Cancer Treatment During COVID-19 - What You Need to Know

MedMaven

Recent research suggests 40% of cancer patients delayed or forewent cancer care in the early phases of the pandemic. This ill advised and unnecessary behavior can only lead to bad outcomes. (4) Cancer treatment can be safely and effectively delivered during the pandemic and patients should not delay or forego care. Cancer clinics and their doctors have worked diligently to implement safety procedures, COVID-19 testing protocols, and innovative new solutions to ensure patients can be safely treated and not suffer the dire outcomes of delaying or deferring treatment. The recent approval of COVID-19 vaccines and progress on managing COVID-19 infection have further improved the ability to deliver cancer treatment. Cancer patients should work closely with their doctor and healthcare team to ensure optimal treatment is delivered to achieve the best possible outcomes.

The "Ask The Experts About COVID-19 and Cancer" Series

What are Clinics and Cancer Centers Doing?

In order to protect cancer patient’s cancer centers and clinics are already adopting measures designed to improve patient safety by decreasing the risk of exposure to the virus. They are;

  • Delaying or deferring non-essential clinic visits.
  • Using phone consultation or telemedicine appointments when possible.
  • If clinic or hospital visits are necessary.
  • Wear a mask or facial covering.
  • Practice physical distancing.
  • Clinics are screening for exposures either at clinic entrance or by phone one day prior to visit by checking for fever, cough, and other symptoms.
  • Minimizing visitors (1 visitor + patient).
  • Increasing the interval between visits when possible.

Connect with other cancer patients for support and to discuss how they are coping with COVID-19

Evaluate your Treatment Plan

Make sure you understand the goal of therapy and that your treatment plan matches that goal. Is it to cure the cancer, prolong life’s duration, or to maintain quality of life? It’s more important than ever to be informed and understand how the treatment you select impacts outcomes compared to other treatment options or no treatment at all. There are several examples below that highlight areas where treatment changes or avoidance can reduce immunosuppression and or decrease the number and frequency of hospital visits. Each cancer center is developing recommendations and you should carefully evaluate your treatment options with your physician.

Does the benefit of adjuvant therapy justify the risk?

The answer for most patients will be yes but some patients with early stage breast, colon or other cancers elect to receive post-operative adjuvant therapy to reduce the risk of cancer recurrence that is of marginal benefit. For example, if chemotherapy increases your chance of cure from 80% to 85% is that benefit enough given the risks of COVID-19? Are there tests that can help better define the benefit of chemotherapy so it can be avoided in individuals that don't benefit? Measurement of cell free ctDNA can help determine who should receive chemotherapy for colon cancer, and the OncotypeDX test helps determine which patients with early stage breast cancer might avoid chemotherapy.

What is the benefit of radiation therapy and can it be administered over a shorter duration of time?

In certain situations, including some patients with early stage breast cancer radiation may be delivered over a shorter period of time and therefore reduce the number of visits and exposures to others during treatment. Accelerated partial breast irradiation (APBI) is radiation delivered at a more concentrated and higher dose over a shorter period of time, (typically over a one week period). APBI can be delivered using intensity modulated radiation (IMRT) which delivers fractionated radiation, meaning that the total dose of radiation is delivered in many small daily, or twice daily, doses or internally using brachytherapy.

Can oral chemotherapy medications be used instead of infusions to decrease clinic/infusion center visits?

Switching to an equivalent oral therapy can help avoid prolonged clinic visits and oral chemotherapy is available for many cancer types. Certain patients with MPN’s require frequent clinic visits to undergo phlebotomy as part of their treatment – phlebotomy can also be replaced by using an oral chemotherapy to control their cancer.

Is maintenance therapy really beneficial?

Many cancers, especially blood malignancies are currently treated with maintenance chemotherapy which is immunosuppressive. Maintenance is used because it delays the time to cancer recurrence, but it rarely prolongs survival. In the COVID-19 era does it make sense to stay on prolonged therapy that suppresses the immune system if there is no survival benefit?

How useful is imaging - are follow up CT/MRI scans really necessary?

Evaluation of a cancers response to treatment is performed at intervals during and following treatment. These tests can provide physicians and patients information about how an individual cancer is responding to treatment. They can reduce anxiety but may also contribute to “scan anxiety” as patients await the results. Another way to think about a scan is to ask the question; how will the scan results change management? The answer is often that it won’t change management but will give the physician and patient some indication about the progress of therapy. During the COVID-19 era it may be prudent for patients to reduce the frequency of scans especially when the result won’t immediately change their treatment. Blood biomarker tests are also increasingly available that can detect recurrence and patients should inquire whether a simple blood test can be performed instead of several scans.

The "Ask The Experts About COVID-19 and Cancer" Series

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References:

  1. Yu J, Ouyang W, Chua MLK et al. medRxiv, 2020 doi.org/10.1101/2020.02.22.2002532010.1101/2020.02.22.20025320. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Zhonghua Liu Xing Bing Xue Za Zhi 020;41:145–151
  2. Why The Death Rate From Coronavirus Is Plunging In China
  3. nejm.org/doi/full/10.1056/NEJMc2004973
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