Cancer and COVID-19: Managing the risk of the virus against the cancer risk


Patients with cancer who are either undergoing chemotherapy/systemic therapy or who recently completed their surgical or radiation treatment have a higher risk of contracting viruses, including COVID-19. Cancer patients are also more likely to develop severe symptoms and require hospitalization if they are infected. This is because certain cancer treatments temporarily weaken the immune system, making patients more vulnerable to infection. Long-term anti-hormonal treatments that may be prescribed for breast cancer or prostate cancer do not put patients at significantly greater risk because they don’t affect the immune system in the same way as chemotherapy or immunotherapy.  
When evaluating patients in the middle of active treatment, it is important to balance the risk for potential infection against detrimental effects of interrupting or stopping cancer therapies. This should be an individualized discussion between cancer patients and their healthcare providers. In some cases, oral medication alternatives or infusions through home medical care can be considered. There are also medications that can be given with chemotherapy to better support the immune system and increase white blood cell count. The order of cancer treatments may also be safely changed based on national guidelines.
For patients who had cancer many years ago, they may or may not be at an increased risk for COVID-19 depending on their overall health. Greater risk would be associated with older age (>60 years) and other chronic health conditions like diabetes or underlying lung or heart disease. 
Patients with a history of cancer who are in surveillance and are otherwise asymptomatic and healthy may be able to temporarily postpone routine follow up visits or engage in telehealth or virtual visits. For breast cancer patients for example, delaying annual mammograms and clinical breast exams may be recommended in high-risk areas for COVID-19.  For patients with new problems or those who cannot postpone visits, rest assured that there are many infection-control measures in place in the hospital and clinics to keep you safe.
Guidelines from several national cancer organizations also suggest that for women newly diagnosed with very small, non-aggressive breast cancer, medical treatments such as anti-hormonal therapy may be recommended before surgery to treat the cancer while preserving critical hospital resources. In certain areas of the country, breast reconstruction is also being delayed so as not to compete for ventilators. It is important for cancer patients to remember that any changes to their care plans are made with collaboration from multiple cancer specialists following safe cancer site-specific national guidelines.
The same general health precautions for COVID-19 that have been recommended for the past several months also apply to patients in any high-risk group (such as cancer patients) and their family members; extra vigilance in this vulnerable population is critical for the prevention and control of infection. The most important practices are staying home if possible, social distancing and limiting exposure in large groups, wearing masks in public, avoiding people who are sick, rigorous handwashing, and disinfecting common surfaces in the household. We encourage patients to have an extra month or two of their medications on hand as well, if their insurance permits.
If a cancer patient or family member does start to have symptoms of COVID-19, the patient’s care team should be notified so appropriate testing and treatment recommendations can be made. Through all of the changes and uncertainties at this time, know that we’re here for you!

Fiona N. Denham, MD, is a board certified, fellowship-trained surgeon specializing in breast oncology as well as benign diseases of the breast and management of high-risk breast patients. She sees patients at Goshen Retreat Women’s Health Center and performs all surgeries at Goshen Hospital.