Amid the ongoing coronavirus (COVID-19) pandemic, many patients with cancer are facing a series of dilemmas, including whether to continue the treatment or not. There are thousands of cancer patients who are treated with radiation therapy and chemotherapy in many outpatient Oncology facilities throughout the country.
Cancer patients are at greater risk of contracting coronavirus that causes COVID-19 owing to their compromised immune systems.
This has put both cancer specialists and patients in a difficult predicament. Patients are worried about their treatment. They ask, “What happens to me if I stop treatment altogether?” On the other hand, oncologists are in a dilemma if they can continue to give treatments which may suppress the immune-system to the patients during the COVID-19 pandemic?
However, chemotherapy drugs damage healthy white blood cells that defends against viruses like the coronavirus but, stopping treatment may put cancer patients at an even greater risk of tumor progression and shorter survival times.
Should treatment be continued or postponed?
Many factors need to be considered while making an important decision, like postponing cancer treatment to avoid a potential infection with COVID-19. Patients receiving treatment for cancer, should call their health care provider and talk to their treating doctor before postponing treatment or keeping their appointment and follow their guidance.
The American Society of Clinical Oncology (ASCO) says that currently, there is no direct evidence to support withholding or changing immunotherapy or chemotherapy in cancer patients. Therefore, to withhold immunosuppressive or anti-cancer therapy routinely is not recommended. ASCO recommends that healthcare providers should make treatment decisions based on each patient, including factors like chemotherapy type, cancer stage and the risk of cancer recurrence.
Weighing the Risk
Since all health care providers are adjusting their activities to address COVID-19, physicians treating cancer patients may also have to change when and how cancer therapy and follow-up visits can be carried out. Cancer physicians will decide and weigh the risk of missing a cancer treatment or medical appointment against the potential exposure of a patient to COVID-19 infection.
For those undergoing Chemotherapy or Radiation Therapy, unless they are exposed/showing symptoms of COVID-19 or tested positive, they should continue treatment.
What if someone with cancer tests positive for COVID-19?
Currently, here is no specific guidance regarding COVID-19 testing in cancer patients. Government or public health directives and guidance on who should be tested and how the tests should be conducted should be followed.
Ideally, if testing kits are readily available, Oncologists should test all patients before beginning cancer treatment, whether or not they show symptoms, to determine their status before their immune systems start getting affected .
It is very important for cancer patients, being immunosuppressed, to take extra steps to lower their exposure to the coronavirus. Staying at home, following social distancing guidelines and following rigorous hand hygiene is vital for cancer patients to protect themselves from getting infected. It may be reasonable to postpone routine or some avoidable follow-up visits of cancer patients and to conduct their scheduled appointments using telemedicine.