- Experts say people with cancer are faced with the dilemma of increasing their COVID-19 risk while going to medical centers for treatment.
- Recent research indicates people with cancer have a higher risk for death from COVID-19 than those in remission or without evidence of disease.
- Experts also note that cancer treatment can weaken the immune system, making a person more susceptible to COVID-19.
Heather Lanie, a registered nurse from San Jose, California, received a diagnosis of triple-negative breast cancer just weeks before the COVID-19 pandemic began in the United States.
Despite the rapid spread of the new coronavirus nationwide, Lanie never once considered stopping or delaying her chemotherapy.
“I just wanted to get through it and get on with my life,” Lanie, 49, told Healthline.
Lanie has continued to work during her treatment and has one final chemotherapy infusion left. She’ll have surgery next month to remove one of her breasts.
Lanie knew there were risks involved in continuing treatment during the pandemic.
But she insists they’ve been risks worth taking.
“COVID-19 is scary because I am immunocompromised. I know I have to be careful. But I was more scared in the beginning than I am now,” said Lanie, who strictly follows physical distancing guidelines.
“I wear my mask religiously and I wash my hands a lot. I feel pretty safe. It’s just my personality. I do not want to live in a bubble. I want to live my life,” she said.
High risk for people with cancer
People being treated for cancer face a difficult dilemma when deciding when, where, and how to treat their disease in the age of COVID-19.
New studies announced last week at the annual American Society of Clinical Oncologists (ASCO) ASCO20 Virtual Scientific Program include new information about the high-risk relationship between COVID-19 and cancer.
The COVID-19 and Cancer Consortium (CCC19) registry presented at ASCO and published in The Lancet show that people with progressive cancer were five times more likely to die within 30 days of a COVID-19 diagnosis compared to people in remission or people with no evidence of disease.
The risk for death was 1.79 times greater for those with stable cancer compared to people who had no evidence of disease.
Dr. Jeremy L. Warner, MS, a lead author of the study and an associate professor of medicine and biomedical informatics at Vanderbilt University in Tennessee, and his colleagues assessed data on 928 patients for 30-day all-cause mortality.
In a press statement, Warner said his team is working to identify the factors that affect disease severity and death.
Warner says he’s also interested in the effects of specific cancer treatments that are being used to treat people with cancer who have COVID-19.
The researchers say there’s more to learn about the relationship between cancer and COVID-19.
“How we improve the care we provide these patients and reduce the number of deaths and severe consequences associated with this disease are among the top questions,” Dr. Howard A. Burris III, FACP, FASCO, the president of ASCO, said in a press statement.
Thoracic cancer and COVID-19
Another study announced at the ASCO conference showed that people with lung and other thoracic cancers who were treated with chemotherapy within 3 months of their COVID-19 diagnosis had an increased risk for death compared to other treatment methods.
In an analysis of data on 400 cancer patients, researchers concluded that only the patients treated with chemotherapy, either alone or in combination with other therapies, had a significantly increased risk (64 percent) of dying from the virus compared to people who didn’t receive chemo.
In a presscast, the registry’s lead author, Dr. Leora Horn, a cancer researcher and director of the thoracic oncology program at Vanderbilt University Medical Center, said that research on COVID-19 and cancer death continues to evolve.
In a press release, Burris added that there are still more questions than answers, but that these findings “give us some insights into outcomes for patients with cancer who develop COVID-19.”
Looking at the immune system
Dr. Matthew Cook, the founder of BioReset Medical, an integrative clinic that specializes in regenerative and functional medicine, says the interplay between COVID-19 and cancer inevitably involves the body’s immune system.
“Chemotherapy, radiation, immunotherapy, and the cancer itself can all have a suppressing effect on the immune system,” said Cook, whose medical approach is to use the most noninvasive, natural, and integrative ways possible to achieve optimal health.
Cook told Healthline that he works in cooperation with oncology to get best results for his cancer patients.
“We take a fairly traditional approach. We are looking at all the body’s systems to see if there are problems that we can optimize,” he said.
For example, he notes that the gastrointestinal system and the immune system are intimately connected, and that the traditional medical world is beginning to embrace this concept.
“I think the oncology community is evolving into accepting some modalities that are integrative. Our goal is to try to take all that into consideration and then develop a treatment plan that supports their immune systems,” Cook said.
While people with cancer are “between a rock and a hard place” when it comes making decisions about treatment, Cook says, the relative risk of a cancer patient getting an infection with the new coronavirus remains low.
“Patients with these conditions just need to have a very careful approach and limit their exposure and risk of infection,” he said.
“In broad terms, I would say that people are generally well served by following their physician’s guidance and, in most cases, moving forward with their cancer therapy, depending on their circumstances in life,” Cook said.
“Cancer patients and physicians have actually known about these risks for a long time. Patients with cancer who are on chemotherapy are already immunocompromised. We already know how to give them the best ways of protecting themselves,” he added.
Being careful while being treated
Binzee Gonzalvo, 47, a university lecturer in Tokyo, Japan, who’s currently receiving treatment for marginal zone lymphoma, is being careful and using common sense.
He’s read the new statistics on cancer death and COVID-19. And while it does give him pause, he’s decided to move forward with his treatment.
“It’s not the best timing to have a cancer diagnosis or relapse. I’m just dealing with it the best way forward given the circumstances,” Gonzalvo told Healthline. “I had to be proactive and consider that in my decision making process. I have stayed indoors at home the whole time, with the exception of treatment days.”
He adds that he wears a mask that’s used for medical staff, and he purchased protective glasses to wear when using public transportation to his cancer center.
“So far, so good and on schedule regarding treatment,” Gonzalvo said.
He notes that COVID-19 has affected communication with his hematologist.
“He was assigned to a COVID-19 task force, and so for my appointments in May for my second treatment, I had to talk with another hematologist who covered for him,” Gonzalvo said.
However, he added on a positive note, “I’m staying strong with hope.”
Patient care in the age of COVID-19
People with cancer and survivors of the disease are also finding it increasingly difficult to get necessary healthcare as the COVID-19 pandemic persists.
Many are experiencing financial stress and mental health issues as they try to navigate the difficult health and economic environment.
A survey by the American Cancer Society Cancer Action Network (ACS CAN) of cancer patients and survivors found that 87 percent of respondents have had their healthcare affected by the COVID-19 pandemic in some manner. That was up from 51 percent in an April survey.
Of those in active treatment, 79 percent reported delays to their healthcare, including 17 percent of patients who reported delays to cancer therapies such as chemotherapy, radiation, or hormone therapy.
The most commonly reported effects for those in active treatment were for changes to in-person cancer provider appointments (57 percent) as well as delays in access to imaging services (25 percent) and surgical procedures (15 percent).
About 20 percent reported delayed access to supportive services, including physical therapy or mental healthcare.
Nearly 1 in 4 patients surveyed say the pandemic has made it more difficult to contact their providers with questions about their healthcare needs.
And 1 in 5 say they’re worried their cancer could be growing or returning due to delays and interruptions caused by the COVID-19 outbreak.
“The situation is getting worse, not better for cancer patients during this pandemic,” Lisa Lacasse, president of the ACS CAN, said in a statement.
“Health practitioners continue to work to balance safety for an immunocompromised population at increased risk for contracting COVID with timely treatment to prevent the spread of cancer. Unfortunately, this results in delays in treatment for many cancer patients,” she said.
Some good news
Amid the fear and anxiety caused by COVID-19, there’s also good news for people receiving cancer treatment.
At the annual ASCO conference, a variety of new data on treatments for numerous types of cancer showed promise in clinical trials.
For example, the Food and Drug Administration has given the fast track designation to ME-401, an oral treatment from MEI Pharma for people with relapsed or refractory follicular non-Hodgkin’s lymphoma (NHL).
Follicular NHL is the most common subtype of low-grade (indolent) lymphoma, making up as much as 30 percent of all non-Hodgkin’s lymphomas.
Follicular lymphoma is treatable but doesn’t have a current cure. For cases that don’t respond to two prior treatments, next steps can be difficult to decide. There are few viable options.
MEI Pharma is conducting an ongoing phase II clinical trial called TIDAL that’s evaluating ME-401 for cases of follicular lymphoma that haven’t responded to at least two prior systemic therapies, including chemo and an anti-CD20 antibody.
Daniel Gold, PhD, president and CEO of MEI Pharma, said in a press statement he’s excited to continue expanding the opportunity that ME-401 represents for cancer patients.
“We are particularly encouraged that the follicular lymphoma patients in the Phase 1b study — the focus of our ongoing Phase 2 TIDAL study — now have a median time on therapy in excess of 1 year with responses that are durable to date while remaining generally well-tolerated,” he said.
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