COVID-19 and cancer
Limited data available on whether cancer patients have higher risk
People with cancer who contract the novel coronavirus (COVID-19) are said to have a higher risk for severe illness, but this may depend on their cancer stage and the type of treatment they are receiving.
In an interview with Muscat Daily, Professor Taha Mohsin Juma Al Lawati, Sr Consultant Breast Oncology-Reconstructive Surgeon and Board member Oman Cancer Association, said, so far, no systematic reports are available regarding a higher incidence of COVID-19 or SARS-CoV2 asymptomatic infections in patients with cancer. However, recent limited data from China, and more recently from Italy and the US, do seem to confirm a higher risk.
“Available data indicate that older people are more vulnerable, with underlying health conditions such as chronic respiratory, cardio-vascular or chronic kidney disease, diabetes, active cancer and more generally severe chronic diseases. Therefore, during the COVID-19 pandemic, the benefit/risk ratio of cancer treatment may need to be reconsidered in certain patients,” he said.
Asked if there are any cases in Oman where cancer patents have contracted COVID-19, Professor Taha said, “In Oman cases are reported by the higher committee and the fact of having co-morbidity does not effect the number of cases, but the treatment outcome of cancer patients have been classified in two groups of patients – patients off therapy (A) who have completed treatment or have disease under control and patients under treatment for metastatic disease (B).”
“Patients with 'active disease can be eligible for surgery, chemotherapy and/or radiotherapy, biological therapy, endocrine therapy and immunotherapy. However, for all patients (A and B), it is mandatory to provide health education about COVID-19,” he added.
He said that cancer patients are advised to avoid crowded places, wear PPE when they visit hospitals for treatments, correctly wash hands, not have contact with friends and relatives with COVID-19 symptoms or live in an endemic zone and guarantee social distancing with all people. “Protect yourself to protect others,” he said.
“For patients receiving active treatment (B), living in epidemic zones or not, hospitals should identify specific pathways in order to guarantee the timing of treatment with curative intent and, when possible, also for patients with metastatic disease,” he added.
Professor Taha said that outpatient visits for cancer patients should be reduced to the safest and most feasible level without jeopardising patient care. “For patients receiving oral treatment for which monitoring can be done remotely, drug supply should be provided for at least 3 courses to reduce visits to the hospital. Blood monitoring for those patients can be done in local labs close to home. We suggest implementation of telemedicine services,” he said.
“We advise to delay all follow-up visits. More intensive surveillance should be used during treatment for patients with lung cancer or those who received previous lung surgery, and for older patients or those patients with other comorbidities. Intensive measures should be undertaken to avoid nosocomial spread,” he added.
Professor Taha said that there should be strict and safe triaging procedures to assess any COVID-19 symptoms and the urgency and necessity of hospitalisation. “In order to regulate access to the 'Cancer Hubs', establish 'checkpoint areas' for screening for early detection of potentially infectious persons. Clinical staff responsible for the checkpoint area should be trained and wear PPE. Individuals who meet criteria for highly communicable diseases requiring isolation, such as COVID-19 or other emerging infections, must be placed in a private exam room as soon as possible,” he said.
Professor Taha said that patients with history of cancer are treated as any other individuals, if they do not have other comorbidities, and added, “COVID-19 is a challenge to all of us and we need to stay united by following the instructions of the Ministry of health and the World Health Organization and, by doing so, we will be able to succeed today for a better tomorrow.”