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Cancer and COVID-19, When Will I Be Safe?

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Published on May 22, 2020

Key Takeaways

  • Experts continue to recommend that cancer patients stay home when possible. If you must go out, wear a mask and use hand sanitizer.  
  • Hospitals and clinics are screening patients, limiting visitors and taking other precautions to minimize risks. If you need an infusion or other critical treatment, be cautious but don’t be afraid to go.  
  • Your cancer care team can also provide coronavirus advice. If you have a question about COVID-19 and how to protect yourself, ask them for guidance.

As states "open up" amidst the coronavirus pandemic, is it safe for cancer patients and other immunocompromised individuals to go out in public? What about having friends and family over? And is it safe to go to the doctor's office?
 
During this Answers Now program, host and cancer patient Andrew Schorr asked these questions and more to Dr. William Donnellan and Dr. Meredith McKean from the Sarah Cannon Research Institute at Tennessee Oncology.
 
If you have questions about adjustments to your treatment plan or the risk of activities like going to the grocery store, eating at restaurants, or going for a walk or jog around your neighborhood, watch now for an expert perspective on this evolving issue.

[Due to extreme load on our website and Zoom platform, viewers may experience a time delay between the audio and video of the interview - please note the transcript can be read below.]

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Transcript | Cancer and COVID-19, When Will I Be Safe?

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 May 19, 2020

Andrew Schorr:
Welcome to this Answers Now program. And for all of us who are cancer patients, who have loved ones, we want to know as all this is happening across the U.S. and in other countries as well, but particularly here in the U.S., state by state opening up—what does it mean for us cancer patients?

I'm Andrew Schorr. I am a cancer patient, but joining us are two medical experts, oncologists and hematologists from the Sarah Cannon Research Institute, and they're based in Nashville, Tennessee. And we have with us Meredith McKean, who is a researcher and a melanoma specialist. Welcome, Dr. McKean. 

Dr. McKean:
Thank you. Excited to be here. Thanks for this opportunity.

Andrew Schorr:
Thank you. And also Dr. William Donnellan, who is a hematologist oncologist, a specialist in blood cancers. Thank you so much for joining us, Dr. Donnellan.

Dr. Donnellan:
Thank you. Glad to be here to answer questions. 

Andrew Schorr:
So, let's ask the broadest question first. Dr. McKean, are cancer patients, whether in current treatment or maybe even sometimes down the road, more at risk for the virus and the complications of the virus? 

Dr. McKean:
Yeah, I think that's what all of us patients, physicians, family members have all been following so closely, for us to be able to give guidance for patients. The first data that came out of China had showed a significantly higher risk for patients with cancer. From the data, if you look, the challenges were that a lot of the cancer care in China happens in the hospital, and so they saw that there was a high inpatient transmission. And a number of these patients were older, had a long smoking history, and had lung cancer. And so it was definitely a high-risk population in oncology or patients who had complications with a respiratory illness.

As more data has come out, I think it's clear our patients are having to deal with issues coming in and out of clinic for treatment, symptom management, and are on treatments that can make them most likely at higher risk. But that's something that's still evolving, and we're still learning what risk factors we can try to help mitigate.

Andrew Schorr:
So, Dr. Donnellan, the answer seems to be: you're learning. I know I have two blood-related cancers, so chronic lymphocytic leukemia and myelofibrosis, so I'm assuming that I'm at higher risk. I get immunoglobulin infusions once a month. So I know my doctor thinks we've had to boost my immune system for other things that have been around before COVID. So I'm wondering, “Well, how much can I venture out?” So what do you tell your blood cancer patients, where may they may have a condition that's very much part of the immune system? 

Dr. Donnellan:
Yeah. So it gets to be really tricky with blood cancer patients, because most of the chemotherapies that we are using are specifically targeting the immune system, because that's part of the problem. So, I think a lot depends on kind of the stage of illness for patients that are newly diagnosed or getting strong chemotherapy drugs. Those patients are going to be especially higher risk. And my recommendation would be to try to not to go out as much as possible, to try to stay quarantined, stay at home. Obviously, there are times you have to get out, you can't stay in the house 24 hours a day, but for the times you must go somewhere, just being extra cautious not to go at peak times when you might be around a lot of people. Obviously wearing a mask is very important, sanitizing your hands.           

And then for patients who are maybe farther out from their treatment, so they were diagnosed with a blood cancer 15 or 20 years ago. And they got treated for it, and they've been in remission, those patients are probably at much lower risk. And I still encourage even those patients to try to stay at home as much as possible, but realistically their immune system is probably recovered, and their risk is similar to the general population.

Andrew Schorr:
Dr. McKean, so some of the people with various cancers have radiation, like some of the solid tumors have radiation. And so, radiation can be debilitating to your immune system too, right?

Dr. McKean:
It can. I think it's again too early to necessarily say what the risk is. But we also know that radiation for breast cancer patients, this is a very important part of their treatment. It's important to stay on a schedule. Interruptions can affect the results. And so I think patients undergoing radiation, I think those are fair questions to discuss with their radiation oncologist and say, make sure to clarify the intent for that radiation, how long will this course take? But I know with our radiation oncology colleagues here, they're also taking precautions to help keep patients safe.

Andrew Schorr:
So, Dr. Donnellan, that leads to the next question. A lot of people are asking, they're saying whether it's a doctor appointment or an infusion, and you deal with myeloid conditions too, some people get phlebotomy or blood transfusions, things like that. Maybe where you are in Nashville, or what your sense is of many of the major centers around the country, should we be afraid to come?

Dr. Donnellan:
So I don't think you should be afraid to come. Our clinic, Dr. McKean's clinic, are taking extreme precautions to minimize the risk to patients. We're screening patients very carefully for symptoms of coronavirus, such as fever, respiratory symptoms. We're limiting visitors. Obviously, we don't want more people in the clinic than need to be there. So if you need your infusion, I think it's important that you come. Now what the bigger question is, what types of treatments can we maybe put on hold right now? And that's different for every patient. There are some treatments where patients are kind of in a maintenance phase, and they're very stable, and it's probably not going to cause any harm to miss a three- to six-month infusion and lessen the risk of being exposed. Whereas for other patients, it's absolutely necessary who is trying to get through a set number of treatment cycles at a very precise period of time, it's critical that they come to their infusion visits.      

One other thing that we've utilized here at our clinic is telemedicine. So for patients who don't necessarily have to come to the clinic to have blood drawn or get infusion, we've been able to still keep in close touch with them with the use of telemedicine. We've also utilized a lot of local doctors. So if a patient lives say a hundred miles away and typically they're traveling back and forth to Nashville to be seen, we try as much as possible to let them stay in their home city, have whatever test can be done there and then just come whenever it's critically necessary. So, it's different for every patient, and we're taking it just patient by patient to make those decisions.

Andrew Schorr:
Dr. McKean, so there are certain routine activities people do. They go to the grocery store, they go to restaurants, they want to interact with family and friends. So what are you telling your patients? And I know it may be very individual. I don't mean to say that everybody with cancer has the same story, so I think we have to make that clear. So how do you approach it with patients who say, "Well, I wanted to get together with my close family relatives," or, "I wanted to feel that I could go to the grocery store," or whatever it may be? What are you telling people?

Dr. McKean:
Yeah, I think right now it's a really tough time, because in many areas of the country they've kind of gotten through the worst of it, hopefully, past the peak. And so now it's this confusing time where things are opening back up, and it's a challenging message. And so, I still encourage patients to try to take their best precautions. So even though restaurants are starting to open up and there's dining inside the restaurants, that still, I don't necessarily feel like is a safe environment for a cancer patient if there are other alternatives. So I still encourage them to try to minimize interactions with people that they don't know who they might've come in contact with. Try to, if you're sick of cooking, take-out is still a safer option than sitting down in a restaurant.

It's all a level of comfort and being able to minimize interactions, because we know that the virus is still out there. We know that there are different risks that we have to take, getting groceries, that's something that patients have to do. But then taking advantage of that time that those grocery stores have set aside for higher risk folks and making sure that you're wearing a mask when you're doing that, using hand sanitizer if you can. So I think there are still measures that patients can take if they need to do things like groceries, but I still encourage them, even as things are opening up to try to stay as safe as they can.

Andrew Schorr:
Okay. So we're definitely keeping cancer patients in a different group than just anybody who has had no health concerns running around. So I think you're advising caution. So, Dr. Donnellan, so research moves forward. There are a lot of answers you don't have yet, but do you feel that people, specialists around the world are starting to talk to one another? For instance, take one of the blood cancers I have, chronic lymphocytic leukemia, patients wonder, “Well, if I'm in a watch-and-wait stage, which often CLL patients are first and they haven't had any treatment, am I less at risk than somebody who's started therapy?” Or, we have some of these cancer therapies that are even being tested for COVID like the Bruton’s tyrosine kinase inhibitors or in myeloid conditions, JAK inhibitors are actually being tested to be, are they anti-inflammatories for the coronavirus? So we're all wondering, are we in different categories? We don't really know any of this yet, do we?

Dr. Donnellan:
Yeah. We don't. There are so many different therapies out there being developed, targeting the virus from different aspects. So there have been some positive studies that have come through recently. A lot of people probably have seen in the media the drug Remdesivir (GS-5734) is an antiviral drug that showed positive results in fairly sick patients who are admitted to the hospital.

The hydroxychloroquine (Plaquenil) story, that's still kind of a question mark. There's a large study that's ongoing that should hopefully answer that. And then I think last time I checked, there were 300 or 400 different clinical trials open evaluating various treatments for COVID. So one of the aspects of Dr. McKean's and I, our job is we're very heavily involved in clinical research usually for blood cancers and other types of cancers, but recently, we've for our patients who have been in the hospital with COVID we've suggested if at all possible to be involved in a research protocol to hopefully find the right treatment for this disease.

Andrew Schorr:
Well, I hope you can. So here are some questions that are coming in. Dr. McKean, you're in Tennessee, right?

Dr. McKean:
Mm-hmm.

Andrew Schorr:
So, okay. So the weather's getting warmer, people want to go swimming, and they wonder something basic, “Is it safe to go swimming, and would the chlorine in the pool kill the virus?” 

Dr. McKean:
Good question, information we don't have. And I think it's also hard because even once, if we get data on chlorine exposure to viruses, it's hard to guarantee that the pool you're in has the same amount of chlorine as another. I think with swimming, there is generally close proximity to a number of other folks. So I think there are still inherent risks with doing activities like that. 

Andrew Schorr:
I'll just mention for myself. So I live in Southern California, not in Los Angeles, and so it's not densely populated. There are people around. So I do go running with my wife, we wear masks, we do go biking, and we do wear masks, and we're not close to anyone else. So that's what we do, because we feel we need to get out some. Okay. So that brings up the question of open areas. So what about outdoors? We know that we've heard all this stuff about meat packing plants, or people are in crowded offices, or we worry about schools and other things where people are close together. Dr. Donnellan, do you have much concern about somebody taking a walk, just going outside or in the backyard, do you have concerns about that in the open air?

Dr. Donnellan:
So personally, I do not. I think it's important for people to get outside and still exercise and breathe fresh air. I think what we're seeing is this virus is affecting people, even who aren't infected with the virus, it's causing a lot more depression, and it's important for people to still get out and enjoy life. I think we just have to be extra cautious that if you're going to get out to take a walk, again, you wear your mask, you don't go to a trail where you're going to encounter a bunch of people, that you try to stay at least 10 or 15 feet away from people. So yeah, I think it's important that people continue to try to do things they like to do, but just be extra careful doing it.

Andrew Schorr:
Okay. Dr. McKean, I'm not sure if you have anybody else in your family who's a medical professional, but some of our viewers either are medical professionals or live with somebody who is, who may be at the hospital. So let's talk about interpersonal safety, right? And I have to repeat the story. We heard it like a month ago from a physician in New York where he actually comes home late at night, and he admitted to us on one of these programs, that he actually strips in the hallway of the apartment building before he goes in, because he doesn't want to infect his family, and everything goes in the wash, and he goes into the shower. But what about precautions among family members, Dr. McKean?

Dr. McKean:
Yeah. I think it's not necessarily evidence-based, but I do think a lot of providers have been taking that approach, because we're also trying to minimize our risk for our patients. Right. We also don't want to get sick that we would end up affecting patients, so we're also taking these same precautions. And so, I think oftentimes a lot of providers will end up doing that, so washing clothes and showering right away when coming home just to try to minimize risk.

And then, as Dr. Donnellan had mentioned, here in clinic, we're all wearing masks. We're all, as a healthcare team, we're all checking our temperature or having our temperature checked in the mornings. So I think doing some of those little measures, I don't know if we'll ever know if taking a shower when you get home after being out at the grocery store or at clinic makes a difference. But I think to some extent, mentally, it makes us all feel a little bit better, like we're doing what we can. 

Andrew Schorr:
So I wear a mask everywhere I go. Not sure how much it protects me. It definitely signals to other people, I think, that we're all in this together. And I read about that, a mask as a signal of like if I go—well, I don't go in the grocery store. And, I will mention that too, my wife and I have taken a lot of precautions where some of the supermarkets around where we are, you can arrange curbside delivery of a grocery order you put in whether the day before or sometimes even two days before, you have to think ahead, and then you come up at a certain time, you call them. And, you mentioned takeout, Dr. McKean, so what we're doing to just have a bright spot in our week is about twice a week we're getting takeout. So we're doing that.

So, Dr. Donnellan, so it sounds like there's definitely a yellow blinking light for cancer patients. We don't know whether it varies in intensity, if you will, if you're newly diagnosed, if you have this cancer versus that cancer, whether you’re years out, even. So, for instance, you maybe have been involved in transplant. Somebody's immune system after transplant, the lingering effects on their immune system may go for quite an extended time, won't it? 

Dr. Donnellan:
Yeah. Excellent point. So all the treatments that we give are different. For patients with blood cancers who go through a stem cell transplant, a lot of those patients are on immunosuppressant medicines for months or even years after the transplant. So, especially that group of people absolutely needs to be extra cautious. 

Andrew Schorr:
Okay. And then you may be involved in this research as well for some of the blood cancers now, chimeric antigen receptor (CAR) T-cell therapy. So this is a big deal, immunotherapy, same thing, right, is that somebody could be affected for quite a long time?

Dr. Donnellan:
Yeah. Another great point. So, CAR T-cell therapy, the initial indication that it was approved in was lymphoma and acute leukemia, and it works really, really well to kill those cancer cells. But one of the kind of bystander or off-target effects is it kills normal immune cells, specifically B cells. You had mentioned the IVIG infusions that we have to give people for months and years after they get these therapies. So it's interesting with the CAR-T cells, it's a one-time treatment that you get one time, but the effects can linger for months and even years.

Andrew Schorr:
Dr. McKean, so some of our folks here with us today have kids in college, or maybe even in elementary school. Now a lot of that's tamped down right now, but maybe it's going to resume in the fall. And so people are already thinking ahead and say, "Well, if my kid is going back and forth to school, what about precautions there or worries about there?" Any thought about that? 

Dr. McKean:
I think as different areas of the community open up, I think each of those places, particularly schools are going to try to do their best to keep kids and teachers and everyone safe. And so I think the same safety measures that we use going to the grocery store will likely be implemented in schools. If kids are having a fever or any symptoms keeping them home so as not to be contagious. I think we'll see, as it gets closer, what strategies schools will use to try to do some virtual learning, try to space things out. I think, sending kids to school, if we can do it safely, and hopefully, schools will have the summer to really think through different strategies on when things dramatically had to change in March. And, and I think patients should feel comfortable that school's a good place for their kids to go, and they're hopefully going to be watching things closely. 

Andrew Schorr:
Okay. So, Dr. Donnellan, moving forward then as people try to take baby steps out, they're wondering about testing. Okay. So somebody says, "Well, gee, okay, I'm a cancer patient, but I really don't have a sense of my immunity." So if there are antibody tests or coronavirus tests, where does that come into play for cancer patients on maybe changing a yellow light to a green light that they could go roam?

Dr. Donnellan:
Yeah. So that's a really complicated question. So the typical testing that we've been doing is something called PCR-based testing, which is actually checking for active virus, that you have the virus, you're infectious, you're shedding the virus. And then after you've cleared the virus, typically what happens is your immune system makes these antibodies that are directed towards parts of the virus, and that's called serologic or antibody testing. The problem with that is we don't know how protective those antibodies really are. And there are now reports emerging of people who were infected with coronavirus, they cleared it, they became negative for it, and then several months later they were positive again. Now in those cases, thankfully, usually the second infection is much more mild than the first. But the fact of the matter is you can be re-infected and if you're re-infected, you can potentially transmit to other people. So I think, right now in our practice, we're not doing the antibody testing. We're just testing people with the PCR test if they seem to have symptoms. Now that might be subject to change as time passes. But for now that's how we're doing it.

Andrew Schorr:
I want to just skip back with you, Dr. Donnellan, one thing I kind of alluded to earlier. With some of the people with the blood cancers, they may be getting interferon. They may be getting JAK inhibitors, like I get, or a Bruton’s tyrosine kinase inhibitor for chronic lymphocytic leukemia or maybe lymphoma, something like that. And we wonder, could we be taking a medicine almost like you were taking an antibiotic before you got pneumonia, where we're actually protected. I know research is going on about it. Is there any knowledge that we have this force field around us at all? 

Dr. Donnellan:
Well, so one thing that people are recognizing is it's not so much the virus that really makes people sick, it's the immune response. And so certainly people who are immunosuppressed are at higher risk to have complications, but theoretically you could think if you're on some sort of medicine, which tampers down the immune response to the virus that could in some way mitigate the symptoms. 

Andrew Schorr:
But we just don't know.

Dr. Donnellan:
We just don't know.

Andrew Schorr:
So, Dr. McKean, you are at the Sarah Cannon Research Institute. Okay. And you do a lot of basic research. So we got two scientists with us here. So I want to know, do you feel we can make progress in this? Because we all want to—we're kind of sick of quarantining, and we see this world opening up, hopefully, it's done safely. We want to participate. So what do you think? I mean, what's your faith in science that we can figure this out?

Dr. McKean:

I think as a scientist, I have a lot of faith. And I think the progress that's being made, you keep hearing the word unprecedented, right? Because everything's unprecedented, the speed that a number of different companies and institutions are trying to work on and developing vaccines. You might've seen the news yesterday, the first vaccine that had started in human Phase I clinical trials, they released some early data showing that it looks like that vaccine does elicit an immune response now. Early data, but I think data to be really encouraged by. I really do think, right now we all need to continue to be safe while we figure out with these trials, are there any drugs that can help slow down the symptoms? That once you're infected, you can have a different disease course than what we've seen. And then ultimately, I do think there's a lot of hope that we're going to be able to have a vaccine. I think in 2020, it's going to be tough. But I do think in 2021, it looks like there are hopefully some candidates.

Andrew Schorr:
So, Dr. Donnellan, as I said, people are used to having active lives. We just got a question in, and this woman says, "Well, I've had cancer twice in the last three years, so should I just plan that I'm going to live at home until there's a vaccine? How do I care? Is it just a huge waiting game for me?"

Dr. Donnellan:
I think that's really difficult. I think it depends on where you live. So certainly densely populated places, this is going to be more of an issue than if you live in a very rural community. But yeah, I think we're in it for the long haul. I think until we get a good vaccine, that we're going to have to exercise extreme caution. So unfortunately, I think that the answer is for the foreseeable future caution is going to be the way to go.

Andrew Schorr:
Okay. So, Dr. McKean, I'll admit it, I had a couple of family members over, my brother-in-law and his daughter who had been quarantining at home. They came over on Sunday. We weren't hugging and kissing or doing anything like that, but we were in the same room. We did share a meal together. I felt confident that they could come, because they've been living just like we are, they've been going nowhere. They've had no symptoms, and this is for weeks and weeks and weeks. So how do you feel if your patient says to you, "Well, very tentatively, I'm starting to have these at least family relationships where we've all been ultra-cautious?"

Dr. McKean:
Yeah. I think that sounds like a scenario where we're going to have to strike a balance over the rest of the year. It sounds like you took every measure possible to make sure that they had also quarantined. They didn't have any exposures, I'm sure. It sounds like if they would have had a fever, they would have stayed home. And then even once you spent time with them, it sounds like were still limiting interactions to some extent, no hugs, no handshakes, and still taking some of those precautions. I think that's a safe way moving forward for us to still have some interaction. I think the important piece is like you said, that they had also not been having a significant number of exposures beforehand. 

Andrew Schorr:
Okay. Let me recap a couple of things. Tell me if I get it right. So first of all, you would agree as best we know now that cancer patients do need to consider themselves at higher risk. Some people let's say who've had a transplant, big time or CAR T like we were talking about, how that breaks down for different subgroups in cancer, we don't really know yet. You all are talking in your cancer treatment community to trade information worldwide. You're urging us to take precautions; hand-washing, stay close to home if we can, if we're going out, wear a mask, not being in close proximity to people, takeout food can be okay, but probably not sitting in a big restaurant or a bar or something like that. My wife, well, she'll maybe go to the beauty salon. I don't need to, fortunately. But what do we do on things like that?

And you feel that you guys are working on it as researchers to try to give us answers. And if we have a concern, call our doctor, right? Don't go, call. But if we do have regular visits scheduled, if it's not telemedicine, you feel that most all the medical institutions are really working hard to keep us safe for the treatments we need. Yes, yes? Okay.

Dr. McKean:
That was a great summary. 

Andrew Schorr:
Okay. Dr. Donnellan, any final comment you want to make to our audience here of cancer patients who worry?

Dr. Donnellan:
Worry in this situation is completely normal. And to go through cancer alone, it's a scary thing. And I applaud everybody facing a cancer diagnosis. And just hang in there. This is going to pass, be cautious now and hopefully, in the coming months, we'll find a vaccine, and this'll be behind us before we know it.

Andrew Schorr:
I sure hope so. Dr. McKean, a final comment from you.

Dr. McKean:
Yeah. I think I'll add that the same team that's been helping take care of you either in the past or now for your cancer care, they're also there to help guide you and help try to keep you safe and help you make the best decisions. So, don't feel alone. We're all in this together, and you've got a team around you that's ready to help.

Andrew Schorr:
Okay. And as I'd say to everybody, hopefully, we can get the cancer cured as well. Stay on your treatment dialogue, and ideally an effective, personalized treatment plan for you. Don't forgo that, because you want to beat the cancer and obviously avoid the virus or the complications of that. But we still have the cancer concern and we can't overlook that. Thank you so much, these two wonderful specialists from the Sarah Cannon Research Institute based in Nashville, Tennessee.

Thank you so much for being with us, Dr. William Donnellan and Dr. Meredith McKean. We really appreciate you being with us and thanks to Sarah Cannon for helping make it happen. We'll let you go. You can flip off your video. I got a little razzmatazz at the beginning and thank you, Meredith, we really appreciate it.       

All right. That's what we do on our Answers Now series. We wish we had really clear-cut answers for me and for you right now, so we have to be cautious, but they're working on it. And we are going to be doing programs like this. We're doing them in a number of different cancer-specific topics and some more general topics.
We have one for our friends with chronic lymphocytic leukemia, like me, Friday with Dr. Matt Davids from Dana-Farber. And we have programs on testing with Susan Leclair and her husband, Jim Griffith next week for everybody. And we have a lot of programs coming up on financial concerns as well. So look at our Answers Now programs under upcoming events on patientpower.info. Thank you so much for being with us. We hope this has been helpful and we'll stay on top of this because hopefully, we'll get clear answers and hopefully, more positive answers. In the meantime, be safe. I'm 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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