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

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.

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 of severe COVID-19 illness:

• 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: A recent report published in the journal JAMA Oncology suggested that individuals who had been diagnosed with cancer within the previous year had about seven times the risk of a COVID-19 diagnosis compared to those without cancer. The highest risks were observed in those with leukemia, non-Hodgkin lymphoma and lung cancer. Risk was further increased among African Americans with cancer – particularly those with breast, prostate and lung cancer.

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

A: In general, yes, but not always. Fever, cough and shortness of breath are common symptoms of COVID-19 infection and would be expected to be common in those who have cancer and COVID-19. But sometimes, people with cancer may not develop the high fever due to immune-suppressing treatments. We have also learned that COVID-19 symptoms are extremely variable, even among otherwise healthy individuals.

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.
• Disinfect frequently touched items.
• Avoid nonessential travel.
• Use telehealth services for routine visits when possible.

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 modified, but in most cases, necessary treatments can be delivered safely. Doctors and cancer centers are using innovative approaches, such as:

• 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: 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.

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.