Published on September 29, 2020
Coronavirus and Cancer: Am I High Risk?
Since early March 2020, when news of the novel coronavirus (COVID-19) becoming a pandemic hit, Patient Power immediately went to work to uncover what people living with cancer needed to know about their risks as cancer survivors and how to stay safe. Was the risk of coronavirus exposure by going to a doctor’s office or a lab appointment more dangerous than skipping the appointment? Should you delay chemotherapy or radiation treatment to avoid going to a public space? What if you were to become sick with the coronavirus, are you more likely to have complications because of your cancer or cancer treatment? We have interviewed many cancer experts on the topic of cancer and coronavirus, to discuss how COVID-19 affects people by their specific cancer type.
What Do We Know So Far About Coronavirus and Cancer?
From our many interviews with oncologists and medical experts, we know that there are some general guidelines about how cancer patients should move forward during the coronavirus pandemic:
- Practice the safety guidelines recommended by the CDC: Wear a mask, avoid public spaces and public transportation, wash hands, maintain a social distance of at least six feet, disinfect surfaces.
- Hospitals and clinics are taking COVID-19 very seriously. Clinics have removed chairs and rescheduled appointments to reduce the number of people in a waiting room. Many non-essential appointments may be postponed or moved to a telehealth/virtual appointment. Call ahead to see what your clinic has in place for COVID-19 safety and talk with your doctor if you should keep your in-person appointment.
- SARS-CoV-2/Coronavirus is a new virus that experts are still trying to understand. It affects people differently, even cancer survivors. Certain types of cancers may be considered a co-morbidity and have a higher chance of severe reactions, other cancers may not.
- Never discontinue your treatments or cancel your appointments without discussing first with your oncologist.
Coronavirus and Acute Lymphoblastic Leukemia
Children with pediatric acute lymphoblastic leukemia (ALL) are most likely already taking precautions to avoid germs and illness because of the effect that treatment has on their immune system. Even without a COVID-19 pandemic, avoiding germs, washing hands and avoiding others who are ill is important to children undergoing treatment for leukemia and should especially continue during the coronavirus outbreak.
What happens if a child with acute leukemia becomes infected with the coronavirus?
Because their immune system is weakened from chemotherapy, a child with ALL is at higher risk for complications from COVID-19. However, even though kids with pediatric ALL are at higher risk for complications, so far the outcomes of children with ALL who’ve contracted the novel coronavirus have been mostly good. These children have had mostly mild symptoms and have recovered from COVID-19. However, that doesn’t mean parents or children should become too relaxed about germ prevention. Children with leukemia can still enjoy outdoor activities, exercise and small gatherings with people who are considered “in the bubble” because they are also limiting their outside exposure.
How does the coronavirus outbreak affect adults who need treatment for ALL?
Older adults who are in remission for acute lymphoblastic leukemia may experience some delays in getting treatment or scheduling doctor’s appointments because their disease is considered managed and they are considered high-risk for COVID-19. Adults who have tested positive for coronavirus but needed to receive treatment for their leukemia may have experienced a delay in treatment because experts needed to figure out if treatment was safe for someone who has tested positive for COVID-19. For the most part, adults with acute leukemia still received their treatment even if they tested positive for coronavirus. However, many patients had to stay at the hospital and weren’t allowed to travel home between appointments.
Stem Cell Transplants During Coronavirus Outbreak
Stem cell transplants are still moving forward during the COVID-19 pandemic. Many people with acute leukemia want to know if they are at high-risk for complications from the coronavirus since they have a blood cancer, and the answer is that it’s not conclusive. The numbers haven’t shown that people living with a blood cancer like ALL have had worse outcomes than other people who’ve gotten COVID-19. However, it is still recommended that people living with acute lymphoblastic leukemia take all the safety precautions to avoid becoming infected with COVID-19.
Coronavirus and Acute Myeloid Leukemia (AML)
People living with acute myeloid leukemia during the coronavirus outbreak want to know if they are more at risk of contracting COVID-19 and having complications from it since they are more likely to be immunocompromised due to treatment. Studies looking at the outcomes of people with cancer who contracted the novel coronavirus showed that cancer patients (mainly those with solid-tumor cancers) had a higher rate of mortality and needing a ventilator. The fact that people with leukemia have a defect in their immune system makes experts concerned that they would have a worse prognosis if they were to contract COVID-19. It is recommended that patients currently in treatment for AML and people who are in remission from AML treatment should still maintain strict safety protocols, such as avoiding crowds, wearing masks, handwashing and limiting exposure to germs to reduce their chance of getting COVID-19.
Coronavirus and Breast Cancer
What does breast cancer treatment look like during the coronavirus outbreak? Are patients having to go to treatments alone? Can women still attend breast cancer support groups? The COVID-19 pandemic has affected all aspects of life, and especially for people who need to go to doctors’ appointments, labs, clinics or radiation therapy.
Does Breast Cancer Mean I am More at Risk for Getting Coronavirus or Having Complications?
People with breast cancer are not more at risk of contracting COVID-19 than someone without cancer. However, there are some risks that people living with breast cancer should be aware of. Small studies out of China and Italy have shown that people with cancer are more likely to need a ventilator or die from complications from the novel coronavirus. Those studies included all types of cancers and were not specific to breast cancer. Studies have shown that people with breast cancer who are on hormone-blocking drugs such as tamoxifen and those who have completed surgery are not immunocompromised because of that, and are at the same risk levels of complications as the general population.
How Has Coronavirus Affected Breast Cancer Treatment?
In the earlier days of the COVID-19 outbreak, some surgeries for nonmetastatic breast cancer patients may have been delayed, if the delay wouldn’t affect the rate of cure. This was to make sure that masks, gowns, ventilators, and gloves were available should hospitals need to make more ICU beds. If chemotherapy was a part of the treatment, it may have been prescribed to begin before the surgery. The goal was to keep early-stage breast cancer patients out of the hospital at the beginning of the epidemic. As time goes on, the rules and procedures as to when to have surgery or oncology appointments will change depending on new information. Many women who need daily radiation will either delay that radiation treatment or will continue to receive radiation but with a health screening when they enter the building. Many non-essential appointments may be moved to a telehealth appointment. However, every breast cancer patient is unique and they should communicate with their health care team about what they would like their treatment path to look like.
Coronavirus and Chronic Lymphocytic Leukemia
The average age of diagnosis for chronic lymphocytic leukemia (CLL) is 70. This means that many people living with CLL are also considered to be in the high-risk category should they contract COVID-19. What do older people living with CLL need to know about staying safe during the coronavirus outbreak? Having CLL means that your immune system is somewhat suppressed. Knowing that people become more high risk for severe reactions from COVID-19 as they get older, and people living with CLL have compromised immune systems, it’s important to take safety measures in order to not contract COVID-19.
How Does the Novel Coronavirus Affect CLL Treatments?
Some patients may be asked to schedule a telehealth appointment instead of an in-person appointment. Lab appointments may be moved to a location that is closer to the patient’s home or may even be performed in the patient’s house. If there are no significant changes to a patient’s CLL status, some doctor’s appointments may be postponed.
Will IVIG Infusions for CLL Be Delayed?
Immunoglobulin infusions help boost the immune system of a CLL patient. In some cases, patients can receive IVIG infusions at home. For others, however, this requires going into a hospital or clinic setting for the infusions to be administered. Is this still safe during the coronavirus outbreak? It may depend on the patient and their levels, as well as where they live. People in the south may be able to take a break from IVIG infusions in the summer months, whereas people who live in northern, cooler climates may need to continue them. Unfortunately, IVIG infusions do not give a CLL patient protection from COVID-19.
Have People with CLL Recovered From COVID-19?
Studies are still being done on patients with CLL and COVID-19 and tracking the outcomes. Although people with chronic lymphocytic leukemia may be more susceptible to getting the novel coronavirus due to B-cell and T-cell abnormalities, they may not have the damaging immune response that some people experience due to having a weakened immune system. There may also be some protection from an over-active immune response from the treatments used for CLL.
Coronavirus and Hodgkin Lymphoma
People living with or who are survivors of Hodgkin lymphoma are not at an increased risk of contracting the novel coronavirus more than the average population.
Does Being Treated for Hodgkin Lymphoma Mean I Have a Co-Morbidity?
It really depends on the patient and how they were treated for their Hodgkin lymphoma. Having radiation to the chest or having been on bleomycin may make a Hodgkin survivor more at risk for cardiovascular disease, which is a co-morbidity.
Am I At Risk of Coronavirus Complications if I Had a Stem Cell Transplant?
Most patients who have undergone a stem cell transplant are going to have normal or close to normal blood counts 90 days after transplant. Even if someone who’s had a stem cell transplant hasn’t received all their re-immunizations, that doesn’t make them more at risk of COVID-19 complications.
Staying Safe From Coronavirus While Living With Hodgkin Lymphoma
In-person doctor visits are a very low-risk activity, and the chance of contracting COVID-19 in a clinic or hospital is rare. People in treatment for Hodgkin lymphoma should practice caution so they don’t become infected. Wearing masks, avoiding people, hand-washing and social distancing are important steps to avoid exposure to the novel coronavirus.
Coronavirus and Lung Cancer
The TERAVOLT study looked at the outcomes of SARS-CoV-2 on patients with thoracic cancers. It shows that there is an elevated risk of hospitalization and mortality among patients living with lung cancer who may have also had other co-morbidities. It is important for lung cancer patients to discuss their treatment options during the coronavirus outbreak and decide whether to move on with treatment as normal or if some appointments can be done online or postponed. It is recommended that people living with lung cancer adhere to safety guidelines such as wearing a mask, avoiding people and crowds, handwashing and social distancing to avoid coming into contact with COVID-19.
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