Cancer and COVID-19: What You Should Know About Increased Risk

Information for patients, survivors and families
woman with cancer worried about covid-19

Since the beginning of the COVID-19 crisis, one thing has been clear: People with a compromised immune system are at increased risk. And this population includes people dealing with a cancer diagnosis.

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Cancer specialist and Director of Breast Medical Oncology Halle Moore, MD, offers insights about the coronavirus and cancer, and recommendations for how you can stay safe.

Q: Why are people with a cancer diagnosis at a higher risk for COVID-19?

A: There are three reasons cancer may raise your risk:

  • Treatment suppresses the immune system: Many people with a cancer diagnosis are undergoing treatments that suppress the immune system.  It’s the treatment (not necessarily the disease) that makes them more vulnerable to infection.
  • Cancer may reduce organ function: Certain advanced cancers may affect organ function, such as lung or kidney function. With reduced organ function, people have a harder time withstanding a severe illness.
  • Cancers may affect immune function: Bloodborne cancers such as leukemia or lymphoma affect how well your immune system works. People with these diseases may be especially susceptible to COVID-19.

Q: How much will the risk increase for people who have cancer?

A: We don’t know yet. Reports from China suggest that people with cancer had worse outcomes compared with the general population. But the information doesn’t account for the different types of patients. It is possible they were older, smoked or had other factors that raised their risk for severe complications.

We believe people with active cancer, or those receiving immunosuppressive treatments, have the highest risk. Those who have undergone a bone marrow transplant may be at particularly high risk. Cancer survivors without evidence of active cancer and who aren’t receiving immune-suppressing treatments may have a lower risk.

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Q: Will people with cancer have the same COVID-19 symptoms as the general population?

A: In general, yes, but not always. Cough and shortness of breath are common symptoms of COVID-19 infection and would be expected to be common in cancer patients with the infection as well. But people with cancer may not develop the high fever due to immune-suppressing treatments. So if a person has cancer and develops a cough and other respiratory symptoms, even without a fever, they should contact their provider.

Q: Do people with cancer need to take extra precautions?

A: They need to take the same precautions and be extra vigilant. Family members or anyone they are exposed to while isolating must also follow the precautions, which are:

  • Thoroughly wash your hands or use hand sanitizer that has an alcohol content of at least 60%.
  • Don’t touch your eyes, nose and mouth.
  • Stay a minimum of 6 feet away from others, especially those who are sick.
  • Steer clear of groups of 10 or more people.
  • Wear a cloth face mask. The CDC now recommends doing so in public, especially in places where it’s hard to maintain at least 6 feet of distance between yourself and another person.
  • Disinfect frequently touched items.
  • Avoid nonessential travel.
  • Use telehealth services for routine visits when possible.

Q: What lifestyle recommendations do you have for people with cancer during isolation?

A: It is vital for people who have cancer to prioritize healthy habits, such as:

  • Activity: If you’re isolated in your home, there’s a tendency to become sedentary, which is not ideal. Take time to stay active in some way. For example, march in place while you’re watching the news. (Only watching the news while marching can also minimize how much “scary” information you’re taking in.) Go for a walk, if you can avoid crowds.
  • Nutrition: Sitting at home and absorbing a lot of doom-and-gloom reports can make you reach for the chips and chocolate. Avoid the urge and instead maintain proper nutrition. Unless you are on a strict neutropenic diet, choose fresh produce when available — it’s safe if you wash it first or cook it.
  • Sleep: Getting enough quality sleep is key to maintaining optimal health. Quality sleep also helps keep stress levels under control.

Q: Should people with cancer continue to receive their treatments?

A: Patients need to discuss individual treatment plans with their provider. There are instances where treatments can be delayed, but if doctors deem a treatment necessary, then they will find ways to deliver it safely. Doctors and cancer centers are using innovative approaches, such as:

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  • Fewer trips: Many centers are devising and using protocols that limit the number of treatments people receive in order to reduce trips to the cancer center.
  • Different treatment delivery: Doctors may choose a different treatment regimen, like using an oral chemotherapy medication over one delivered intravenously.
  • Virtual visits: Patients can often receive a routine evaluation through telemedicine.
  • Preventive measures: Centers are limiting visitors and screening everyone for fever, cough or symptoms. They may also have fewer people receiving treatment at one time.

Q: What does this mean for those who haven’t yet started cancer treatment?

A: The uncertainty is one of the challenges we’re dealing with — we don’t know if this is going to last for weeks or months. Cancer centers are actively developing guidelines to ensure that we can safely deliver treatments. We won’t withhold treatment from newly diagnosed patients who need it; our patients’ health and safety is our top priority.

Doctors will consider many factors, including the stage and type of cancer (some are slow-growing), to determine the next steps of your care. They’ll also make adjustments they feel are safe. For example, your doctor may delay surgery and instead use a non-immunosuppressive treatment, or choose an oral chemotherapy drug to limit your trips to the cancer center.

Talk with your doctor about any concerns you have. We want you to feel confident and safe in your care.

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