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Coronavirus: What Precautions Should Cancer Patients Be Taking?

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Published on March 12, 2020

Key Takeaways

"Every person has an ethical responsibility to protect their own health, because by doing so in the midst of a viral outbreak, you're actually protecting others, those who are more vulnerable than you are even," says expert Dr. Mark Lewis from Intermountain Healthcare. 

As the World Health Organization (WHO) declared coronavirus (COVID-19) a global pandemic, how can cancer patients protect themselves? What are the risks for those in active treatment? 

Watch now as Dr. Lewis gives recommendations for cancer patients, in and out of active treatment, on ways to reduce the risk of disease exposure and transmission, interact safely with others and travel.

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Transcript | Coronavirus: What Precautions Should Cancer Patients Be Taking?

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.

Andrew Schorr:

Hello. It's Andrew Schorr from Patient Power and joining us from Salt Lake City is a medical oncologist who specializes in GI medical oncology, Mark Lewis, who also, we should mention, is a patient who's been treated for a neuroendocrine tumor of his pancreas. So he thinks about it as a doctor and as a patient. Mark, we're in this time of coronavirus concerns.

Dr. Lewis:

Yeah.

Andrew Schorr:

And so you must have patients, cancer patients, saying to you, "Dr. Lewis, what should I do?" So I have a couple of questions. One is when they talk about underlying health conditions about the COVID-19 virus, where does cancer come in? And since you've practiced for a while in oncology, not just in GI, but more broadly, are there certain subtypes of cancer, like me as a hematologic patient, where there's even more concern? So take us through that.

Dr. Lewis:

Absolutely, Andrew. And I'll say obviously this is a worrying time for everybody, regardless of whether they have medical co-morbidities like cancer or not. So I share genuine concern for anyone that might be watching this video. I will say also that it's been a remarkable time in global health. We've learned so much from our colleagues in other countries such as China and Italy. They've been so intellectually generous during a time of enormous adversity.

And I think where I've learned the most, and this is just because of the sequence of events, has been from analysis of cases in China. And one of the analyses from our colleagues there showed that cancer patients, just as a broad category, were five-fold more likely to incur serious effects from coronavirus infection or COVID-19 than the general public. Now, that's got to be taken with a grain of salt, because we don't have any more information than that. We don't know what proportion of those patients were on, to your point, active immunosuppressive treatment. But it does raise the stakes for cancer patients beyond the average American, I would say.

And then in terms of what I advise them, I have the benefit, for patients in front of me, of knowing with some precision what their immune system is doing. So every time they're seeing me, I'm measuring their complete blood count. And as a hematologic cancer patient, you'll understand the wealth of information therein. So then I get a differential, and I can actually look at the different parts of your immune system that help defend not just against bacteria, but against viruses. And so if I see someone is lymphopenic, their lymphocyte count is low, that does make me worry that they're in that category where there'll be particularly vulnerable.

I think the real tricky part for cancer patients to navigate is, while increasingly people are being told to either stay home or at least practice social distancing and stay away from crowds and public areas, patients who are undergoing treatment might not have the luxury to do that. In every single place that I practiced, cancer patients show up almost without fail. Whether it's severe weather, whether there are some other complications, they will come, because they feel like their lives depend on it, and they might not be wrong.

So, what we're trying to do here is really get down to the essential visits. Anything that can be done remotely, in fact, we have a video set up for some of our patients, much as I'm talking to you now, using telehealth and then another app we have here called Connect Care where the patients use their smartphone or tablet. If we can utilize those avenues and not bring the patient to clinic, we're trying to do that.

For the people that are here and are needing active therapy, it's really all the same precautions everyone else is following. We try to model very conscientious handwashing. Frankly for all of the panic buying of hand sanitizer, just washing your hands well probably goes the farthest of any measure to eliminate the virus if it's on your skin. The soap actually has a viralytic property that I think people are grossly underestimating. So that's important. Respiratory droplet precautions, if you're around people who are coughing and spluttering, it's actually probably not necessary for most people to wear a mask. I understand the instinct to do so. There's actually some literature to show that, if you wear a mask, you may be more likely to touch your face and that might be counterproductive.

So long answer to your question, it's a scary time. I think we are going to see in the coming weeks which path America is going to go down. I think we fear becoming Italy. I think we are hopeful that our outcomes will look more like South Korea. But it's going to take a joint effort, not just from patients who are already known to be sick, but frankly from the entire public. I actually would argue strongly that every person has an ethical responsibility to protect their own health, because by doing so in the midst of a viral outbreak, you're actually protecting others, those who are more vulnerable than you are even. So, it's a scary time, but I think we will unite around this.

Andrew Schorr:

Mark, I want to dovetail on a couple of things you just said. So as you know, most, not all, but the majority of cancer patients are older and have gray hair like me. And we certainly may have adult children or grandchildren. Some people may live in senior centers.

Dr. Lewis:

Yes.

Andrew Schorr:

Right? And we want to have the social interaction with our families, but we don't know can the grandkid give us a hug?

Dr. Lewis:

Right.

Andrew Schorr:

Can our adult daughter or son give us a hug? Should we have that kind of social distancing even from people that we're so close to?

Dr. Lewis:

Right. And to be honest with you, I don't want to discourage anyone from showing affection to their loved ones, but we might get to that point, Andrew. And I'm certainly listening to recommendations from organizations like, say, the CDC or the National Institutes of Health. I think this is evolving very, very rapidly. I know there was a concerning update just earlier today from Dr. Fauci from the NIH saying he anticipated tens of millions of Americans becoming infected.

I will say really quickly, though, just as you and I are talking now, I would encourage people to use these means of communication. FaceTime is such a wonderful app. I know it's not quite the same as being in the same room, but it's actually how I talk to my mother every week. She lives in Wisconsin. So I would encourage people to use measures like this.

Real quickly on the children, thankfully if there's a silver lining to COVID-19, it might be that children do not seem to be terribly affected. What I think we're still trying to figure out, though, is to what extent are they still hosts and transmitting to other relatives, older adults, say? That, I think, remains to be seen.

My wife does pediatric urgent care. So she's really on the front lines having, if it's not too graphic, secretions coughed upon her by kids. So believe me, this is a something I care greatly about, because I love my wife, and I worry about her health. But I think we're still figuring out exactly the safety of interacting with younger and younger people.

Andrew Schorr:

So, Mark, one last thing for cancer patients specifically, and I'm living with two hematologic cancers, CLL and myelofibrosis—travel.

Dr. Lewis:

Yes.

Andrew Schorr:

So people, seniors often, have booked cruises.

Dr. Lewis:

Yes.

Andrew Schorr:

And we've seen what's happened on some cruise ships. We have planned for that wonderful retirement and then vacation. Actually, I'm still planning to go on a trip to Hawaii. But I'm less worried about being with not many people in Hawaii, but what about on the planes, things like that? And so we cancer patients, if we've gotten through it, and you're a cancer patient yourself, you want to go on living.

Dr. Lewis:

Right. Right. Exactly.

Andrew Schorr:

So that tension between wanting to go live your life and yet not hibernate for safety, what do you say?

Dr. Lewis:

Well, I would say this is actually an excellent question of the day, because just earlier today, the World Health Organization declared this a pandemic, meaning infectious disease of global concern. Again, I'm not an expert on travel medicine. I would say I think containment at this point is unlikely, meaning almost anywhere you go, I would imagine, and obviously to varying degrees, you run the risk of exposure to this virus. I think that cat is out of the bag. 

I'm actually not so concerned, and maybe I'm naive here about being on the plane. Again, I think a lot of it comes down to contact, and I realize you might be cheek by jowl with other passengers in coach. Exactly. So already I've actually seen a lot of people being fastidious on planes even before this, making sure they're wiping down the seat, trying to avoid excessive contact with surfaces that might not be clean, such as the table, the tray that comes down.

And then in terms of travel, one common sense precaution I've been told is don't go anywhere that you're not prepared to stay for two weeks. And I think that's probably a decent rule of thumb. Interestingly, certain academic institutions and healthcare institutions are strongly encouraging and/or restricting their employees' travel. So I'd also encourage people, especially if they're in the workforce and not yet retired, to make sure they're checking with Human Resources, because you might end up in an unfortunate situation of unpaid leave.

So, I think, again, this is rapidly evolving. And so far, as you know, air travel is continuing. Cruise ships are a special case where not only is containment not an effective global strategy, but a cruise ship is the perfect environment where you have a lot of people packed in together, as we've seen, for instance, with the Global Princess, where disease can spread quite quickly. So probably cruise ships, I personally would not go for. I'm not yet convinced that air travel is prohibitively dangerous.

Andrew Schorr:

Okay. Well, Mark, we'll get back together with you again. And I know you see this in a number of different lights; You as a medical oncologist, seeing patients every day, you as a cancer patient and survivor yourself, you with a wife who's a pediatrician, seeing people, right, in emergent situations.

Dr. Lewis:

Yeah.

Andrew Schorr:

So you're all around it. Well, let's get through it. Thank you so much for your guidance today. Mark Lewis from Intermountain Healthcare in Salt Lake City, thank you.

Dr. Lewis:

Thanks, Andrew.

Andrew Schorr:

I'm Andrew Schorr. Remember, knowledge, accurate knowledge and evolving 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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