even longer. This will change the way we treat cancer patients as treatments cannot be delayed for so long.

I am continuously being asked about home based respirators and chloroquine. Based on reports, it is possible that some patients after initial stabilization may require respirator support for a few weeks. This will have to be medically supervised, hence having a respirator / oxygen unit at home is not going to help without medical support. Regarding chloroquine, this is an anti-malarial drug which is well tolerated and is used widely also for treatment of rheumatoid arthritis. The Indian Council of Medical Research has approved the drug for prevention in high risk health care workers and those in close contact with patients affected with the COVID-19. Each patient should have an individualized discussion with their oncologist regarding this and consider starting this if appropriate.