Andrew M. Evens, DO, MSc, FACP, Associate Director for Clinical Services and Director, Lymphoma Program, Rutgers Cancer Institute of New Jersey; Medical Director, Oncology Service Line, RWJBarnabas Health; and Professor of Medicine, Rutgers Robert Wood Johnson Medical School.
Is someone with cancer at a higher risk of contracting COVID-19?
It’s not currently known whether cancer patients have a higher risk of contracting COVID-19 or not. There is a fairly high rate of transmission of the virus irrespective of a cancer diagnosis. However, since some cancer patients are immunosuppressed, they may be at a higher risk of contracting the virus. The virus is so new that this has not been fully studied yet. There is emerging data that suggests that if an individual with cancer did contract COVID-19, there may be more severe complications due to the infection.
Why would COVID-19 be more severe in an individual with cancer?
The immune system of an individual with cancer is often weaker, especially during chemotherapy. Therefore, during this time they may be more susceptible to the complications once an infection occurs with any virus, including influenza. A cancer patient’s risk for developing a more severe case is individualized based on several factors. These include patient history and type of cancer they have, whether they’re receiving chemotherapy, and how immunosuppressed they are.
Are all cancer patients immune-compromised?
No, definitely not. In fact, a number of patients who are in survivorship care, who have been in remission for years, in most instances their immune system is close to, if not completely, back to normal. Even among patients currently receiving chemotherapy, the immune system is often reconstituted in a fairly brisk manner within a couple months of concluding treatment.
How long are you immunocompromised after a round of chemotherapy?
It depends on the treatment. Lymphoma treatments, for example, are often given every three weeks. About a week after receiving chemotherapy, a patient’s immune system will be suppressed, and it will remain that way for seven to eight days and then recover within three weeks.
Can chemotherapy patients do anything to boost their immune system in the meantime?
Thankfully, we have many supportive care medications that can help protect cancer patients while receiving chemotherapy. Certain antibiotics can protect the body, not from COVID-19, but from general infections that can harm the body. There are also “immune booster shots.” These granulocyte booster shots don’t prevent the immune system from being suppressed but help to restore it quicker – reducing a seven to eight day window with a suppressed immune system to two to three days. In addition, we have historically recommended social distancing to chemotherapy patients in order to avoid sick contacts. During the COVID-19 time, these recommendations are acute amplified.
Should cancer patients currently receiving treatment at a medical facility continue to go for treatment?
There’s not a one size fits all answer for this. It should be highly individualized. Patients and their physicians must weigh the benefits versus the risks. In many cases, the benefits of treatment outweigh the risks of stopping or delaying therapy. There are other situations in which we have some more flexibility in terms of delaying or rescheduling treatment. Again, it’s not one size fits all. It depends on the type of cancer, the treatment, and of course the patient’s preference. Patients should talk with their oncologist to determine the best individualized treatment plan for them.
Are the symptoms of COVID-19 the same in cancer patients?
The data set is small, but at this time, we believe that the symptoms are likely the same. Patients with COVID-19 have mild to severe respiratory illness symptoms including:
- Shortness of breath
- Loss of appetite or diarrhea
What should a cancer patient do if they are having COVID-19 symptoms?
Call your oncology team. Your next steps will be individualized depending what symptoms you have, where you are in your treatment course, whether the symptoms may be related to the cancer or cancer treatment, if you need to go to the emergency room, and the resources available to your healthcare team.
How can cancer patients protect themselves from COVID-19?
The same medical guidelines and precautions being recommended for everyone else.
- Wash hands often with soap and water for 20 seconds or more
- If soap and water are not available, use hand sanitizer with at least 60% alcohol
- Avoid touching your eyes, nose or mouth
- Avoid contact with people, especially those who are sick
- Cover your mouth and nose with a tissue when coughing or sneezing, and then discard the tissue
- Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe
- Exercise appropriate social distancing
What is being done to ensure the safety of cancer patients across the RWJBarnabas Health and Rutgers Cancer Institute of New Jersey?
The experts from Rutgers Cancer Institute as well as individuals from the oncology service lines across all 11 RWJBarnabas Health hospitals established a COVID-19 Cancer Taskforce to address emerging issues and make recommendations for safe oncology practice during this unprecedented time. Our Taskforce of 50 plus people includes representation from every hospital and at every level, including doctors, nurses, administration, etc. We hold a virtual meeting every day to share best practices and disseminate new guidelines. The communication across the system has been critical. We’re ready to share not only best practices, but health equipment between hospitals if needed as well as manpower. Guided by our commitment to ensure the health and safety of all patients, clinicians and staff, we are also following the direction from the Centers for Disease Control and Prevention (CDC) and NJ Department of Health.