Breast cancer survivors
Healthy people with average cancer risk
People with a genetic mutation linked to cancer risk
The current COVID-19 pandemic has led to many changes in our communities. In this XRAY review we focus on the intersection between COVID-19 and cancer: who may be immunosuppressed, coping with changes in surveillance or treatment, and evaluating and dealing with media. (4/13/20)
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|At a glance||Guidelines|
|COVID-19 symptoms||Questions to ask your doctor|
|What are risks for infection?||COVID-19 in the media|
|Immune system and treatment||What does this mean for me?|
|Changes in care||Resources and references|
The issues faced by people with cancer or at high-risk of cancer during the COVID-19 (coronavirus) pandemic.
The coronavirus pandemic brings new challenges to people coping with cancer or people who are at increased risk for cancer have unique concerns.
Coronavirus Disease 2019, or “COVID-19” for short, is a disease caused by a type of virus known as a coronavirus. There are different types of coronaviruses. This particular strain—officially known as Severe Acute Respiratory Syndrome Coronavirus 2 (or SARS-CoV2)—is new to people and therefore has not been well-studied. This is why some reports use the term “novel coronavirus” to describe SARS-CoV2.
Health care experts rely on research and facts to help guide medical care. However, because COVID-19 is very new, there are still many unanswered questions. Research on COVID-19 is ongoing, but experts will need more time to learn the best ways to prevent and treat the virus. Although much of the media coverage has been accurate, some misinformation has also been making the rounds.
In the face of such uncertainty, our goal is to provide you with information that is reasoned and evidence-based so that you can make the best possible healthcare decisions. We address issues specific to hereditary cancer and link you to credible resources. We will provide updates as these guidelines, insights or knowledge about COVID-19 change.
Symptoms of COVID19 vary by person. Some people infected with coronavirus do not have any symptoms. The most common symptoms of this virus are:
Other symptoms include:
The exact time between exposure to the virus and the appearance of symptoms may vary, but it is thought to be between 2 and 14 days. The virus can be passed between people before or while they are experiencing symptoms. Some people may be infected with this coronavirus and never have symptoms. Even without symptoms, people infected with the virus are still able to pass it to others.
Although people of any age can become infected and develop severe COVID-19 illness, the risk of having a severe infection varies with age. The risk is greatest among older adults, particularly for those over 60. The rate of infection among people without symptoms is unknown at this time.
The risk of infection, severe illness and death are greater for people who have other underlying health issues and those who have a weakened immune system.
Conditions that affect the risk for serious COVID19 complications include:
Experts are uncertain if just having a cancer diagnosis can increase the risk of becoming infected or of complications related to COVID-19. However, the World Health Organization and representatives of 25 countries, including the United States, published "Report of the WHO-China Joint Mission on Coronavirus Disease" on February 28, 2020. They found that among 56,000 SARS-CoV2 patients, the risk for death was higher in people diagnosed with cancer compared the study group overall. More research is needed to confirm these findings.
An editorial posted in the Journal of the American Medical Association stated, “Cancer and cancer-related treatments frequently cause immunosuppression, and patients with cancer have excess mortality risk from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The magnitude of this risk is not yet known but early reports suggest a substantial increased risk of death associated with COVID-19 infection among patients with cancer, perhaps highest among those older than 60 years and those with pulmonary compromise.”
There is no evidence or reason to believe that having an inherited mutation in a cancer gene suppresses the immune system or leads to increased risk of serious infection.
If you are unclear about your risk for COVID-19, contact your doctor for advice. This type of consultation is best done remotely (telemedicine by phone, email or online).
Experts know that people with a weakened or altered immune system have an increased risk of severe illness or death from COVID-19. Different cancer treatments may affect how the immune system responds to infection.
Experts believe the following treatments do not cause immune suppression:
The health care community is working to minimize the risks of exposure to coronavirus for patients and providers during the pandemic. The CDC is asking healthcare providers to:
This has led to changes in medical care for people with cancer and for those at high risk for cancer including:
Information about COVID19 and its effects on health and cancer care are changing daily. For this reason, experts are working hard to study the disease, report on findings quickly, develop guidelines and update them frequently. Because rates of infection vary by location, national, state and local experts must work together to help provide people with the most relevant to their situation.
The following organizations have developed guidance for providers and patients during the pandemic.
Centers for Disease Control and Prevention (CDC).
The CDC has published guidelines with information on what to do to help prevent infection from COVID-19.
If you do have to go out in public:
Call your healthcare professional if you have concerns about COVID-19 and your underlying condition or if you are sick.
Make sure that people who spend time with you also follow these guidelines. Even if they are not immune-compromised, they can become infected and pass the infection on to you.
You can read these CDC’s guides and resources:
Environmental Protection Agency (EPA)
The EPA publishes a list of disinfectants that may be used to clean surfaces to reduce the spread of coronavirus.
America Society of Clinical Oncology (ASCO)
ASCO lists recommendations from different professional societies for health care providers and notes that they will update it with any new information as it becomes available. ASCO's Cancer.net site has resources on COVID-19 for cancer patients.
Society of Surgical Oncology
The Society of Surgical Oncology issued recommendations regarding surgery during the COVID-19 pandemic for different cancer types.
American College of Surgeons (ACS)
ACS has a COVID-19 resource center where they have posted recommendations for “COVID-19 Guidelines for Triage of Breast Cancer Patients."
American Society of Breast Cancer Surgeons (ASBrS)
ASBrS published an executive summary on March 24, 2020 with “Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic.”
ASBrS and the American College of Radiology issued a joint statement recommending that screening tests including mammograms, ultrasound and MRI, as well as routine breast visits and consultations for non-urgent issues, should be delayed for now.
American Society of Radiation Oncology (ASTRO)
ASTRO posted recommendations for radiation oncologists.
Be aware that all news is not equal. Information is changing quickly as new studies are conducted, new technologies are tested and new data is analyzed. Some media reports contain helpful, accurate, evidence-based and fact-filled news, while others promote fear, unsubstantiated rumors, hyped promises without support and inaccuracies.
A few tips for evaluating media
It is easy to be overwhelmed by the amount and rapidly changing information about COVID-19. Here are a few tips for deciding whether a particular media report is worth your time:
Almost everyone has been touched in some way by the COVID-19 pandemic. There are many factors that may influence how it affects your health and wellbeing, including your age, where you live, your general health, whether you have been diagnosed with cancer, which treatments you are taking, and your employment, financial and housing situation, among others. Here are some general suggestions:
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