Cancer Care During Covid-19
Dr Arun Warrier, Consultant – Medical Oncology, Aster Medcity, Kochi, Kerala
Some people with cancer have a weak immune system which reduces their ability to fight infections like Covid-19.
Patients with a suspicion of cancer
Consult a General Physician and undergo basic tests. If there is a rapidly growing lump or excessive bleeding or any other signs of an aggressive tumour, the doctor will prescribe further tests, as needed.
The Oncology team at the hospital will triage the patient and decide if an urgent workup is needed.
Patients diagnosed with cancer
A multidisciplinary approach is preferred. There are guidelines from various societies about management of each type of cancer according to stage and prevalence of COVID - 19 in the community:
Surgery: The risks to patient during hospitalisation for surgery is required to be minimised. Slow growing cancers like Melanoma, Hormone Positive Breast Cancer and Prostate Cancer may be observed for a few months with alternative medical treatments, wherever feasible.
Chemotherapy: In aggressive cancers like Leukaemia, chemotherapy cannot be deferred. In solid tumours like Lung, Breast or Colon cancer, chemo regimen causing less of low blood counts may be chosen and days in a protocol may be skipped or duration can be changed. Growth factors and antibiotics are given liberally to avoid low counts leading to infections. Injections may be substituted with equally effective tablets to reduce being admitted in hospital. Immunotherapy or targeted therapy can be given in place of chemotherapy as per recommendations.
Radiation: On its own, it does not have an impact on immunity or susceptibility to the COVID – 19 virus. Risk is through travel and increased hospital visits. Short course radiation or protocols with same dose given over lesser visits can be adopted. In selected cases of Prostate cancer, radiation may be delayed without any major impact on outcomes.
Healthy persons who have normal blood counts do not have any increased risk of contracting COVID – 19 virus nor having more morbidity if at all infected. Like everyone else, they should also practice social distancing, use PPEs and avoid crowded places. There are no recommendations to suggest special diet or prophylactic medications for survivors. For regular follow-ups, telemedicine consultations can be done. To avoid travel, they can do blood tests, scans, mammograms etc. with a local GP and have a teleconsulting appointment with the oncologist for guidance.