Coronavirus outbreak has affected thousands of people in at least 186 countries which has affected the cancer care delivery system apart from affecting the overall health system. Cancer patients are more susceptible to coronavirus infection than individuals without cancer as they are in an immunosuppressive state because of the malignancy and anticancer treatment. Oncologists should be more attentive to detect coronavirus infection early, as any type of advanced cancer is at much higher risk for unfavorable outcomes. Oncology communities must ensure that cancer patients should spend more time at home and less time out in the community. Oncologists and other health care professionals involved in cancer care have a critical opportunity to communicate to their patients to pass on right information regarding practice modifications in view of COVID-19 outbreaks. Countries must isolate, test, treat and trace to control the coronavirus pandemic. There is a paucity of information on novel coronavirus infection and its impact on cancer patients and cancer care providers. To date, there is no scientific guideline regarding management of cancer patients in a background of coronavirus outbreak. In this regard Dr BS Ajaikumar, CEO and Chairman, HealthCare Global (HCG), Bengaluru shared his views on what cancer patients need to know about the coronavirus.

Which patients should be most careful? Lung Cancer, Head & Neck Cancer, Blood Cancer, etc. Advice for specific cancer types

In general, cancer patients are at a higher risk of being infected with COVID-19 as a result of the tumour or due to cancer treatments that tax the immune system and its ability to respond to a newer threat like COVID-19. Patients who have undergone treatment for metastatic lung cancer, head and neck surgery, tracheostomy surgeries in the past three months, elderly and paediatric patients and those undergoing chemotherapy might be more susceptible to infections.

What about childhood cancer patients and their treatment?

Children with cancer and especially those receiving stem cell transplants need to be more careful and adhere strictly to the shielding strategies like:

1. Strictly avoid contact with anyone who is displaying symptoms of coronavirus (COVID-19). These symptoms include a high temperature and continuous cough.
2. Do not leave the house except for essential medical visits. Home visits from nurses who provide essential support should continue as advised by the doctor.
3. Do not attend any gatherings of friends and families in private spaces, for example, family homes, weddings, religious services, etc.
4. Shopping, leisure, and travel must be strictly avoided; any online ordered food or medication deliveries should be left at the door to minimise contact.
5. Treatments shall continue as planned; patients and caregivers are urged to use HCG’s teleconsultation and home health services to continue cancer care.

Any advice for the cancer patient family members?

HCG has instituted a maximum of one nominated attendee per patient to control the patient visitor inflow at the hospital; therefore, family members need to plan their visits accordingly. It is generally advisable that relatives and attendees with a compromised immune system do not visit cancer patients at the hospital, and is it highly relevant during the time of the pandemic.

All the attendees are being screened for the symptoms of COVID-19. If necessary, they are isolated and are required to be forthcoming about their travel history and details regarding possible exposure to other COVID -19 positive patients.

Are all cancer patients at risk, or only those in active treatment?

While the evidence for this is still evolving, the virus poses similar threats to all cancer patients. Having said that, it seems like patients who are newly diagnosed have an active immune response already manifested as a result of cancer, and doctors around the world are finding that newly diagnosed cancer patients might not be as susceptible to COVID-19. However, this does not warrant any delay in initiating cancer treatment.

Some surgeries like bone marrow transplant and chemotherapies that require immune suppression are not advisable during this pandemic. Alternates like minimally invasive surgeries and oral chemotherapy might be available, and patients are encouraged to enquire about this with their oncologists to know if they are suitable candidates for such treatment modifications.

Those who have completed their treatment for cancer also need to be careful. If cancer treatment is completed less than three months before today, the immune system might not have recovered adequately to withstand the COVID-19 infection. However, if it has been more than three months, it is advisable to take all necessary measures of social isolation in line with the general population.

What else do cancer patients need to know about the coronavirus?

COVID-19 primarily infects the body through exposed epithelial layers like the eyes, mouth or nose and also through the surgical wounds. Extra care is advised if you have undergone surgery recently. Throat irritation and respiratory distress are common symptoms of COVID-19 infection. Therefore, patients with cancers in respective organs shall closely monitor themselves for these symptoms and any new ones. The virus also causes a very strong immune response; immunocompromised patients might be more susceptible and unable to generate this response to confront the virus. When cancer patients are infected with COVID-19, some guidelines indicate that the treatment of COVID-19 takes priority and might result in delays in cancer treatment.