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Coronavirus and What Do Lung Cancer Patients Need to Know

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Published on March 30, 2020

Key Takeaways

  • The risks of untreated lung cancer are higher than the risk of getting coronavirus. If you're undergoing treatment, it’s not currently recommended to stop unless you become sick during therapy.
  • Hospitals are proactively taking safety precautions for patients who must come in for treatment and, when appropriate, doctors are doing telehealth visits. Talk with your doctor about whether an appointment can be done remotely.

Renowned expert Dr. Ross Camidge, from the University of Colorado Anschutz Medical Campus, answers pertinent questions from lung cancer patients and care partners regarding the coronavirus (COVID-19) outbreak.

Dr. Camidge addresses concerns about the risk for infection, treatment, family interaction, doctor visits and more.

Dr. Camidge also breaks down the data on coronavirus outcomes and draws an important distinction for lung cancer patients between the risk of getting the virus and the risk of having serious complications if infected. Watch now to find out more from a lung cancer expert.

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Transcript | Coronavirus and What Do Lung Cancer Patients Need to Know

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded March 26, 2020

Andrew Schorr:
Greetings to another one of our live webinars, Ask the Expert, at this time of coronavirus (COVID-19). Now, I'm Andrew Schorr. Joining us from outside Denver, Colorado, in the Anschutz Medical Center is the Director of Thoracic Oncology at the University of Colorado, Dr. Ross Camidge. Dr. Camidge, thanks for being with us for this live Ask the Expert program.

Dr. Camidge:
It's my pleasure. Hello everyone.

Andrew Schorr:
Okay, hello. Well, we've gotten in a lot of questions. We're going to get right to it. First of all, for people affected by lung cancer, for people living with it, who've been treated for it, Dr. Camidge, are they at higher risk, just because of the lung cancer, of getting the virus?

Dr. Camidge:
So, we should draw a distinction between the risk of getting the virus and the risk of severe or serious complications if you get it. I would say there's nothing about lung cancer per se that increases your risk of getting it. Your immunity is okay if you're on chemotherapy, that is most in relation to bacterial infections rather than viral infections. But there's no doubt that if you were to get it, your chance of becoming more severely ill is much higher.

Andrew Schorr:
Okay. Now, I should just tell our audience, some of you have sent in questions, comments to patientpower.info, but there's a little Q&A button at the bottom, and you can send in a question there. And then Esther Schorr, who's our producer behind the scenes, will go through it and then send it to us, and we'll do the best we can over the next 30 minutes or so. Okay. Now, if you have cancer that's been treated in your lungs, because it's a respiratory condition, how does the cancer interact with the virus in your lungs?

Dr. Camidge:
Well, I don't think the cancer and the virus directly interact. Let me try and explain some data that I got from one of my old trainees who now works in Shanghai. Barely two weeks ago, he sent me an email. I was in the clinic, and I opened it up. He said, "You spend a lot of time with your patients. You need to know that this virus is coming, and you need to take serious precautions."

And as we chatted about the Chinese experience, he said, "Look, this is what happens. So, about a third of people have almost no symptoms. About a third of people get some moderate flu-like symptoms, but recover. And then probably less than a third, maybe about 10 to 20 percent of people, maybe about 20 percent at most, get severely ill and have to be hospitalized. And of those, about 20 percent die."

So, 20 percent of 20 percent is about 4 percent. That's where you get that 4 percent death rate that people are throwing around. The issue is that that 4 percent is not evenly distributed amongst the population. It is biased towards older people and people with co-morbidities. And lung cancer, and some of the treatments that we have for lung cancer, will increase your chance of coping with the virus less well. So, you are more likely to be in that severe category.

There's not a direct interaction with the lung cancer per se, but if you've got compromised respiratory function or you have other co-morbidities, maybe you're diabetic, maybe you have COPD, maybe you have a heart condition, your chance of running into problems if you get the virus is higher.

Andrew Schorr:
Okay. You talked about therapy. So, many people have radiation, and are maybe even on a schedule for radiation now, and so they're told to stay close to home. Let's talk about radiation programs now, and whether people continue, can they take a break. I know it's going to vary by patient, there's not a one size fits all, but what are you telling people?

Dr. Camidge:

I mean, we should recognize the difference between a clear and present danger of potentially an untreated lung cancer, and a theoretical risk of catching the virus, and then a theoretical risk, if you catch the virus, of being in a group that does rather unwell. So, if you're going through treatment for your lung cancer, which is designed to cure you, so radical radiotherapy, a defined course, I would not interrupt that.

Your much greater risk is from untreated lung cancer than from a theoretical risk of the virus. Now, if you're in the middle of your radiotherapy and you get sick, that's a totally different matter. Sometimes treatment has to be interrupted, because somebody has developed the flu or something like that. But I would not second-guess the risks to your life of catching the virus just if you're in the middle of some treatment designed to cure you of a much clearer and present danger in terms of the lung cancer.

Andrew Schorr:
Okay. That means coming to the center, whether it's for that or maybe for some infused therapy.

Dr. Camidge:
Yeah.

Andrew Schorr:
And so people worry, well, hospitals have always been places where you worry about infection. What precautions, for instance, at the University of Colorado, at your big Anschutz campus, are you taking to protect people who have that worry? And they may be going for a scan, or radiation or infusion, or just to see you. How can they feel protected?

Dr. Camidge:
That's a great question. The same logic when we're talking about this virus could apply to if you're going to King Super's or Super Target. I think the hospital is probably being a little bit more proactive in terms of lessening the risks of coming in than half the grocery stores are doing, although they're trying to do something too. Let me tell you what we're doing here. Social distancing is going on. Nobody is sitting right next to each other in the waiting room. There are now spaces between the chairs. Everything is being wiped down.

The staff you'll see are wearing masks. Now, that's not to protect the staff. The masks that we're tending to use are not a gas mask. If you open a can of orange juice or make a coffee, you can still smell it through the mask. So, if you can smell it, the virus can get in too. The reason we're wearing masks is because you guys are the vulnerable population, and we don't want to give you anything. So, if we sneeze it's going to into that mask, not elsewhere. We are washing our hands multiple times a day, to the point of dermatitis in many cases. So, we're doing everything we can to minimize our risk.

We're also lessening the number of people in an individual room, whereas maybe you'd come with your 20 relatives, now you're allowed one companion. And equally from the medical side, I might have gone in with the nurse practitioner and the nurse and the fellow or whatever, now it's just me. Or if it's the nurse practitioner, it's just her in there too. We're doing what we can to minimize our risk. You can't make that risk zero, but I would have thought a hospital in terms of a virus is no higher risk than the grocery store.

Andrew Schorr:
Okay. Let's talk about therapies. We talked about radiation. Some people are on infused therapy, some people are on oral therapies, and some people are on infused therapies that are immunotherapy. So, maybe you could take us through that, the different kinds of treatments that are used, and the worry people have of whether I should continue, does it boost my immune system, does it inhibit my immune system? Go ahead.

Dr. Camidge:
Okay. So, when you're on a treatment that is given intermittently, like chemotherapy or immunotherapy, there's an intravenous infusion every two weeks, three weeks, four weeks, whatever, you're usually on that treatment for a reason. And most doctors are going to be trying to not to interrupt those treatments. Occasionally, if you've been on treatments, being incredibly stable for a long time and you were debating, "Can I move from every three weeks to every six weeks or whatever?" you can have that conversation.

If you were to get unwell, then that would be interrupted anyway. Let's say you were on intermittent chemotherapy and you came down with a terrible case of the flu, then usually, yeah, we'd delay your chemotherapy for a while, and the same would happen if you got unwell with COVID-19. I think the more challenging question is let's say you're on an oral-targeted therapy, something that you're taking every day. We don't have any evidence that that changes your risk of catching the virus, or of getting unwell if you catch it. But let's say you do catch the virus and you're starting to feel very unwell, so you're edging more towards that serious category.

The debate is should you stay on that target therapy or not? It's going to vary on an individual basis. If you're so unwell you need to be admitted to the hospital, probably they'd put it on hold, and nothing bad will happen. But I don't think people should proactively stop their targeted therapy just because this virus is out there in the community. I think the real worry is then you're dealing with an active cancer in addition to your risk of a virus. Oh, let me talk about immunotherapy, I'm sorry.

Andrew Schorr:
Please.

Dr. Camidge:
Immunotherapy, again, the immune system is super complex. When we're giving immunotherapy, this is not a tonic for your immune system. This is taking off one of the brakes for something very specific to do with anticancer immunity. There's no data that that's going to increase your protection against the virus, so it doesn't mean people should suddenly jump on it. Indeed, one of the complications of the virus and why people get so sick, is you get an exaggerated immune response. We don't even know if the immunotherapy might worsen outcomes. We just don't know.

Andrew Schorr:
Okay. We're talking about the oral therapies. So, we had a question that came in from an adult daughter, where her father is on an oral therapy and worries about the supply. We know we're dealing with a global situation. Some of the ingredients, and sometimes the medicine as a whole, is made overseas. Have you heard anything from any of the companies for these oral lung medicines where we should worry about refills?

Dr. Camidge:
So far, no. There are two things. One is yes, the supply lines sometimes come from other countries, sometimes just the ingredients, and then they're assembled together a bit like car parts in other parts of the world. First of all, China is probably up and running again. Second of all, it's not like they send in one bottle at a time. There are warehouses full of this stuff with a long expiry date, so no one is going to run out anytime soon. And certainly in our hands, there hasn't been any issue.

I don't think you need to stockpile this. When the CDC and other people talk about making sure you've got a supply of medicines, they're talking about if you're on insulin or a heart medication such that if you can't go out to the shops and you miss one dose, something terrible is going to happen. That's not the case with tyrosine kinase inhibitors, these things are so far good, and I don't think you should either worry about it or completely try and hoard this thing just for fear reasons.

Andrew Schorr:
Okay. Well, a series of questions from a patient you know, Laura, who's there in Colorado. Laura wrote in and said, "Should patients take extra vitamin C, D, zinc or just eat healthy as usual?" This is really part of the broad category, what can the patient do themselves to have the strongest immunity possible?

Dr. Camidge:
I mean, I'm really glad you asked that question. One of the things is we don't really know. In the same way that we could be having this conversation about colds or flu or anything, I think there is a good opportunity to try and stay as healthy as possible, to try and eat as healthy as possible within the limits of what you can get access to. I don't think there's any specific evidence that a particular supplement is going to make a difference. There was some data that zinc could shorten the duration of the common cold, but we're taking a leap of faith here that zinc, if you get the cold, can shorten the duration of it. That doesn't mean it's a preventative either.

The other reason I'm glad you asked that question is we have well-meaning but somewhat misleading data coming out from some of the higher public offices. Great examples are people wanting to say we're going to have a new treatment. Chloroquine (Aralen) was raised, and they've had a few patients saying, "You've got to prescribe me chloroquine." This is complete nonsense, okay? The data is very preliminary. You guys have all had cancer. You know what it's like. There's a news story about this works in cancer last week and 10 next week.

So, having people in high public office saying, "We're really going to accelerate the development of that," means absolutely nothing. It's completely misleading. It's inappropriate. Drugs take a while to be developed. We want them as quickly as you. We're just as high a risk if you're in a healthcare profession, because we're in the frontline, as a patient. So, nobody's trying to actively delay these things. But we also know that somebody's anecdote isn't proof. So, just be careful about, “Oh, there's going to be a vaccine next week, there's going to be a pill next week.” We're just in this for the long-run.

Andrew Schorr:
Dr. Camidge, do you think the CDC and their website is a pretty good source people can rely on?

Dr. Camidge:
Well, it's pretty conservative. I looked at it in advance. I mean, again, they're describing the risk of complications in the setting of severe COVID-19. They don't talk anything about your risk of catching it, and they also list all of these things that might influence your risk of severe complications. But they use the word may.

And if you've ever worked in marketing, words like may are "This product may cause hair loss," or, "It might cause 10 times your body strength." These are words that don't mean anything. They list amongst the other things as, "Complication may arise if you're on a blood thinner." Zero data for that.

Now, if the blood thinner is an indication of some underlying health condition, that might be an issue. But if you're well and happen to be on a blood thinner for other reasons, it's not that there's an interaction between the drug and the virus.

Andrew Schorr:
Right. We have gotten a question exactly about that. And when you say may, it's like we may run out of toilet paper and that became a self-fulfilling prophecy.

Dr. Camidge:
Yeah.

Andrew Schorr:
Yeah, yeah, all these kind of things.

Okay, so now let's talk a little bit about relations in a family. Let's say somebody is in active lung cancer, and they're not feeling great. Maybe they're tired. They've been going through radiation, or they've been going to hospital for infused therapy. Whatever. They're not feeling terrific. And they have someone else in the family, typically now it's often a younger person, who maybe has an essential job. Maybe they're a first responder. Maybe they're in healthcare. Maybe they work at the grocery store as a checker. And they're out and back, out and back. What are you telling people about just the relations like that?

Then also, I know you were telling me a story before we began, about a man with lung cancer who was wondering should he get on a plane? So, maybe you could talk about both instances, in your home, and if you feel compelled that you need to go somewhere.

Dr. Camidge:
To some extent, this is a data-free zone. Again, what we're quantifying here is the risk of catching something. Now, you will remember when you're first diagnosed and they start putting you on chemotherapy and we're in the flu season, they say, "Look, you don't have to live in a bubble. You don't have be completely isolated. But if a friend or a relative's coming round and their kids have got runny noses and streaming [inaudible], you just say, ‘Just stay away.'" That logic remains true.

Now, what happens when you say, “Well, that person could have been in contact with COVID-19 yesterday?” You don't know. That's a personal risk assessment you have to make. There was an example on the radio of a couple who were married but living in separate parts of their house, because he's a first responder and she's not, and so they're trying to separate. And she's pregnant with their first child. People make calculated risks within their own family. But certainly, we are not routinely saying you need to wall yourself off from other members of your family, unless you know that they have COVID-19, or unless they have symptoms or a fever. So, again, it's very much on a case-by-case basis.

Andrew Schorr:
Right. I know what we're doing in our own house, and we have our 22-year-old here. He's more conservative than we are. We're just doing all the things they say. We're washing our hands. If we go out, we're not touching things. Where we are in Southern California, and I'm not sure whether it's this way in Colorado at this point, the restaurants are closed except for takeout. There's really no place to go. Even the parks where I live now, the California state parks are all closed, so you can't go there. There's no congregating.

As far as somebody flying to see a sick relative, going on a plane, I think that's an individual decision. Okay. Well, we got this question. We talked about radiation earlier, Dr. Camidge, and people on active radiation. But many people have had radiation in the past. Is there any lingering effect of the radiation that puts them at higher risk?

Dr. Camidge:
Radiation, if it was to the lungs, will reduce a proportion of your respiratory function. If you're not on oxygen, it's probably a fairly trivial change in your respiratory function. But again, if you were to get sick, you've got less a reserve tank, and so it would marginally increase your risk of complications. I mean, it's hard to know what to say. It's not inherently an absolute disaster waiting to happen.

Andrew Schorr:
Okay. Let's talk about communication with your doctor or clinic. When someone has lung cancer, they have a thoracic team, whether it's thoracic oncology, medical oncology etcetera, your nurse practitioner, etcetera. You have a relationship. They also might have a primary care doctor too, had they gotten the cold or something like that. If they're concerned, who should they call? And then how do you do it? Do you have some consultation over the phone? What are you telling your patients, your thoracic patients in Colorado, how are you proceeding?

Dr. Camidge:
In the last two weeks, things have changed dramatically in the clinic. So, probably our clinical in-person volume has shrunk by about 50 percent. That's probably because we're just kicking the can down the road for some people. They were going to be getting their annual CT scan and we say, "Okay, well put it off for a couple of months." That only works if things are different in a couple of months, otherwise we're just moving the problem just a little bit further away. There are some people who are still on more active surveillance, or more on active treatments, and we've done some as telehealth visits. This has really come on board incredibly quickly. The technology was always there. In the same way that you and I are talking to each other, you can do that with your physician.

The issues have related to two things. One is the legal complications of it. Often the patient has to sign a consent form to say that even if they're in the same state this is an acceptable way to interact. If the patient is out of state, it's even more complex, because if I'm not just giving an opinion but I'm actually still the primary oncology doctor, I could be seen as conducting medicine across state borders, and technically that's illegal. And then the other aspect, which is on the back side, is the doctors, or more particularly the health systems, are worried about the reimbursement. The technology was there, but Medicare is the major health insurer for a lot of the population, didn't cover these until very recently. They've said they'll cover them, but of course the health system is saying, "Well, are they covering the same amount? Is it a certain amount?"

So, will health systems start to fall apart between their income stream, which is your insurance, suddenly is lessened because you get $10 for a phone call and $20 for a video and $100 if they're actually there in-person, and we have to factor that all in. I think at the moment the doctors are doing the right thing. I phoned everybody, I didn't bill anyone a dime, and I think that's the right thing to do. The financial bosses above me will probably start to come down on my back at some point because they'll say, "Who's paying the rent?"

Andrew Schorr:
Well, you guys are angels, Ross, you really are. First of all, just to our audience, if you have a question use the Q&A button right at the bottom of the screen and then Esther Schorr, our producer, will take a look at that. We did get a question from someone, Ross, you and I know well, Janet Freeman-Daily. And Janet says, "Has there been an impact on lung cancer clinical trials? Are they stopping?" And, of course, anybody with cancer wants you guys, researchers, to get faster to a cure. So, you've got trials underway, what happens now?

Dr. Camidge:
Yeah. I mean, there is an impact because many staff, both at the drug companies, the sponsors of many of these clinical trials, and the clinical research support staff here, a lot of them are being told to work from home. So, there's much more of a supply-and-demand issue going on. What we've done here is recognize that it's become harder to put people on clinical trials. But if that clinical trial is still the right treatment, we shouldn't compromise that.

So, we have definitely continued to accrue treatments that we think are transformative in clinical trials. If the clinical trial is Pepsi versus Coke and you can get Coke outside of the trial, we don't need to overload the very limited system there to put people on that. So, some trials are definitely going to be deprioritized. Me too kind of drugs, deprioritized. But if it's a transformative—I'll give you an example. A RET inhibitors, that there are no licensed RET inhibitors but we've got 70 percent response rates from the drugs in clinical trials, you're still going to be accrued to those.

Andrew Schorr:
Okay. Now, I understand the FDA has made some relaxation policy, where let's say you have people sometimes coming from far away to you, flying to Colorado, to be in a trial that you have. Are there some things now that the FDA is allowing to be done remotely…

Dr. Camidge:
Yeah.

Andrew Schorr:
...closer to home?

Dr. Camidge:
I mean, I think oncologists are inherently optimists, but I can definitely see some positive aspects of this pandemic that we're in. One is that the appropriate utilization of telehealth, particularly in clinical trials, will hopefully continue even after this pandemic is long gone.

In the past, you would have somebody who's in California, and they would get treated on a clinical trial. And the following week they would have to fly back to see me, even though they're not getting an infusion that week, just so I can take their blood pressure and ask them how they're feeling and do some basic blood tests. Now, I can get the blood test done locally. I can do most of this over the phone call. I can't quite physically examine you. There are things that I could miss. For example, I'm looking at you and your feet could be purple, and I wouldn't know because I can only see the top part of your body.

So, there are things that have improved, but they're not 100 percent as good as they were before. But I think a rational use of telehealth is one of the benefits, particularly in clinical trials. Again, the whole issue in terms of how do you bill their insurance, if that was perceived as a standard care does it have to be figured out? But hopefully these will be useful things in the future.

Andrew Schorr:
Here's a question we got from Joyce, who sent in, "Do you think that mild damage to the lungs from lung cancer, like a small effusion and scarring, constitutes a weak lung that might put someone at higher risk if they're exposed to the virus?"

Dr. Camidge:
We don't know. But here's perhaps the way to think about it. Let's imagine that if you get severely unwell, such that you need a ventilator. They talk about the need for ventilators. But that's the 10 to 20 percent of people who get admitted to the hospital, of whom a fraction will go on ventilators, and of whom a fraction won't get off. If you need to get to the point where you are on a ventilator, you have dropped their lung function by 50 percent or more let's say.

So, the real question is, depending on what your baseline lung function is, can you tolerate that? If your lung function is you're on the edge of needing oxygen to begin with, you're going to have a much harder time than someone who has a little bit of scarring in their lungs but can still run a marathon. So, it's not just about what you've got. It's your physical functionality and how much you can tolerate a drop in that, if you like, your reserve capacity to deal with bumps in the road.

Andrew Schorr:
Ross, could you explain the connection between these co-morbidities? We think of lungs and the virus going in our lungs, but if I also have diabetes or if I have heart cardiovascular issues, where does that come in to make it more difficult?

Dr. Camidge:
Some of this is still in the hypothesis range. Some of it is very basic. The virus, sure, it enters through your lungs, but it then goes throughout your whole body. So, you can get organ dysfunction, because the virus is now in your heart or your liver or somewhere else.

So, again, if your organs are a little dodgy to begin with, organ function is that much harder to deal with. If you look in an intensive care unit setting, your risk of mortality relates very much to the number of organ systems which are compromised. Every single additional one that's compromised, your chance of getting out alive goes down. So, if you're entering with problems because you've got preexisting heart failure, preexisting diabetes, some of it is just that.

But there may be something else. There may be something specific about this virus and some of the way it enters the system or some of the complications relating to it. This is in theory only. The molecule that it binds to on the surface of cells to get into is called the angiotensin-converting enzyme, or one of them, and that's partly what's related to vascular health.

So, I suspect people who've got worse vascular, people who are on the medications for diabetes, people who are on the medications for heart failure, there may be something very specific going on there too. It's not just every co=morbidity, some seem to cluster. I don't know whether that's a chance effect or whether there's true biology behind it.

Andrew Schorr:
Okay. Here's a question we got in. "If recently diagnosed and progress on the current treatment and I need to make a change, what needs to be considered to begin or delay that treatment change?"

Dr. Camidge:
This is a great question. Again, progression isn’t progression isn’t progression. Some people have really indolent progression, or a few millimeters growth, and it depends on what they're talking of changing you from. If you're on a TKI and they have to put you on chemotherapy that you're worried will compromise your immune system and just make you less safe if something were to happen, like getting COVID-19, that might make you pause for thought.

However, if your cancer is progressing and you have symptoms from, that is the clear and present danger, and you have to deal with that rather than some hypothetical risk in the future. Again, you just have to look at the risk that is staring you in the face, a progressing cancer, and quantify that. It's serious, lot of growth, lots of symptoms, or it’s modest, and then factor that in against the potential risks of the COVID-19 if you were to pick it up.

Andrew Schorr:
Dr. Camidge, you talked about some silver linings that are going on that come out of this. One of them is it seems like collaboration worldwide among physicians and researchers, and I imagine you've been on lots of programs talking to lung specialists around the world. Am I right that you feel people are working together, sharing information for us to get to a better place?

Dr. Camidge:
Well, absolutely. I do a lot of international work, but I don't think I've ever been in a situation where we've all had so much in common. I mean, last week I had a phone call with Spain, with Israel, with Japan, with the United Kingdom, and we're all in it together. I mean, it's incredible. And we're sharing our experiences, and sometimes we're just emotionally and physically supporting each other.

I want to go back to the example of Harry Wren, who's the guy I trained who's now in Shanghai Pulmonary Hospital. He reached out and said, "Look, we're just getting through our wave of this. I'm worried about you. I'm worried about how much time you spend with your patients. I want to look out for you." This week he sent me an email saying, "I'm going to send you some N95 masks, because I understand they're in short supply there." I mean, the fact that I'm getting aid parcels from China I think is fantastic.

Andrew Schorr:
Oh yeah, it absolutely is. A couple of other questions. Someone said is there a concern about 70 percent alcohol cleaning, or 60 percent? I mean, I know these are CDC guidelines. Do you have any sense about what percentage should people be cleaning with or washing their hands?

Dr. Camidge:
That is hardly my area of expertise. I'm taking the same guidance everyone else is. And fortunately I don't have to buy the stuff for the hospital. They're making that decision, I'm just using what they give me.

Andrew Schorr:
Okay. Then also somebody was saying actually, and I don't think Dr. Camidge will know, but was wondering whether a certain percentage of alcohol could start a fire in their home, and I know that's not your expertise.

Dr. Camidge:
Well, if it's the same stuff that you could flambé with, then no, that's not the right stuff.

Andrew Schorr:
Right, right. Okay. You're a scientist, of course, Ross, so let's look into the future. You know people are working worldwide on this, both on the vaccine side and the treatment side. Treatments including, notwithstanding what President Trump said about are there existing medicines that could be repurposed for this, or are there new medicines. Do you feel we can get past this?

Dr. Camidge:
Well, so let's talk about medicines in two separate ways.

Andrew Schorr:
Okay.

Dr. Camidge:
One is something that is a preventative that lessens your chance of picking it up even if you're exposed to it. Then the other is a treatment if you get it.

Andrew Schorr:
Yes.

Dr. Camidge:
So, the treatment if you get it is nothing to do with oncology. It's almost barely an antiviral thing. It's much more about how do you lessen this inflammatory reaction in the organs, how do you get someone through it?

People have looked at some of the medications people have used to suppress what's called the cytokine storm that can sometimes happen with some kinds of immunotherapy, CART-T cells, for example, and can you use those in the intensive care unit? It's in the anecdotal phase to be honest in the intensive care unit. Having once worked there, every patient is their own experiment, and they can do well or badly, and you don't 100 percent know if it's because of your intervention or whether that was just going to be the natural history of the disease.

So, these things are still being worked out. I think the chloroquine one is interesting. It has a role mostly as a preventative for malaria. It would be very interesting if we had a preventative for viruses. But so far, we don't have that. Our best hope of a preventative is to develop a vaccine.

My guess is this is going to become a seasonal thing. It'll be like flu. The virus will mutate, we'll get partial protection from the vaccine. And the hope is by the time we're having this conversation in a year's time, that maybe there will be some partial protection with a vaccine. But that's not going to happen next week or next month. These things take months to develop properly. And that's not because we want it to take that long, that's just how long it takes.

Andrew Schorr:
All right, let's sum a couple of things that we've covered over this last half-hour, and we're very grateful for your time, Dr. Camidge. First of all, it's an individual discussion between the patient and their thoracic oncology or radiation oncology team about their plan and staying on the plan if they're in treatment, right? That's that discussion. There's no indication that they should stop taking a certain medicine, or let's say an oral therapy, or even worry right now about the supply, right? Stay the course, you're communicating with your team. Versus some other kinds of cancers, lung cancer you don't feel people are at higher risk of getting the virus?

Dr. Camidge:
Yeah. I mean, I feel they're at higher risk of getting complications if they do get the virus, and I should point out those things about not stopping your treatment would all change if you were to get the virus and being sick, in the same way that if you were sick for some reason treatment is often interrupted. But I wouldn't prophylactically stop any treatment, no.

Andrew Schorr:
Okay. How are you feeling about lung cancer generally? I have to ask you that, because everybody here who's with us, they're living with that concern. Hopefully, we can put this virus at bay. Are you feeling that our progress against lung cancer continues to march forward?

Dr. Camidge:
Well, there are two things I'd like to say. The first is I have never been prouder of my medical team. They may not be in the emergency room, but they are dealing with highly vulnerable people, and they have been unbelievably professional. And I see this all around the world. I think the healthcare profession has stepped up to this plate, and I think they are all fantastic people, and I'm proud to be one of them and to know these people as well.

The second thing is there was a real insight that I got from a patient last week. The concept of not knowing if you're going to be well this week and sick next week, the concept of not knowing if you're going to go into financial ruin because of what's going on in your body at the moment, is not new to people with lung cancer. It's not new to people with any kind of advanced cancer.

So, you guys have already been through this. You've figured out the mental way of dealing with the chaos of cancer. This is just another bump in the road. And what I said to that patient is I said, "You are not a victim. You are our inspiration to figure out how to deal with the chaos going on, because you walk that walk already." And that's what I would like to share.

Andrew Schorr:
Wow. Well, Dr. Ross Camidge, I want to say on behalf of our community who's with us today, kind of like what they're doing in Spain now is they're applauding the healthcare providers. Thank you so much of the devotion of you, your team, and those other people who are devoted to thoracic oncology around the world. We wish you Godspeed in figuring this out and also figuring out lung cancer overall, so that people can live longer and live better. Thank you so much for being with us, Dr. Ross Camidge, from the University of Colorado. We really appreciate your time.

Dr. Camidge:
My pleasure. Stay safe everyone.

Andrew Schorr:
Okay. All right everyone, thank you for joining us. Send us questions any time to comments@patientpower.info. Let us know how we did today and if a future program would be helpful. Even suggest other experts in the lung cancer community that you'd like to hear from, and we'll see if we can get them.

There will be a replay patientpower.info, so just look for that under the coronavirus area, and you will see that as soon as we can get it edited. We have a wonderful team working hard on this. And we wish you the best of health. Be safe. Hopefully this information was helpful for you. Thanks for those 100 people who were with us today. Tell others that the replay should be there in a day or two days at the most, we're working hard on that.

As I like to say when I sign off—Andrew Schorr, remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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