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Updated 30 May 2020

As of 30 May 2020, the number of people infected by COVID-19 is nearly 60 lakh and the death toll has reached 3.65 lakh globally. In India, more than 1.6 lakh people have tested positive for the COVID-19 infection and around 4,700 deaths have been reported. To prevent the spread of the disease, the Indian government proposed a lockdown across the country starting from 25 March 2020. (The lockdown was extended thrice and lasted till 31 May 2020.)

This was an essential step to prevent the spread of the disease throughout the country, but it has created problems for people who are getting treated for severe conditions such as cancer. Time and again, doctors have been telling senior citizens and those with any pre-existing condition to stay home as they are more prone to get severe symptoms of COVID-19 if they get infected.

People who are already suffering from cancer are having a hard time dealing with this lockdown as most of them are getting treated for an active disease which is rapidly spreading in their body. Also there has been a lot of questions about the effect of COVID-19 on cancer patients, which is making them more anxious.

Here in this article, we will tell you how COVID-19 affects cancer patients.

  1. Effects of COVID-19 on cancer patients
  2. What can be done to protect cancer patients during COVID-19 spread?
  3. Doctors for COVID-19 and Cancer

Doctors have already concluded that people with pre-existing medical conditions like high blood pressure, diabetes, heart disease, lung disease and cancer are prone to get severe symptoms of COVID-19. As per medical professionals, cancer patients have a compromised immune system and that is the reason why they are vulnerable to this infectious disease. 

Doctors further believe that people who are undergoing active treatment with chemotherapy or radiotherapy are at a higher risk of developing serious illness from COVID-19.

On 28 May 2020, US-based scientists associated with the Cancer Consortium Registry 19 published the findings of an ongoing study in The Lancet. In the article, titled "Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study", the researchers said that they observed a marked increase in all-cause mortality in cancer patients who also contracted COVID-19. They added that more research needs to go into understanding this data.

The researchers also listed some reasons why cancer patients may be more prone to COVID-19 and some reasons why they are more prone to severe illness if they do get COVID-19 infection:

  • According to the researchers, cancer patients are more prone to catch the infection because:
    • Cancer patients are often immunocompromised. This is because cancer therapies such as antineoplastic (anti-tumour) therapy and supportive drugs such as steroids suppress the patient's immunity.
    • Cancer is known to have immunosuppressive properties of its own, too.
    • The researchers pointed out that patients receiving anticancer therapy must also meet healthcare providers on a regular basis, which may also increase their risk of contracting the infection.
  • Cancer patients are more likely to get seriously ill if they do contract the infection:
    • Though people of any age can get cancer, the researchers pointed out that most cancer patients tend to be older. Age is also a risk factor for more serious illness if someone over 60 contracts the disease.
    • Older patients are also more like to have comorbidities—other chronic conditions, like hypertension and diabetes. Comorbidities also increase the chances of serious illness if these people contract the infection.

According to the researchers, who studied 928 patients between 17 March 2020 and 16 April 2020, all-cause mortality (death for any reason) was higher in patients who had both COVID-19 and cancer. Further, they found no evidence to show whether the combination of hydroxychloroquine and azithromycin helped patients or made them worse. The use of hydroxychloroquine for COVID-19 has become hotly contested, with the World Health Organization halting its trial temporarily in May 2020.

Hydroxychloroquine is an anti-malaria drug that is being considered for use in COVID-19 treatment. Azithromycin is an antibiotic.

Of course, these are early findings in an ongoing cohort study. And as the researchers pointed out themselves, the cause of higher mortality needs to be studied in depth.

Separately, another research paper on COVID-19 and cancer, also published in The Lancet, showed that there was no reason to believe that cancer therapies like immunotherapy, hormonal therapy, targeted therapy, radiotherapy, cytotoxic chemotherapy or other anticancer treatment had anything to do with this increased mortality.

Indeed, this UK study with 800 cancer patients who also had symptomatic COVID-19, argued that the higher mortality could be attributed to older age, sex (male) and comorbidities (other health problems).

The article, "COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study", was based on the findings of the UK Coronavirus Cancer Monitoring Project Team.

 

Blood cancer and bone marrow cancer

Though there are no certain reasons behind this, doctors believe that people who are suffering from blood cancer or bone marrow cancer are more prone to get severely affected by the disease. 

Stem cell therapy is an essential part of cancer treatment. DKMS is a Germany based non-government organisation that provides bone marrow to those with blood cancer. The CEO of DKMS UK stated that they have been facing difficulties in providing and providing stem cells to different countries due to the lockdown and travel restrictions.

The problems are exacerbated as stem cells remain viable for only 72 hours after being donated and should be transplanted within that time period.

Oncologists are facing a lot of problems especially with those who are actively getting treated with intravenous chemotherapies or radiotherapies. Moreover, the supply of medication has also been hampered due to the lockdown.

For now, doctors do not have sufficient research to conclude if cancer patients are prone to get more sick if they get infected with COVID-19. Meanwhile, doctors can do the following to make sure cancer patients get the required treatment without being exposed to the COVID-19 infection:

  • The treatment for cancer should be continued in the same manner as any delays in the treatment could lead to tumour progression and ultimately poorer outcomes. 
  • Doctors should provide essential cancer services while taking all the necessary measures to protect the patients. Doctors should wear PPE (Personal Protective Equipment) to protect the patients and themselves from contracting the COVID-19 infection. 
  • The oncology (cancer) departments should provide cancer services according to urgency. People who are getting treatment for an active disease should be kept in the high priority list, while follow-up visits can be postponed until the risk of (COVID-19) infection subsides. 
  • Medications and other resources should be re-allocated to the high priority section. Medical staff dealing with dirty laundry, buckets (for vomit) and other cancer medications should thoroughly sanitize and while wearing PPE. 
  • The oncology departments of respective hospitals must talk to the local administrators to have plans for the provision of cancer care in case of critical situations. 
  • Since patients are asked not to come to the hospital, the doctors can stay in touch with their patients remotely with the help of telephone and video consultations.
  • Patients who have been on oral therapies and re-evaluating regimen can be managed easily over teleconsultation. 
  • If possible, rather than weekly intravenous medications, the doctors should prescribe two or three week-long oral or subcutaneous medication to the cancer patients to reduce their visit to the hospitals. 
  • Cancer patients who have started showing symptoms of COVID-19 should call a day before they plan to visit the hospital. This would help the medical staff to take appropriate measures to prevent the spread of the disease.
Dr. Neha Gupta

Dr. Neha Gupta

Infectious Disease
16 Years of Experience

Dr. Lalit Shishara

Dr. Lalit Shishara

Infectious Disease
8 Years of Experience

Dr. Alok Mishra

Dr. Alok Mishra

Infectious Disease
5 Years of Experience

Dr. Amisha Mirchandani

Dr. Amisha Mirchandani

Infectious Disease
8 Years of Experience

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References

  1. Science Direct (Elsevier) [Internet]; Cancer care in the time of COVID-19
  2. Science Direct (Elsevier) [Internet]; Risk of COVID-19 for patients with cancer
  3. European Society of Medical Oncology [internet]; COVID-19: SUPPORTING ONCOLOGY PROFESSIONALS
  4. Kuderer N.M., Choueiri T.K., Shah D.P. and Shyr Y. et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. The Lancet, 28 May 2020.
  5. ClinicalTrials.gov, US National Library of Medicine [Internet]. COVID-19 and Cancer Consortium Registry (CCC19).
  6. Lee L.Y.W., Prof. Cazier J.B., Starkey T., Turnbull C.D., UK Coronavirus Cancer Monitoring Project Team, Kerr R. et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. The Lancet, 28 May 2020.
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