Why it is important for cancer patients to take extra care

Data from different countries show that cancer patients are slightly at a higher risk than others. Such patients are thought to be immunocompromised, that is their capacity to fight back against the diseases is not enough as that of an average person. The presence of other co-morbidities like heart diseases and diabetes also reduce a person’s capacity to fight back, making people with such diseases more vulnerable.

If a cancer patient develops Covid-19 infection, the chances of organ-related complications arising increase, as some of these patients might have undergone radiation therapy, or chemotherapy, or some may have had their kidney removed, which automatically suppress their immunity.

Should cancer patients follow the same precaution as normal people?

Cancer patients should also take general precautions — washing hands often with soap and water for at least 20 seconds; using hand sanitizer that contains at least 60% alcohol; wearing a mask; avoiding touching eyes, nose and mouth with unwashed hands; practising social distancing; cleaning and disinfecting frequently-touched surfaces, etc. However, along with these precautions, their treatment pattern also may change.

Cancer patients are divided into 3 categories:

• Patients under maintenance therapy.
• Patients under active therapy.
• Patients being got ready for treatment.

Are patients who have completed treatment and are cancer-free, like in the case of breast cancer patients, but are on hormonal therapy more at risk of getting infected? No. There is no such incidence, or any study saying that such patients suffer more, or are at a higher risk. They can follow their normal routine, but should take proper precautions, and eliminate such fears.

Patients undergoing treatment in the induction phase of blood cancer which kills the entire bad cells in the blood, cannot postpone their treatment. So, extra care and precautions (using personal protective equipment, etc.) must be taken while continuing their treatment.

In the case of patients planning to undergo breast screening programs, or if the oncologist feels that there will not be any benefit in giving chemotherapy at an early stage, then you can delay such procedures by 4 to 5 months, or till that time when everything becomes normal. The government is trying to flatten the curve of this pandemic, which means reducing the number of cases, or controlling it altogether.

Can patients skip regular visit to their doctor to avoid exposure?

One can avoid moving out for the regular check-up and screening. But instead can communicate with the doctor through teleconsultations or virtual internet consultation, which has become legal now.

What if a patient skips chemotherapy in this lockdown?

Ideally, a patient should never skip a chemo procedure, and if a person misses it due to the lockdown, nothing can really be done. Normally, you can postpone the treatment for up to 3 months. If the gap between two consecutive sessions increases by more than 3 months, then the therapeutic benefits will be lost. So be in touch with your consultant and try arranging the chemo procedure at a nearby hospital as per his guidance.

Cancer surgeons are taking precautions

Cancer surgeons prefer that their patients undergo Covid-19 tests. Droplets are taken from the patients’ mouth and nose, and then tested by specialists. These tests have up to 60-70% accuracy. Also, various modifications have been made in the treatment of patients, which all cancer specialists are aware of. There are some special procedures where chemotherapy is done at a much higher degree, and such patients are at a higher risk, and hence doctors take extra care in such cases.

Hence, do not fear if you get tested Covid-19 positive. You can definitely recover, but will have to take extra precautions and treatment compared to normal people. You are at a higher risk, and should follow Covid-19 protocols — washing hands frequently and maintaining social distancing; using alcohol-based hand sanitizer frequently, especially if you have to go out.

There are lots of ways to deal with isolation even as you make sure that you are not physically close to people. These are the most vital elements to reduce the spread of corona virus. Besides, stock medicines and other household items including swipes, sanitizers, etc. Call your doctor or contact the nearest healthcare center immediately if you feel you have some Covid-19 symptoms.

If I have cancer now or had it in the past, can I get vaccinated?

The Centers for Disease Control and Prevention recommends that everyone 12 years and older get vaccinated. That includes people with underlying medical conditions such as cancer, and people who are participating in cancer trials, although those taking part in trials should talk to their clinical trial research team and follow their guidance.

If you have recently received cancer treatment that suppresses the immune system —such as chemotherapy, stem cell or bone marrow transplant, or cell therapy — doctor may suggest that you wait until your immune system has recovered before you get vaccinated. Or your doctor may suggest that you wait until 2 weeks after the vaccination to get immunosuppressive treatment.

Covid-19 vaccine trials have shown that the safety and efficacy of the vaccines are similar in people with underlying medical conditions as in people without those conditions. And vaccines for other infections, like the flu, are safe and recommended for people with cancer.

However, most Covid-19 trials have excluded people with cancer; so more data are needed on the safety and efficacy of Covid-19 vaccines in these individuals. There is some evidence that people treated for cancer and others who are immunosuppressed may have a weaker response to the vaccines. To help protect people with cancer from Covid-19, it is important that family members, loved ones, and caregivers get vaccinated.

Dr. Dharma Kumar K.G., MBBS, MS, M Ch (Surgical oncology), is the Consultant Oncosurgeon at Indiana Hospital & heart Institute, Mangalore.