Samantha Bonar

Mar 10, 2020

Sanjeet Dadwal, M.D.

As the number of people infected with COVID-19 increases across the U.S., cancer patients are concerned about how this virus might affect them.

It is becoming more evident that this infection is likely to spread further, especially with increasing instances of community spread (transmission with no known source).

Those at risk for major complications from COVID-19 include those who are older (particularly over age 70) and those with underlying health conditions such as chronic lung disease, cardiovascular disease, diabetes, chronic kidney disease — and cancer.

Some cancer patients are at particularly high risk. According to Sanjeet Dadwal, M.D., chief of City of Hope’s Division of Infectious Diseases, “The risk is likely to be higher in patients with hematologic malignancies such as acute and chronic leukemias, lymphoma and multiple myeloma, and those who have undergone bone marrow transplantation, especially those who have chronic graft-versus-host disease that requires treatment to suppress the immune system. Patients undergoing active treatment (chemotherapy, radiation or surgery) are also likely to be at high risk for complications from this infection.”

City of Hope has strict protocols in place to protect patients, family members and staff, including screening patients for illness, and recent travel out of the country and travel limitations and mandatory quarantine rules for staff. The institution has already developed detailed initial guidelines for diagnosing and treating all of its most vulnerable patients — including those with hematological malignancies and those who have received bone marrow transplants (BMT).

In addition, City of Hope scientists are working around-the-clock on their own version of a COVID-19 vaccine, while City of Hope's affiliate TGen is working on a rapid-response testing kit.

Dadwal, who specializes in treating cancer patients who develop infections, shared some additional information about how COVID-19 could affect cancer patients, as well as some advice on how they can minimize their risk while managing their fears.

Do we know how COVID-19 affects cancer patients?

We are still learning how this virus may impact those who have cancer. So far, data from China suggests that patients with cancer have the highest risk of complications. This includes events such as admission to the ICU, need for ventilator support and poor outcomes. The risk is higher in patients with more than one chronic medical condition.

Are all cancer patients at risk, or only those currently undergoing treatment?

Patients who are undergoing active treatment for cancer are presumably at higher risk than those who are in remission. Patients who are in the first year after stem cell transplantation or CAR T cell therapy could be at higher risk for complications if they get infected with COVID-19. Those who are beyond one year after transplantation and are still considered to be immunocompromised and may remain at an elevated risk for complications.

Should I be washing my hands or using sanitizer/wipes more often than others? Is there a special sanitation regime I should be undertaking?

Hand washing for 20 seconds with soap and water or the use of alcohol gel/sanitizer with a greater than 62% alcohol content on a regular basis is recommended. Touching of the face, eyes or nose with unclean hands is strongly discouraged. When in shared spaces, wipe down surfaces such as desk, chairs, doorknobs, tabletops, airline seat/table (travel is discouraged!) with disinfectant or antiseptic wipes.

Do I need to wear a mask?

If you have symptoms of a cold — cough, runny nose, sore throat or shortness of breath — please wear a surgical mask (especially when in a clinic or a public place) to limit spread to others. Wearing a mask in public just to protect yourself from the virus is not recommended. We do ask our patients who have had allogeneic BMT to wear an N95 mask through day 100 (according to the City of Hope Blood and Marrow Stem Cell Transplantation Patient’s Guide) or per physician direction to protect them from fungal infections.

Should I keep my follow-up appointments, or is it better to avoid the hospital for the time being?

If you are doing well and are asymptomatic, consider contacting your doctor to determine if routine follow-up is necessary at this time. Avoiding a hospital visit would limit your risk. If you have mild symptoms of fever, runny nose and cough, please stay at home, as you would do for the common cold. However, if you have worsening symptoms or shortness of breath, then contact your doctor and seek medical attention (call ahead so the team can be prepared to take care of you).

All necessary visits and treatment as scheduled by your doctor should be kept, unless you meet one of the above criteria.

If I have chemo or a BMT scheduled, should I postpone it?

If you have no symptoms and feel well, with no exposure history, the treatment can continue without interruption (as determined by your doctor). Postponing a BMT must be decided by your transplant doctor.

What should I do if a family member develops symptoms?

If family members develop an illness, it is imperative that they and you wash hands frequently. Keep surfaces clean and maintain distance from them if possible (e.g., sleep in different rooms, don't eat at a common table, etc.) to minimize the risk of infection. We empathize that this can be very difficult for families with children — however, having a candid discussion with the family about recommended preventive steps could be helpful.

How will I be able to tell if I have COVID-19 or just the cold or flu?

It will be difficult to distinguish one viral infection from another when experiencing a mild illness, especially with no recent travel history or contact with someone known to have COVID-19. If your symptoms worsen or you develop shortness of breath, you will need routine tests for infection (e.g., influenza) and COVID-19.

Should cancer patients avoid public transportation, travel and events? What about survivors and caregivers? Is it safe to leave home at all?

Social distancing is recommended for our patients to limit the risk of acquiring COVID-19. This includes limiting crowded and closed spaces — these scenarios include a crowded bus or train, movie theaters, malls, sporting arenas, restaurants, etc. Travel should be limited such as air travel and particularly cruise ships. Cancer survivors may have some lingering immune deficits and may be at risk for serious disease even years after stem cell transplantation. It is important to contact your doctor with any questions.

However, this does not mean that you cannot leave home. You may plan to take walks around the neighborhood and go grocery shopping during off-peak hours if it cannot be done by someone else — bring your own grocery bags, disinfect cart handles, and wash hands or use hand sanitizer after using the cart. The most important aspect is prevention; hand hygiene is critical.

Are there ways to boost the immune system?

Get a good night's sleep — lack of sleep has been associated with weakened immunity. There is no substitute for healthy meals — make sure you are eating lots of vegetables and fruits. There is no proven role of supplements; however, if someone chooses to use supplements such as vitamin C, it is unlikely to be harmful. Exercise will keep you strong and conditioned, but avoid gyms.

How can I deal with my anxiety over this virus?

It is most likely that this virus will be circulating in the community for some time, increasing the likelihood of acquisition. However, by employing frequent hand hygiene, environmental disinfection, social distancing (including of family members if they are ill) and avoiding travel and crowded places, you can minimize the chances of contracting COVID-19. We also have a strong team of supportive care experts who can provide support as needed.

Lastly, we recommend vaccination for influenza (for both the patient and family members/caregivers) — it is still circulating in the community and it is also a major cause of poor outcomes in patients with compromised immune systems.

INFORMATION ON COVID-19

Please visit cityofhope.org/covid for more information.