What Cancer Patients Should Know About COVID-19

The COVID-19 crisis poses new challenges to Canada’s cancer community. Although these changes are only temporary, we must keep in mind that if you have cancer, you are at a higher risk of getting an infection, and right now health care providers are taking extra steps to protect cancer patients, their families and staff members. 

**For the most up to date information on COVID-19, please check: the WHO’s COVID-19 Webpage, the Government of Canada’s COVID-19 Webpage, and the CDC’s COVID-19 Webpage.**

Coronavirus disease 2019, abbreviated COVID-19, is the infectious disease caused by a recently discovered coronavirus named “SARS-CoV-2”. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. The virus can cause pneumonia-like symptoms. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs, as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were vulnerable because of existing underlying health conditions.

COVID-19 symptoms can be mild to severe, and some people with the disease may not develop any at all. Also, you may not know you’re infected because symptoms are similar to a cold or flu and can take up to 14 days to appear after exposure.

Most people with COVID-19 have mild symptoms that affect how you breathe.

Symptoms can include:

–  A fever over 38 °C (100.4 °F)
–  New or worsening cough
–  Shortness of breath
–  Muscle aches and pains
–  Sore throat
–  Chest congestion
–  Diarrhea

Currently there is no vaccine to help control the spread of the disease, but research is ongoing and experts are working to develop one.

Human coronaviruses are a family of viruses that often cause mild illnesses, such as common colds, but can sometimes cause more serious respiratory diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The first coronavirus was identified and described in the 1960s and it’s likely that you’ve already one at some point in your life.

The new coronavirus, now known as Covid-19, was first encountered in November 2019, and has gone on to affect over 425,000 people in over 150 countries around the globe, causing more than 18,000 deaths. The name Covid-19 was announced on 11 February by the World Health Organization. The director general, Tedros Adhanom Ghebreyesus, said: “We had to find a name that did not refer to a geographical location, an animal, an individual or group of people, and which is also pronounceable and related to the disease. Having a name matters to prevent the use of other names that can be inaccurate or stigmatising.”

A crucial difference is that unlike flu, there is no vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the population – elderly people or those with existing respiratory or immune problems – to protect themselves. Hand-washing and avoiding other people if you feel unwell are important. One sensible step is to get the flu vaccine, which will reduce the burden on health services if the outbreak turns into a wider epidemic.

Current research shows that COVID-19 spreads through others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth when they cough or simply exhale.

–  Droplets can be breathed in when a person coughs or exhales. This is why it is important to stay more than 2 meters (6 feet) away from a person who is sick.
–  Droplets can spread from close personal contact, such as hugging or shaking hands.
–  Droplets also land on surfaces. People may touch the surface and then touch their eyes, nose or mouth.

*Research in determining how the virus is spread is still ongoing. Researchers are looking into whether people without symptoms can spread the disease. We suggest monitoring the following pages to ensure you stay up-to-date: the WHO’s COVID-19 Webpage, the Government of Canada’s COVID-19 Webpage, and the CDC’s COVID-19 Webpage.

The Public Health Agency of Canada (PHAC) has stated that there is an increased risk of more severe outcomes for Canadians:

–  With compromised immune systems
–  With underlying medical conditions
–  Aged 65 and over

Compromised immune systems are weaker than an average healthy adult’s. As the primary role of the immune system is to help fight off infection, individuals with compromised immune systems are at a higher risk of getting them, including viral infections such as COVID-19. This includes those currently undergoing cancer treatment and cancer survivors with weakened immune systems from treatments.

Not all cancers affect patients’ immune systems, but some cancer patients and survivors have weakened immune systems, often as a result of treatment. For example, bone marrow transplants and intensive chemotherapy can cause a weakened immune system. Intense radiation therapy and surgery can have the same effect. The risk of having a compromised immune system is typically highest during the time of active cancer treatment.

Ultimately, at this point in time, it is believed that cancer patients and survivors DO have a higher risk of COVID-19 than other individuals. Additionally, it has been shown that patients with cancer have poorer outcomes from COVID-19 than average healthy adults. If you are concerned about COVID-19 and you are a cancer patient or cancer survivor, talk to your doctor or healthcare team. They are the best and most trustworthy source of information for your specific situation and will also be the most up-to-date on COVID-19.

Hospitals are trying to decrease the spread of the infection, which means several possible changes which could impact your next hospital visit. For example:

–  A “no visitor policy” at hospitals, subject to some exceptions, such as: language barrier, mobility, cognitive ability, mental health, end-of-life
–  Oncologists conducting virtual appointments where possible, with video-streaming check-ins and follow-up
–  Scheduled cancer surgeries changing times on a daily basis
–  When clinically safe, delays to:

o  Radiology scans
o  Biopsies
o  Preventive care procedures
o  Elective surgeries

These efforts are aimed at minimizing hospital traffic and reducing the risk of infection for you, other patients, and hospital staff. Remember that it is very important you continue all required treatment and follow-ups with your oncologists. Patients are advised to speak with their cancer care team for advice on non-essential clinic visits. Skipping cancer treatment because of concerns about the risk of infection is a serious decision and something that must be discussed with your oncologist. If you are considering this, please call your health care provider before your next treatment appointment and follow their guidance.

We also have a couple tips to help you on your next appointment:

1. Call or video chat with your partner or a friend when speaking with your doctor.
2. Write your questions down before your appointment and bring them with you, then write down your doctors answers as they give them.
3. If easier, ask your doctor if you can make an audio recording of your appointment on your phone or another audio recording device.

For more helpful tips, take a look at the following article: 7 Tips for Making Your Solo Hospital Visit Better During COVID-19

First and foremost, it is important to ask your doctor or nurse if they have special recommendations based on your health or type of treatment.

Generally speaking, there are no special steps cancer patients, cancer survivors, and people close to them must follow. The best way to protect yourself is to be extra cautious and extra careful in avoiding exposure to the virus. These precautions are the same as for other contagious respiratory illnesses.

1. Avoid all non-essential trips, including trips in your community.
2. Wash your hands often with soap and water or an alcohol based solution.
3. Maintain social distancing by avoiding close contact (6 feet, which is about two arm lengths).
4. Avoid touching your eyes, nose and mouth.
5. Clean and disinfect frequently touched services.
6. Do not gather in groups.
7. Avoid all cruise travel and non-essential air travel.
8. Call your healthcare professional if you have concerns about COVID-19 and your underlying condition or if you are sick.

People who are at higher risk of getting very sick from COVID-19 should avoid any non-essential travel during this time of COVID-19 outbreak. In most parts of Canada a “stay at home” order is in effect. For people with cancer who live in these areas, do not leave your home unless it is absolutely necessary. For in-depth instructions on protecting yourself, visit the WHO’s “Advice for the Public” page.

Yes. Merry Jennifer Markham, MD, FACP, Interim Chief of the University of Florida (UF) Division, an Associate Professor in the UF College of Medicine, and the Associate Director for Medical Affairs at the UF Health Cancer Center, has offered a couple of tips:

1. Be sure to have enough essential medications, both prescription and over-the-counter, to last for at least 1 month.
2. Create or update an emergency contact list that includes family, friends, neighbors, and community or neighborhood resources who may be able to provide information or assistance to you if you need it.
3. Stay connected to your support system. Make plans to connect with your family and friends virtually, through video chat or phone calls. Some examples of technology that can be used for video or other live chats are FaceTime, Zoom, Google Hangouts, and social media platforms, such as Instagram and Facebook.

You can read her full article on “What People with Cancer Need to Know” here.

You can do a short self-assessment online using the Government of Canada’s COVID-19 Symptom Self-Assessment Tool.

Call you doctor right away if you experience any of the following:

–  You have a fever higher than 38 °C (100.4 °F).
–  You feel short of breath.
–  You develop a cough, runny nose, or congestion.

What Cancer Patients Need to Know about COVID-19

A variety of information produced by Toronto’s University Health Network. Updated regularly.

Coronavirus and COVID-19: What People With Cancer Need to Know

Reviewed and updated every day. Written by Merry Jennifer Markham, MD, FACP.

Cancer and COVID-19 (novel coronavirus)

The Canadian Cancer Society’s page on COVID-19.

Common Questions About the New Coronavirus Outbreak

The American Cancer Society’s page on common COVID-19 questions for cancer patients.

Common Questions About COVID-19 and Cancer: Answers for Patients and Survivors

ASCO Chief Medical Officer and Executive Vice President Dr. Richard Schilsky answers cancer patients’ and survivors’ frequently asked clinical questions about COVID-19.

Coronavirus: What People with Cancer Should Know

The National Cancer Institute’s page on COVID-19.

COVID-19 and Cancer Patients

The National Comprehensive Cancer Network’s fact sheet on COVID-19.

Self-Care & Distress Management During the COVID-19 Pandemic

The National Comprehensive Cancer Network’s booklet on handling the mental aspect of the COVID-19 pandemic.

Psychologist Dr. Johns answers questions about COVID-19

Dr. Shelley Johns’ answers questions about how cancer patients and survivors can manage stress caused by the pandemic.

Infographic | What patients with cancer should know about COVID-19

The Mayo Clinic’s infographic on COVID-19 and cancer.

Coronavirus disease (COVID-19)

Canada’s Central COVID-19 information page.

Coronavirus disease (COVID-19): Outbreak update

Canada’s outbreak tracker, including the current risk to Canadians.

Canada’s Official COVID-19 Self-Assessment Tool and App

The government’s COVID-19 self-assessment tool you can use from your computer and the COVID-19 support app to keep up to date using your Android and Apple devices.

Canada’s COVID-19 Economic Response Plan

Information about financial resources available to you during the pandemic.

Coronavirus disease (COVID-19) – Employment and Social Development Canada

Information on how to access and apply for benefits and access other Service Canada services.

Coronavirus disease (COVID-19): Awareness resources

Information on areas ranging from mental health during the pandemic, to advice for caregivers of infected children, to how to properly wash your hands.

Coronavirus disease (COVID-19): How to care for a person with COVID-19 at home

Advice on how to be an effective caregiver to a person diagnosed with COVID-19 while also protecting yourself.

Infographic | Know the Difference: Self-Monitoring, Self-Isolation, and Isolation for COVID-19

An infographic explaining when and how to self-monitor, self-isolate, and isolate.