Q&A: Covid-19 and impact on people with cancer

Why is Covid-19 a big risk for people with cancer?

The Covid-19 pandemic is immensely challenging and distressing for people with cancer, but also for those not sure if they have the disease – not to mention their families.

This is greatly added to because cancer patients undergoing treatment often have weakened immune systems. Evidence from China shows their vulnerability is heightened if they become infected by coronavirus. While those with cancer have a heightened risk of death in such circumstances, it should be stressed the great majority survive.

People with weakened immune systems are at greater risk of getting infections such as the common cold, flu and pneumonia as well as Covid-19. That is why people with cancer are classified in the most at-risk group and subjected to severe restrictions.

Should all cancer patients cocoon at home or healthcare settings?

The short answer is yes. The Irish Cancer Society (ICS) outlines key categories that must cocoon, including people who are being treated with chemotherapy, those undergoing radical radiotherapy for lung cancer and patients with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma at any stage of treatment.

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It includes people having immunotherapy or other antibody treatments for cancer and those undergoing targeted cancer treatments which can affect the immune system. People with bone-marrow or stem-cell transplants in the past six months, or who are still taking immunosuppression drugs, are also included.

Those who have had cancer in the past are advised to take precautions, factoring in their age and if they have other conditions.

What’s reality on the ground for cancer patients?

The Irish health system has had to radically redirect services to brace itself for a surge in Covid-19 cases. This had huge implications for those with cancer whose treatment has in many instances been curtailed or postponed.

That reality was summarised by oncologist Prof John Crown: "Many cancer operations and clinic appointments are being cancelled or postponed. Radiotherapy services are being scaled back. Drug treatments are being delayed, discontinued or altered. Patients who have just received the distressing news of a cancer diagnosis have on occasions been left wondering when their own treatment can start. Others who are already on treatment wonder if it is safe to continue."

Is there variation in risk for those with cancer?

According to the World Health Organisation, risk may be higher for those with blood cancers like leukaemia as opposed to solid tumours – ie breast, prostate or pancreatic cancer.

Some specialist services are no longer able to process referrals from GP patients with lumps and other symptoms suggestive of potential cancer. Delayed diagnosis and treatment adds to risk but many cancers advance slowly.

The bottom line is cancer patients must avoid infection and cocooning is best to ensure this doesn’t happen.

Is cancer treatment is on hold?

Unlike Italy, quality cancer services and diagnostics are still in place in Ireland, according to ICS head of research Dr Robert O'Connor. Patients with active cancers are being seen and getting treatment – once Covid-19 risk is minimised.

Oncologists, however, have to weigh up the benefits of treatment against the risk of what might happen if someone gets the virus during that treatment.

For this reason, certain scans, procedures, treatments or surgery may be postponed. Everyone’s cancer treatment is individual and decisions on treatment are being made on a case-by-case basis.

This is complicated by having a cardiovascular condition; diabetes or an autoimmune disease. Some difficult conversations have to be had on additional “adjuvant” treatments and on palliative care.

What’s the advice for people who suspect they may have cancer?

They are advised to contact their GP, who often can provide assurance symptoms don’t indicate cancer. Those with overt symptoms are getting treatment.

What supports are there for people with cancer who are anxious?

The ICS has set up remote counselling for adults and children with cancer – and their carers. It is targeted at those who cannot access face-to-face counselling due to coronavirus restrictions. It's available through its Nurseline service (Freephone 1800-200700) or via email cancernurseline@irishcancer.ieIt also offers help for patients who may be finished treatment but unsure how Covid-19 affects them.