COVID-19 Information

Summary guidance for Covid-19 vaccination for cancer patients.

Patients should be vaccinated, regardless a) if they have an active cancer, b) the type of cancer therapy they receive, c) if they are in follow up after treatment management, d) if they are cancer survivors [2-21].

Nevertheless, some specific recommendations for Covid-19 vaccination timing and prioritization in cancer patients were suggested by different national and international institutions (ask your doctor for your vaccination timing and prioritization details) [2-8,10-13,15,16,18,19].

1. If you have active cancer or a haematological malignancy requiring chemotherapy, or you were diagnosed with solid tumor in the last 5 years, you might have an increased risk for severe Covid-19 disease and you will be most probably prioritized for Covid-19 vaccination [4-8,10,11,13,15,16,18] (ask you team for your particular risk group and need of prioritization).
2. Vaccination is indicated irrespectively of the specific cancer treatment you receive (radiotherapy, immunotherapy, chemotherapy, or other specific biological treatment), or if you have received stem cell transplant [2-21]. Waiting for vaccination is not a reason to defer or delay your treatment.

– Vaccination is recommended to be done before the initiation of chemotherapy, when feasible. If you are already receiving chemotherapy, it is suggested to have the vaccine when the white blood cells are within normal limits [7,8,10,15,16,19,20].

– If you receive cytotoxic chemotherapy or immunotherapy, some authorities suggest the vaccination to be given 15 days after treatment and 7 days before next therapy, when it concerns three weekly regimens [ref.16]. Alternatively, vaccination is advised to be given between chemotherapy cycles and away from the nadir period (period of low blood counts, usually 7-14 days after treatment, but this can vary depending on the specific treatment). It is generally suggested the treatment to be avoided when vaccine side effects are expected [4,5].

– For patients who are about to complete cytotoxic therapy, the first dose of the vaccine is recommended to be given after therapy completion and nadir period resolution [4]. In either case, the decision is taken after discussion, with your physician or team group for your best option.

– In case of planned surgery, vaccination is advised to be given at least 1 week before operation. Vaccination can be done at any time after the operation, with an optimal white blood cell count [ref.4,5,10]. Please ask your doctor or medical team for further advise.

3.  If you have had a) allogeneic stem cell transplantation in the absence of graft-versus-host disease (GvHD), or b) B-cell depletion therapy, you can receive the vaccine some months later, with policy and suggestions being different among providers (ESMO, HCS, BSMO, DGHO, ASCO, ASH, UK Chemotherapy Board) [3,4-7,10,13,18,19]. Ask your physician which best applies to you.

Some patients may experience reduced protection after vaccination because of their treatment. Trust your doctor, if you are in this patient subgroup, your physician will keep you informed.

4. Vaccination isn’t prohibited to patients with past Covid-19 infection or infection after the first dose of a vaccine and it is not necessary to have a test for Covid-19 infection before vaccination, since even if you have experienced a Covid-19 infection in the past, vaccination strengthens your safety (by reinforcing immune system ‘s memory). AIOM, COMU, CIPOMO, HESMO suggest to be done 15 days after full recovery from COVID infection, or 1 month after initiation of the infection [8,16].

ASCO, CDC suggest to be done up to 6 weeks (42 days) after the first dose of a vaccine in case of infection after the first dose of vaccination [4,5].

If you have received passive antibody therapy (monoclonal antibodies or convalescent plasma) as part of Covid-19 treatment, you can be vaccinated after at least 90 days [4,5].

Contraindications to vaccination

The contraindications to the vaccination are the same that apply to the general population. [ 4-6,8,10,11,12]

• Vaccination is NOT indicated to you if you have contraindications to the vaccine or any specific component of SARS – CoV 2 vaccines, such as severe allergic reaction [4-8,10,12,13,15-19,23].
• If you have experienced in the past a severe allergic reaction to other vaccines or injectable drugs or you have specific types of allergy, discuss it with a doctor, since guidance may vary [4-6,8,10,12,13,15-19,23].

Additionally, it is generally accepted that if you have a history of allergic reaction/anaphylaxis to a vaccine, medicine or food, you are advised not to receive the Pfizer vaccine. Discuss it with a doctor, since guidance may vary among different national authorities and medical providers [4-6,10,12,19].

If you had a severe allergic reaction after the first vaccine administration, you will probably not be given the second dose. Even in this case, since vaccination policy may vary in different countries, discuss it with your doctor [4-6,19].

Regardling AstraZeneca vaccine, patients with a history of anaphylaxis or angioedema were excluded from clinical trials [19].

Since there are limited data on the effects of Covid-19 vaccination in patients with cancer concerning the efficacy and duration of immunity, as well as the interactions with cancer therapies, information and guidance on cancer patients’ vaccination will result from the experience unearthed by each country’s vaccination programs and real world data. All information is empiric and increases with time, since Covid-19 pandemic will be long lasting, comprising different phases in time [24,25].

References

1. Mauri D, Kamposioras K, Tolia M, Alongi F, Tzachanis D; International Oncology Panel and European Cancer Patient Coalition collaborators. Summary of international recommendations in 23 languages for patients with cancer during the COVID-19 pandemic. Lancet Oncol. 2020 Jun;21(6):759-760. doi: 10.1016/S1470-2045(20)30278-3. Epub 2020 May 13. PMID: 32410877; PMCID: PMC7220173.
2. ASTRO-American Society for Radiation Oncology (ASTRO); 2021; COVID-19 Clinical Guidance -ASTRO Recommendation on COVID-19 Vaccination for Cancer Patients Receiving Radiation Therapy; https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-

Information/Clinical-Guidance

3. ASH: https://www.hematology.org/covid-19/ash-astct-covid-19-and-vaccines

4. ASCO: https://www.asco.org/asco-coronavirus-resources/covid-19-patient-care-information/covid-19-vaccine-patients-cancer
5. CDC:https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html
6. AACR:https://cancerdiscovery.aacrjournals.org/content/early/2021/01/04/2159-8290.CD-20-1817.full-text.pdf
7. ESMO:https://www.esmo.org/covid-19-and-cancer/covid-19-vaccination
8. AIOM,COMU,CIPOMO: https://www.aiom.it/wp-content/uploads/2020/12/20201231_Vaccino_COVID_19_AIOM_CIPOMO_COMU_1.0.pdf
9. BSMO: https://www.bsmo.be/news/bsmo-statements-on-covid-vaccination/
10. Hungarian Society of Oncologists: oncology.hu, Országos Onkológiai Intézet-National Institute of Oncology https://onkol.hu/wp- content/uploads/2021/01/covidtaj_onkologiai_betegeknek20210108.pdf,   https://koronavirus.gov.hu
11. FHI-Folkehelseinstituttet: https://www.fhi.no/sv/vaksine/koronavaksinasjonsprogrammet/hvem-kan-fa-koronavaksine/
12. HZJZ:https://www.hzjz.hr/wp-content/uploads/2020/03/CDC_preporuke_prijevod_o_cijepljenju_protiv_COVID-19_za-klinicare.pdf
13. DGHO: https://www.dgho.de/publikationen/stellungnahmen/gute-aerztliche-praxis/coronavirus/covid-19-vakzine-20210107.pdf
14. PTO – Polish Cancer Society: (http://pto.med.pl/pto-chorzy-na-nowotwory-powinni-byc-uwzglednieni-priorytetowo-w-narodowym-programie-szczepien
15. FACME – Spanish Federation of Scientific-Medical Societies, Spanish Medical Oncology Society (SEOM) and Spanish Radiation Oncology Society (SEOR): https://facme.es/covid-19/covid-19-documentos/, SEOM website (https://seom.org/vacunacion)
16. HESMO: https://www.hesmo.gr/el/
17. SWISS CONFEDERATION,DFI,CFV: https://www.infovac.ch/docs/public/coronavirus/covid-19-recommandation-pour-vaccins-arnm-120121.pdf
18. Austria’s Bundesministerium, OAK, Onkopedia(DGHO,OeGHO,SSMO,SGHSSH):

Www.sozialministerium.at, Www.aerztekammer.at, Www.onkopedia.com

19. UK Chemotherapy Board Member organisations(BOPA,ACP,UKONS, Royal college of Physicians, Royal college of Radiologists, Royal college of Pathologists): https://4bd2316d-e45d-4e90-96b5-431f1c12dd3e.filesusr.com/ugd/638ee8_bc24796daf974cfa830a432248401191.pdf ,

https://www.gov.uk/government/publications/covid-19-the-green-book-chapter-14a,

BSBMTCT-British Society of Blood and Marrow Transplantation & Cellular Therapy, Bloodcancer.org.uk, The European Society for Blood and Marrow Transplantation-EBMT

20. Czech Oncology
    https://www.mou.cz/informace-k-ockovani-proti-covid-19-pro-pacienty/t5366, National Czech oncology guidelines:  https://www.linkos.cz/lekar-a-multidisciplinarni-tym/personalizovana-onkologie/modra-kniha-cos/online-novelizace-dodatky/online-novelizace-modre-knihy-kapitola-39-vakcinace-doporuceni-pro-ockovani-prot/

https://covid.gov.cz/situace/ockovani/informace-pro-osoby-s-chronickym-onemocnenim
https://www.linkos.cz/pacient-a-rodina/pomoc-v-nemoci/covid-19/onkologicka-pece-v-dobe-pandemie/ockovani-proti-covid-19-informace-pro-onkologicke-pacienty-a-jejich-blizke/
21. Slovenia’s Institute of Oncology: (https://www.onko-i.si/onkoloski-institut/medijsko-sredisce/novice/novica/priporocila-za-cepljenje-proti-covid-19-onkoloskih-bolnikov),

Slovenia’s National Institute of Public Heath:  https://www.nijz.si/sites/www.nijz.si/files/uploaded/004-cepiva_gradivo_za_strokovno_javnost_29122020.pdf

22. SBOC- The Brazilian Society of Clinical Oncology:https://sboc.org.br/guias-e-infograficos/item/2150-covid-19-vacinacao-de-pacientes-oncologicos
23. Albanian Ministry of Health and Social Protection:https://shendetesia.gov.al/fushata-e-vaksinimit-shqiperia-buzeqesh/

https://shendetesia.gov.al/vaksina-anti-covid/

24. Mauri D, Tzachanis D, Valachis A, Kamposioras K, Tolia M, Dambrosio M, Zarkavelis G, Gkoura S, Gazouli I, De Lorenzo F, Apostolidis K. Behind the numbers and the panic of a viral pandemic: fixed restrictive oncology guidance may jeopardize patients’ survival. J BUON. 2020 May-Jun;25(3):1277-1280. PMID: 32862566.
25. Kamposioras K, Mauri D, Papadimitriou K, Anthoney A, Hindi N, Petricevic B, Dambrosio M, Valachis A, Kountourakis P, Kopecky J, Kuhar CG, Popovic L, Chilingirova NP, Zarkavelis G, de Mello RA, Plavetić ND, Christopoulos C, Mostert B, Goffin JR, Tzachanis D, Saraireh HH, Ma F, Pavese I, Tolia M. Synthesis of Recommendations From 25 Countries and 31 Oncology Societies: How to Navigate Through Covid-19 Labyrinth. Front Oncol. 2020 Nov 19;10:575148. doi: 10.3389/fonc.2020.575148. PMID: 33330049; PMCID: PMC7711151.

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The COVID-19 pandemic has made imperative the use of security protective protocols (social-distancing of 2 meters from each other, use of waterproof apron, goggles glasses, masks) and the re-organization of hospitals, ambulatory clinics, personnel and structural domains in order to counteract the violent public health impact of COVID-19. Cancer patients are at high risk of infection, and the entire picture aggressively alters their oncology routine and management.

Professional guidance for cancer patients on what to do, whom to trust, and how to behave becomes of extreme importance in order to reduce the risk of contracting the virus, promote patients’ safety, support compliance and ameliorate patients’ anxiety and depressed mood.

In these unprecedented circumstances that we couldn’t even imagine a few months ago, National and International health providers and oncology societies make various attempts to provide some guidance to their patients.

An international oncology panel of 45 physicians from 26 countries, screened most of these guidance in order to provide COVID-19 comprehensive recommendations for cancer patients in one text.

Since language issue is not redundant, to help as many patients as possible, the resulting comprehensive summary of recommendation is under translation in 20 languages. The majority of translations have already been completed. All physicians involved in the project are participating in a voluntary form.

The study Coordinator

Davide Mauri 

Assistant Professor of Oncology

University Hospital of Ioannina, Greece

What is a coronavirus and what is COVID-19 ?
Coronaviruses are a family of viruses that can cause common cold. Sometimes they may cause more serious respiratory diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

COVID-19 is a disease linked to the novel beta-coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) firstly reported in China in December 2019.It is an RNA virus, highly infective, producing higher levels of lethality than the influenza and H1N1 viruses. The Director General of the World Health Organization declared COVID-19 a global pandemic on 11 March 2020.

What is a Pandemic?
A pandemic is an infection that has spread over several countries or continents, usually affecting a large number of people. At time of guidance writing, COVID-19 was affecting 209 countries and territories around the world with more than 1.563.000 certified infected patients and causing more than 91.830 deaths. At that time, Italy, Spain, USA, France, China, and Iran were the countries reporting the highest death rate from the disease.

Am I likely to have a serious illness if I get the COVID-19 disease?
In general, COVID-19 spreads in a similar way to the common cold or the influenza virus,with the vast majority ofindividuals contacting the infection being asymptomatic or experiencing mild to moderate symptoms.

Mild symptoms are generally managed staying at home and treating symptoms like in the case of a cold or flu.

Similar to other coronaviruses, it can occasionally lead to serious viral pneumonia and severe acute respiratory distress and rarely it can be fatal.

Who is at major risk of serious respiratory infection? As a cancer patient am I at a higher risk?
Severe forms of respiratory infection are mainly encountered among elderly people,people with weakened immune system and patients with severe co-morbidities (cancer, diabetes, lung and heart diseases, renal failure, autoimmune disease, organ transplantation, immunosuppression) or during pregnancy.

For these reasons the recommendations to avoid infection should be followed with particular attention by cancer patients.

Indeed, despite the limited evidence available to drive firm conclusions, two reports from China clearly highlighted that patients with cancer had a higher risk of SARS-CoV-2infection and a higher risk of being admitted to the intensive care unit, and death.

This could be probably explained by the fact cancer patients might have a decreased immunity due to the disease itself, post-surgical complications, the immunosuppressive effect of treatments (chemotherapy, cortisone, radiation therapy, transplantation), low performance status, malnutrition and/or cachexia.

Nonetheless, the level of immunosuppression varies and depends on patient’s fitness, type of therapy received, time elapsed from last therapy, presence of haematological malignancy , bone marrow transplantation, patients ‘age and co-morbidities.

Thus, if you are receiving treatment for cancer or you had been treated in the past, you can contact your physicians or medical center to ask about overall risk of COVID-19 infection.

How does SARS-CoV-2 virus spread?
SARS-CoV-2 is a virus that is principally transmitted by air and spreads from person-to-person when an infected individual talks, coughs or sneezes. The virus spreads through respiratory droplets from the airways of infected people and may reach directly into the eyes, nose, or mouth of people who are in close contact to the patient(within 2 meters,~7 feet).

Alternatively, the droplets may land on surfaces. People touching something that the droplets have landed on can either contaminate themselves (by touching their own eyes, nose, or mouth), or other individuals (by close personal contact such as hugging or shaking hands) who in turn will touch their own eyes, nose, or mouth.

What are the symptoms?
Symptoms most commonly appear 2-14 days (average 4 days) after exposure and include fever, cough, runny nose, sore throat, tiredness, body aches and diarrhea. Isolated sudden onset of loss of smell and/orloss of taste (even in the absence of upper respiratory tract symptoms) has also been reported, but isuncommon.

IMPORTANT! Immediate medical attention should be sought in case of: high fever (higher than 38°C or 100.3 degrees F), trouble breathing,shortness of breath, chest pain, confusion, blue lips or face.

How can I protect myself?

Follow the recommendation of your National and Health authorities.

Primary prevention: In the absence of specific treatment for COVID-19, the best way to prevent COVID-19 illness is to avoid being exposed to SARS-CoV-2virus.
Primary prevention can be reached implementing some strict hygiene and behavioral measures.

At time of guidance writing, the COVID-19cases is rapidly increasing , Although this guidance is particularly restrictive, we do not suggest you to reduce the level of awareness until the outbreak dramatically declines and the local situation (in your area) has improved.

Measures of personal and environmental hygiene.

The importance of hygiene measures was recognized by all the scrutinized oncology societies.

Recommendations include:

Personal hygiene:
 Wash your hands often with soap and water for at least 20 seconds (just the time it takes to sing twice “Happy Birthday To You”).
 Use hand sanitizer with 70% or more alcohol-solution until you can wash your hands with soap and water (If possible have always a hand sanitizer with you!).
 Avoid touching your eyes, nose, and mouth. Wash your hands first!
 Cough and sneeze in a paper towel, and then throw it in the garbage right away. Alternatively, if do not have any handkerchief, cough and sneeze into your elbow.(Never into your hands!)
 During oral anticancer treatments, the oral cavity can be a major source of infection, so besides regular brushing, remember of rinsing with antibacterial mouth wash.

Environmental hygiene:
 Regularly clean and disinfect objects and surfaces at home (regular household wipes and sprays will kill the virus) and in the office (use disposable tissues and then throw them away)
 Remember to clean places that people touch a lot, such as door handles, phones, keyboards, chairs, table surface and light switches. (As reported by WHO coronaviruses may survive on surfaces for a few hours or up to several days).
 Handle as few objects as possible in vehicles, shops, hospitals (keys, handles, handrails, cash, pin coder either at the shops’ POS or at the banks’ ATM).
 Wash your purchased vegetables and fruits.

Behavioral modification

As the pandemic rapidly gets worse, and cancer patients are at major risk of COVID-19 infection, the first step toward COVID-19 control is driven by robust infection and environmental control. Thus, at this stage of pandemic, strict “stay at home” and “no gathering in public” policies are strongly recommended.

Stay at home!!! …and no gather even within your home!!!
Practice social distancing even if you are feeling well!

Cancer patients who currently undergo radiotherapy or chemotherapy, or short time has elapsed since their last treatment(immunosuppressive therapies or corticosteroids ), have severe co-morbidities (severe respiratory, cardiovascular, autoimmune disease), are elderly or have had bone marrow transplantation should be particularly careful to follow stay-at-home and stop-gathering measures, as their immune system can be suppressed by the treatment.

You should avoid leaving the house unless it is essential.
You should not go out to do shopping for essential supplies, food, pick up medicine or exercise. You can use delivery services from supermarkets and e-markets or ask friends, family or neighbors to pick-up shopping and medicines for you. They should leave them outside your door.

If you are out of treatment and you have to work, set how to implement home-working and eventually home schooling (go to work only if you cannot work from home).

Use tele-health services and email, instead of seeing your doctor in person, when possible. If you need a drug prescription, your doctor may prescribe it electronically while you stay at home.

Stay with e-friends, implement social-distancing and avoid gathering at home with people outside the family.

During this time, it is advisable not to not invite or accept guests and friends at home.
(Be careful!!! Coronavirus infected people may look healthy!) and avoid baby-sitting at home …they might be a potential source of infection from the outside environment.

In case you are obliged to go outside due to extreme necessity:
 Avoid being in public areas, densely populated physical spaces (cinemas, theaters, party, human crowds)
 Avoid the use of public transport (trains, buses, metro, taxis and non-individual ambulances).
 To the bakery, just grab the rolls, croissants, bread in the shop with a bag or a handle, and better still buy packaged bakery products.
 Avoid traveling!!!

Avoid handshakes, hugging, make greetings with kisses, shaking hands, standing or sitting close to people, friends and familiars … and keep distance of approximately 2 meters (~ 6-7 feet) even if you are at home! (until the COVID-19 disease outbreak will calm)
Avoid sharing food and kitchen utensils (cutlery, glasses, napkins etc) and other types of objects without cleaning them properly.

Ventilate frequently your house and spend time in the fresh air.

Particularly avoid any contact with people who have symptoms of respiratory infection (sneeze, cough, sore throat, or shortness of breath, general muscle aches or fever), and don’t share personal belongings with them.

Avoid contact with people arriving from abroad, with or without flu-like symptoms.

Cancers survivors and patients not under treatment

If you are a cancer survivor, or long time has elapsed since your last treatment, you may not need to follow so strict measures, especially if you are not aged, had not bone marrow transplantation and you have no other reasons of weak immune system. You can ask your cancer care team about your risk of infection and any specific precautions are needed in your case.

Nonetheless, during a pandemic, like the one we live in at the moment, you have to pay attention to the messages from local authorities, since they may impose further measures (like strict “stay at home” and “no gather”) for the control of pandemic. Furthermore, measures of personal and environmental hygiene as well as most of the behavioral restrictions (social-distancing, frequent and proper hand washing, avoiding gathering , keeping surfaces clean and disinfected, and not touching your face when your hands are not washed ASCO) should be in any case adopted. Ask your doctor!

During the pandemic, avoid non-essential international travel and sea-cruises (even they are permitted in your country) and stay at home! This will help in the control of COVID-19 outbreak and will reduce your risk of exposure. Note that in some countries you can contact local authorities to be informed about the any specific measures you should follow when you visit the country.

Use of mask

Up to date the use of a face mask in the general or even in vulnerable population was not routinely recommended unless the individualwas ill. Very recently though, the guidance from both the Centre of Disease Control and Prevention (US) and European Centre for Disease Prevention and Control have suggested the general population to wear a mask or a cloth to cover the mouth whenever an individual is found in a crowded place even if asymptomatic . This will help reducing the risk of viral transmission from individuals that may have the virus but they don’t know they have it.

The same guidance should be followed by cancer patients.
You need to wear a mask or a cloth to cover your mouth whenever you are found in a crowded place even if you are asymptomatic.

The use of face masks in the community should be considered only as a complementary measure and not as a replacement for the established preventive measures that have been described above [ECDPC, CDC]

Use of mask, is mandatory while visiting your Cancer Care Center, both for you and your accompanying person

There are some warnings that the incorrect use of a mask can increase the risk of infection.
This may be due to mask misplacement or frequent contact of the hands with the face (e.g. because the glasses mist up, to scratch because of itching, sensation of need for mask replacement, continual put it on and removal for any reason).

Patient should thereafter be instructed about the correct of the mask, its placement and removal. Remember! Do not touch the outer face of the mask, and wash your hands immediately before and after its removal.
The mask must not be reused!

Since the use of mask contributes to a false sense of security, please remember that the use of mask does not completely protect you, and you must maintain sufficient distance to other people (approximately 2 meters, ~six – feet).

What to do if someone in the family is symptomatic? (or if someone asymptomatic but possibly infected)

 You should avoid:

• Infected persons either symptomatic or asymptomatic, until their test will be negative.
• asymptomatic but possibly infected (exposed to a positive case), for 14 days quarantine / test negative
• if mildly symptomatic (and test not performed by local health authorities), for 14 days and being asymptomatic. (ask your doctor)

If possible, you should live in different accommodations but as this may not be possible in the majority of cases, you should avoid close contact. You should avoid sharing a bed (when possible), sharing food and kitchen utensils (cutlery, glasses, napkins, bath and shower towels, hand towels, tea towels etc.) and any other objects without cleaning them properly. If possible, avoid using shared spaces, such as kitchens or bathrooms, and remember of regularly ventilating shared spaces. If you do not have a second bathroom or WC, clean the shared bathroom by wiping the surfaces you have to touch. When sharing places, keep safe distancing!!!  (2 meter, ~ 6-7 feet). Inform him/her about the importance of being self-isolated for 14 days. He/she should not shake dirty laundry, as this may spread the virus in the air. In the washing machine he/she can safely wash her/his laundry with other people’s items. Regularly dispose household waste. Limitation of this measure may be that people living in the same house to be already infected at the time of the symptoms and/or the diagnosis.

What to do if you are symptomatic?

IMPORTANT! You should seek immediate medical attention in case of: high fever (higher than 38oC or 100.3 degrees F), shortness of breath, chest pain, confusion, blue lips or face. Please contact immediately your doctor or your Cancer Care Center.

Note: if you are on active Oncologic treatment (chemotherapy/radiotherapy/immunotherapy) and you have fever, regardless of other symptoms, please contact immediately your doctor or Cancer Care Center. You may have treatment-related side effects that will need to be addressed and you may need to be admitted in the hospital. If COVID-19 is suspected you will undergo specific tests.

What to do if you have been in contact with a person with coronavirus infection and/or if you are asymptomatic / mildly symptomatic either with suspected or documented COVID-19?

Most people with COVID-19 will be asymptomatic or will have mild flu or cold symptoms.

Action: If you experience mild symptoms like fever, runny nose, mild dry cough, or other mild symptoms contact your doctor by tele-health and stay at home!

Attendance at emergencies should be preserved for patients with severe symptoms.

Simple measures to follow when symptomatic: Cover your nose and mouth when you cough or sneeze. If you use a tissue, put it in the garbage right away. If you do not have a tissue, cough or sneeze into your elbow crease.

Use paracetamol to reduce fever.

Living at home: If you are infected or there is a suspicion of COVID-19 infection, you should remain strictly quarantined, withdrawn from social life, until you fully recover. This is the measure with the greatest impact for the cessation of the transmission.
• If you are self-sufficient and don’t need any assistance, you are not aged and you don’t have severe co-morbidities, move family members to another house, when possible.
• Alternatively, you can stay at your home but do not share a bed (if possible), do not share food and kitchen utensils (cutlery, glasses, napkins, bath and shower towels, hand towels, tea towel setc.) and other types of objects without cleaning them properly. If possible, avoid using shared spaces, such as kitchens or bathrooms, and remember of regularly opening windows in shared spaces (if you can). If you do not have a second bathroom or WC, clean the shared bathroom by wiping the surfaces you have to touch. When sharing places, keep safe distancing!!! (2 meter, ~ 6-7 feet). Inform your familiar and people living with you about the importance of your self-isolation for 14 days. Do not shake your dirty laundry, as this may spread the virus in the air. In the washing machine you can safely wash your laundry with other people’s items. Regularly dispose household waste. Limitation of this measure may be that people living in the same house to be already infected at the time of the symptoms and/or the diagnosis.

Is there any vaccine or medication available against COVID-19 infection?

Vaccines: There are no vaccines available against COVID-19.
Since March 2020, some vaccines against COVID-19 have been tested in healthy volunteers in clinical studies. Nonetheless it may take up to 12 months before a vaccine becomes available for use. Until there is a vaccine available, the behavioral measures remain the mainstay of treatment against the spread of the disease.

Drugs: There are no drugs available yet for asymptomatic or cases with mild COVID-19 symptoms. Treat similarly to cold or flu.

As the situation is rapidly evolving, you will be advised by your doctor on any specific treatment needed if you develop severe COVID-19 infection. (Ask your doctor using tele-health)
Several new drugs are being tested in clinical trials, most of them used in severe COVID-19 illness. [ACS, ASCO, WP ]Chloroquine, a drug currently used to treat malaria, has shown some encouraging results. It is currently used in many countries to treat patients with severe COVID-19 infection. Nonetheless no randomized trial is actually available to clearly assess and quantify the value of chloroquine for the treatment of this coronavirus infection.

Are there any specific medicines to prevent COVID-19 infection?

At time of manuscript writing, there is no specific medicine recommended to prevent the new coronavirus infection.

Antibiotics work only against bacterial infections and are not useful in preventing coronavirus infection.

Is there any dietary or other supplementation, or any drug from the area of Complementary and Alternative Medicine (CAM) that had been shown to be effective against COVID-19 infection?

Despite some claims appearing on the WEB, there is no solid evidence that dietary, CAM or supplement (foods, super foods, intravenous infusion of nutrients, vitamins, minerals, amino acids, antioxidants and other nutrients) may help against COVID-19 infection by strengthening the immune system.

A coronavirus disease (COVID-19) advice for the public Myth busters was generated by WHO and is WEB accessible. (WHO: World Health Organization)

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

Stay Healthy
Healthy living can positively affect the risk of getting sick (including tendency to and severity of viral infections, flu or cold; probability to have cancer, heart disease and diabetes).

Stay as healthy as you can!
• Breath fresh air!
Ventilate frequently your house and spend time in the fresh air.
– Open your window every day, many times a day
– You can spend some time in your private garden, especially if the weather is good. But remember social distancing even with the family members!
• Do mild physical exercise
• Stay busy – enjoy your time!
– It is time to dedicate to your indoors hobbies!
– Use your creativity! You can cook, draw, and play board games…
– Take care of your house. What about your wardrobe? In some areas is still time to seasonal exchange of clothes! It is probable time to make something in at home you had never time!
– Oh! ..Yes, it is time to have some constructive pleasant time with your family. Remember social distancing.
– Listen to the radio, watch TV or attend online relaxing programs. (Try to avoid programs that over-emphasize the COVID-19 pandemic problems. This will not help you).Prefer pleasant programs.
– Relax and pass more time with your friends by using social-distancing technologies(Face-book, Instagram), blogs and microblogs (Blogs, Twitter), texts and phone calls, and video-calling (Zoom, Skype, etc).
– Time for some videogames
– Switch to online home-working and home-schooling.
– Be sure you have enough medications to cover your needs for 30 days.
– Use delivery services from supermarkets and e-markets or ask friends, family or neighbors to pick-up shopping and medicines for you. They should leave them outside your door.
• Have some rest as needed …you have time!
• Drink plenty of water/stay hydrated .
– this will help your health being and your performance
– remember that elderly and vulnerable people may have a reduced sense of thirst (program your daily water and when to drink. You are like a flower!
• Avoid smoking and alcohol
– they are harmful to health, weaken the immune system and may potentially ease viral infections.
– you are at home in a closed environment, you need clean air!
• Eat healthy:
– introduce more fruits and vegetables (remember to clean them thoroughly)
– reduce animal fat
• If you have pets in the household
– There is no evidence that companion animals/pets such as dogs and cats can be infected with coronavirus. You can have a nice time with your pet.
• Get plenty of sleep
• Manage your stress.

Stress and anxiety

Outbreak of coronavirus disease 2019 (COVID-19) may be stressful. Fear and anxiety about a disease maybe overwhelming.

Am I stressed?
There are some signs that may indicate you are stressed.
Recognizing these signs is particularly important for people vulnerable to stress, such as those already known having some form of mental health problem.
– Do you feel anxious, nervous, easily irritable blaming others or getting into arguments, restless, agitated and cannot relax or sleep? Do you feel down and not performant, cannot concentrate or remember, cannot complete some works and are distracted? Has your appetite changed or do you have headache? Do you want to stay constantly alone?

• What is suggested in the stay healthy section may help you.

We also suggest you:
• Be creative about how to maintain connections with others. See suggestions above on how to relax and pass more time with your friends by using social-distancing technologies.
• Telephone or e-talk with people you trust (family member, friends, mentors, spiritual/religious you trust) and share with them your experiences, feelings and concerns. This can be very helpful.
• Engage in pleasant activities and try to accept circumstances that cannot be changed
• Relax your body and mind by meditation, yoga, mild-exercise, walking, music, reading for pleasure and practice slow, steady breathing and muscle relaxation
• Realize that it is understandable to feel anxious and worried about. Try to maintain a sense of hope and think positive. Change the moto from “this is a terrible time” to “this is a terrible time, but I can get through this”.
• If you find that you are getting stressed by watching the news, reduce your exposure, particularly prior to sleep.
• Eat healthy food (avoid high sugar foods, alcohol, and too much caffeine).
• Maintain daily routines and schedules as much as possible, despite disruptions. For example, continue to wake up at a regular time even if you are working at home.
• Increase positive coping behaviors that have worked in the past.
• Plan ahead to avoid any shortages of goods or medications (as described above)
• Have adequate sleeping hours. Good sleep hygiene includes:
– Follow the same sleeping routine (same sleeping and waking times)
– Try to sleep when you are tired, but if sleeping is not feasible, try something relaxing like listening to audio books or sleep meditations found on free Apps.
– Avoid caffeine, nicotine, and alcohol 4-6 hours prior to sleep
– Avoid day naps with the exception of a less-than-one-hour nap before 3 pm., if necessary.
– Use your bed only for sleeping.
– Turn off the lights of any kind and keep your phone away from bed. In addition, two hours prior to sleep, lights from computer, TV or phone should be avoided
– Physical exercise may help the quality of sleep and reduced stress

The above mentioned stay healthy measures may help you to feel better. If you remain stressed consult your medical healthcare provider.

You can find more detailed information on how to help your physical and psychological performance on the American Cancer Society website (both in English and Spanish languages):
ACS https://www.cancer.org/latest-news/tips-for-staying-healthy-while-stuck-at-home.html
ACS https://www.cancer.org/latest-news/nurture-your-emotional-health.html
CDC https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
https://health.ri.gov/publications/guidelines/coping-with-stress.pdf

Trust your doctor and your treating team

The main goal of your treating team is to keep you safe and guarantee high quality of care.

During an extended epidemic outbreak aggressive measures might be undertaken by physicians and the Cancer Care Center to reduce the frequency of hospital visits for patients with cancer.

This is based on the :

1. experience from China (like that of Zhongnan Hospital of Wuhan University in Hubei) where it was noticed that the incidence of COVID-19 was particularly high among cancer patients. Oncologic outcomes were adversely affected, while there was a higher probability of early death due to the COVID-19 infection.

2. staff shortages that may affect you Cancer Care Center duringCOVID-19 outbreak
– redeployment of health care professionals to cover the demand of COVID-19 outbreak
– health care professionals that will be on quarantine or self-isolation

Please trust your doctor and your Cancer Care Center guidance on what to do.
In many cases the risk of SARS-CoV-2 infection and the relevant complications outweigh the benefit of the cancer treatment. Your physicians may suggest you to omit one or more treatment cycles or delay it for few weeks till the risk of the infection will be lower.

If you were in contact with a diagnosed COVID-19 case and you are in quarantine, cancer chemotherapy should be deferred until the potential incubation time (14 days) has elapsed.
In case of confirmed infection, treatment will be discontinued or will not be started until the infection is resolved.

With the assistance of telemedicine, consult your doctor on the benefits and risks of continuing or delaying treatment and the possibility of postponing treatment.

Possibility of postponing a treatment or increasing treatment intervals will be evaluated on a case by case basis, according to the overall clinical picture, the biological characteristics of the tumor, and the potential health risks from severe COVID-19 infection.

During the pandemic it might be safer and advisable:
– to postpone routine, preventive care appointments and non-urgent follow-up visits.
– to delay and reschedule appointments for elective surgery especially in high risk patients either aged or with co-morbidities (risk of complication is increased for those undergoing oncology surgery within one month prior COVID-19 infection).
– to prioritize oncology surgery for emergency and aggressive tumors (to avoid tumor mortality)
– to delay and reschedule adjuvant chemotherapy (especially in case the benefit of surgery / radiotherapy is high, while the magnitude of benefit from adjuvant chemotherapy is low or questionable).
– to delay medications such as bisphosphonates (used to decrease bone events in myeloma and solid tumors) and therapeutic phlebotomy (or therapeutic bleeding) (e.g. for polycythemia, hemochromatosis)
– To maintain the “LIFE SAVING” chemotherapy treatments.

COVID-19 outbreak may affect the way Cancer Care Centers operate

COVID-19 outbreak may affect the health care work force changing the way a Cancer Centre operates. Different security procedures are followed to minimize patient exposure. Health care workers may need to be redeployed to different working areas affecting the existing staffing levels in the various departments. It is also expected that planned clinical visits in your care cancer center may need to be canceled or delayed.

In rare cases, oncology departments may need to operate as acute wards to support the increase demands due to the COVID-19 outbreak. In these extreme circumstances and if you are undergoing a lifesaving treatment, especially with radical intent, your care is expected to be handed over to another functioning oncology center to continue your treatment.

Be mindful that, under these circumstances your Cancer Care Centre will adopt different measures to keep you and the rest of the patients and personnel safe. This might alter the routine you have experienced so far.

Follow the guidance, keep calm and be confident your oncology team will support you!!! PTOK
We would thank you to appreciate these changes.

Oral chemotherapy treatments

To reduce hospital visits, and whenever appropriate, a bigger quantity of oral medications could be dispensed. Clinical assessment by telephone or tele-heath should be offered before any subsequent cycle.

Radiotherapy during the outbreak

In the coming weeks and months, it is expected that patients, health care professionals and radiation equipment (can be also infected as well) will be significantly affected by the pandemic.[DGHO,ÖGHO,SSMO]

This may affect the way Radiotherapy is delivered.

Thus:

• Oncological emergencies (spinal cord or airway compression, tumor bleeding) will be treated urgently.
• patients with pathologies in which treatment cannot be delayed or those with curative and palliative intent radiotherapy will be prioritized using proven hypofractionation schemes.
• For the rest of the cases, a case by case evaluation, by the clinician and the tumor board, will be made according to the overall clinical picture, the biological characteristics of the tumor and the potential health risks from severe COVID-19 infection.
• In COVID-19 confirmed or suspected cases, the possibility of initiation, continuation, delay or omission of radiotherapy will be evaluated on a case by case basis by the clinician and the tumor board, according to the overall clinical picture, the biological characteristics of the tumor.
• If during your treatment you develop any clinical symptoms, you should immediately let your doctor and your treating team knows since weekly reviews will be offered only at patient’s need or in presence of clinical symptoms [SEOR]
• In symptomatic patients or any documented COVID-19 infected cases; it is mandatory to wear a surgical mask and gloves before arrival in the radiotherapy department.

A telephone consultation , without you coming to the Cancer Center, is suggested if

1. you have a temperature of >38^oC, cough, sore throat or runny nose
2. you have been in close contact with someone who has had a blood test and found to be COVID-19 positive or is waiting for a result of this blood test.

Oncohematological patients:

The level of immunosuppression is particularly high in patients with haematological malignancies and bone marrow transplantation.
Personal hygiene, use of protective equipment and social isolation are thereafter really important to minimize exposure.
• Patients on routine follow-up should stay at home and the consultations should be deferred, as there is high risk of infection in the community.
• Due to the prolonged and deep immune-suppression, non-urgent transplantations are not justified during COVID-19 outbreak (decision should be individualized based on risk and benefit for the patient)

Your medical team will decide the best actions for you! Do not decide by yourself! Ask your medical staff what is the best for You! Stay safer!

Do not interrupt your cancer treatment whenever it is indicated by your physicians. Fear of infection with the coronavirus must not interfere with the fight against a pre-existing tumor.

Important details

• If you’re due for your screening to detect breast, colon, cervix, or lung cancer, postpone your appointment to the near future.
• Non-urgent follow-up in asymptomatic conditions may be temporary performed by tele-health
• As restrictions lift, both screening exams and follow-up visit should be reinstated.
• Do not confuse symptomatic status with routine cancer screening, and follow-up
• If you have symptoms that could be related to cancer, please contact your health care provider about the best course of action at that time

Communication tools:
ΝΟΤΕ: Since “communication” and “trust” are mainstay to determine the best sequence of actions for you and the finest form of interaction with the medical center, it’s important for you to know who and how to communicate in order to reach your cancer care team and find out how to proceed. (Telephone numbers, fax, emails, protected Institutional microblogs platforms, etc).

Patient Internet Protection

Due to the different measure (like “stay at home” and “no gathering”) you may need to spend a lot of time at home, occasionally navigating the internet. You should be aware that many misleading information may spread through the web (“Dr browser”), microblogs and social media in general (facebook, instagram, Blog, twitter etc).
You should be careful in uploading and assessing information from uncontrolled e-sources and unsafe WEB contents without the appropriate medical guidance.

To find safe information on specific cancer patient oriented COVID-19 guidance, patients should prefer dedicated web-based links and dedicated phone lines (whenever present) especially provided by their related medical center, National official oncology societies and state guidance.

Tele-health, personnel and hospital protection
We have the responsibility to contribute to the protection, not only of cancer patients, but of health personnel and the hospitals themselves, in order to ensure adequate provision of healthcare both in general care and cancer care. [RANCR,SEOM]
The containment and slowdown of the wave of transmission is a fundamental element to preserve human resources and other technical infrastructure.

Patients and Visitors who are sick (or under the age of 18) should not visit the Care Cancer Center

Call before coming to any Cancer Care Center facility and notify your doctor /treatment teamif:

• If you have COVID‐19 symptoms such as feveror cough
• If you have been in contact with a diagnosed case of COVID-19 in the last 2-3 weeks
• If you have travelled outside your country or in an area at risk for COVID-19 inside your country

Dedicated physicians and personnel trained in the management of COVID-19 infection will discuss your symptoms with you and explain you what to do.

Remember that safety of other patients, providers and members of staff depend on patient’s correct behavior. Your Cancer Care Center will be deeply grateful to you.

If you are symptomatic and you have already arrived at the center:
• Report immediately to your attending physician or medical staff if you experience flu-like symptoms. (please avoid entering treatment and/or waiting areasto reduce the risk of viral transmission)
• Cough in a paper towel and if you do not have any, cover the nose and mouth with the forearm when coughing [MKOT] or sneezing, ask for a mask and put it on.

Arriving at the hospital

During your visit to the Hospital (in the period of COVID-19 outbreak) we suggest you and your accompanying person to put on face surgical masks independently of the presence of symptoms.

Physical contacts

• Avoid direct physical contact even with your doctor and staff.
• Avoid physical contact such as greetings with kisses and hugs and handshakes.
• Do the same with all people who are circulating in the hospital environment.
• In any hospital area patients should keepsafe distance (2 meters, ~ 6-7 feet) from other individuals

Visitor OR accompanying person:
Hospital visits should be constrained to absolute essential.

• Number of visitors OR accompanying person: To guarantee safety and in order to avoid overcrowding, only one (1) visitor or accompanying persons should be allowed in the building at a time (outpatient clinics, infusion units, in patient floors, and surgical or procedure visits).
• Exceptions may be made for visitors of patients receiving end‐of‐life care, but not in areas particularly affected by the COVID-19 pandemic.
• Pay attention to local regulations at any time. In areas particularly affected by the COVID-19 outbreak medical authorities are expected to promptly implement further regulations and some hospitals will notallow any visitors / family members to stay in clinic, ambulatory department, waiting rooms and areas where anti-cancer therapy is administered.

• When possible attend the oncology service alone to carry on with your treatment
• Access for visitors or accompanying persons in radiotherapy treatment areas should not be allowed.
• Patients, visitors or accompanying persons must stay in the hospital, oncology and radiotherapy services just for the time needed.
• Hospital visits must be restricted to those extremely necessary.
• Patients, visitors or accompanying persons must wash their hands or use sanitizer with 70% alcohol before entering and upon leaving a patient room, exam room, or other hospital facilities. Hand sanitizer will probably be stationed at all the entrances. Please plan extra time for appointments and visits.
• Patients, visitors or accompanying persons must talk in front of the glass or plastic barriers at reception areas.
• Encourage patients not to arrive early in order to avoid unproductive attendances at hospital and minimizecrowding in waiting areas (they can wait in their car).

Rest, Coffee and Dining Areas

• Avoid crowded areas in the hospital: coffee areas, restaurants, rest areas.
• In these environments the risk of contagion is particularly high even keeping safe distance (2 meters, ~ 6-7 feet) from other individuals.
• Valet parking services should be suspended (or at least avoided). Exclusive use of self‐park for patients and caregivers, with a wheelchair provision for patients in need should be available.

For hospitalized patients
In order to protect oncology patients without COVID-19 infection and the safety of the ward, infected patients are usually kept separately from those who may be at risk of infection and those that have no risk.

No visitors or accompanying personsshould be allowed to visit patients with confirmed or possible COVID‐19 infection.

For non COVID 19 infected patients it is advisable to avoid visits, nonetheless the presence of only one (1) visitor or accompanying personmay be allowed for a limited time and after a specific authorization.

Expressing Your Health Care Wishes

Expressing Your Health Care Wishes
In extreme circumstances, hospital policies will impose no hospital visits (even for non-COVID-19 infected cases)
You should consider Important question to ask yourself, to discuss with your loved ones, and write down:
• What level of quality of life would be unacceptable to me?
• What are my most important goals if my health situation worsens?
• If I am unable to speak for myself, who is the person in my life who I would want to speak for me?
• Who should not be involved in making decisions for me?
• If my heart stops, do I want to have CPR (cardiopulmonary resuscitation) done? [from ASCO]

Donate blood & blood transfusion during COVID-19 pandemic

Can I get COVID-19 from a blood transfusion?
Up to date there is no evidence that coronaviruses are transmissible by blood transfusion.
Pre-donation screening procedures are designed to prevent donations from people with symptoms of respiratory illnesses. All donors are asked to self-screen before coming in to donate.
Nonetheless since we are facing circumstances that we’ve never had to see before and couldn’t have imagined even several weeks ago, strength of data are based only on last three months world experience.

Can I donate blood to find out if I have COVID-19?
No. You should not donate blood to find out if you have COVID-19. Bloodcentersarenottestingfor COVID-19.

Can I catch COVID-19 by donating blood?
No. Donating blood is safe. New sterile needles that are discarded after use are always used. In case you are in need of blood, your relatives, friends, visitors and accompanying persons may safely donate blood for you.

I want to know more on COVID-19!

List of possible questions to ask your health care team are also available at: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/questions-to-ask-about-coronavirus.html

The World Health Organization provides the latest information on COVID-19 in their WEB site:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Further useful information can be found but not limited on the following websites:
CDC (Center for Disease Control and Prevention)
https://www.cdc.gov/coronavirus/2019-nCoV/index.html
ACS (American Cancer Society) Coronavirus, COVID-19, and cancer
https://www.cancer.org/about-us/what-we-do/coronavirus-covid-19-and-cancer.html
ACS (American Cancer Society) Fight Cancer During COVID-19 |
https://www.cancer.org/involved/help-fight-cancer-from-home-during-covid-19.html

• Arabic version
• Bulgarian version
• Catalan version
• Chinese version
• Croatian version
• Czech version
• Dutch version
• English version
• English Version with sources
• French version
• German version
• Greek version
• Hungarian version
• Italian version
• Japanese version
• Norwegian version
• Polish version
• Portuguese version
• Romanian version
• Russian version
• Serbian version
• Slovenian version
• Spanish version
• Swedish version
• Urdu version

ECPC fully supports our member organisation Federation of Cancer Patients Associations and their urgent appeal for critical protective materials and resources. If you can donate or support them at this difficult time please contact them http://bit.ly/39F6xIr

Find more information here: fabc.ro

News Article: The cancer patients, in a desperate situation after the emergencies only operate in hospitals. Warning of an oncologist: Surgery for cancer has a precise timing.

In 28 years of existence HOSPICE Casa Speranței has been close to its patients in their hardest moments of their lives, with a full support system for them and their families. Help the hospice by donating on https://www.hospice.ro/doneaza/  or send an SMS at 8844 with the message TIMP (2 EURO), or donate directly on Facebook: bit.ly/CancerulNUstaladistanta

Read their open letter here.

Our member Asociatia OncoPacientilor Phoenix  is a non-governmental organisation based in Bucharest representing all types of cancer patients and providing them with legal, emotional, financial and medical support.

They are urgently requesting donations for vital medical materials such as protective masks. You can help by donating what you can through their Facebook.

For more information on their important work visit aminvinscancerul.ro

In this section, we will share any opportunities to apply for grants for patient organisations amid the COVID-19 challenge. Now more than ever, we need the voice of patients to guide decision-making around the COVID-19 crisis, and continue to gather attention for other disease areas.

There are no grant opportunities at the moment.

The East Galway & Midlands Cancer Support Centre in Brackernagh, Galway is a non-profit organisation offering psychological, emotional and practical support for cancer patients. You can see their response to the COVID-19 outbreak here:

Cancer Support Centre to man 24 hour helpline

CORONAVIRUS: QUÉ DEBEN SABER LOS PACIENTES CON CÁNCER

¡ESTRENAMOS PODCAST! PRIMER EPISODIO: CORONAVIRUS Y PERSONAS CON CÁNCER

5 TÉCNICAS DE RELAJACIÓN PARA MANEJAR EL ESTRÉS Y LA ANSIEDAD

QUÉ EJERCICIOS HACER EN CASA PARA MANTENERSE ACTIVO

CONSEJOS PARA EL MANEJO EMOCIONAL DEL MIEDO AL CORONAVIRUS

The Spanish Association Against Cancer offers other helpful services at this time including:

• Infocáncer, a help line open 24 hours a day, 7 days a week, for free.
• A new service to offer online psychological support in bereavement for any person that might need it, no only for the oncological community but also for any person that has lost a relative due to coronavirus.
• Online voluntary services to accompany cancer patients that live alone or to help them with shopping, and also online support groups for carers.
• Online groups to quit smoking run by our professionals (psychologists an physicians).

Please visit their Facebook, Instagram and Twitter for further updates.

The #SolutiiCancer (Cancer solutions) platform is a civil society initiative being initiated by Alina Comănescu, the founder of the Community Health Association and Vlad Duțescu, a volunteer within the Melanom Romania Association.

You can find there:

• General and updated information about COVID-19, from Romania and the world
• Information and resources for cancer patients as provided by international guidelines
• Information collected from medical service providers – hospitals, doctors, clinics, laboratories, imaging, as we can integrate them into the providers map, and covering 8 regions
• Patients support provided in various forms, including food and drug delivery at home, psychological support
• Integration with other local or EU patients associations specialized in different oncological pathologies – pulmonary, colorectal, melanoma, breast, head and neck.

Association Les Zuros is a patient organisation dedicated to providing visibility and support to bladder cancer patients since 2017. They have released their document on frequently asked questions in relation to COVID-19 and bladder cancer patients.

COVID-19 ET CANCER DE LA VESSIE

The Russian Association of Oncological Patients “ZDRAVSTVUY” are providing ongoing services for their patients in this crisis. The help they are offering includes:

– delivering food to the patient’s home;
– assisting patients and doctors to the place of treatment;
– providing resources for protection and disinfection;
– distributing protective equipment to doctors and patients;
–  introducing ONCONET-online program for monitoring treatment, adverse events and rehabilitation; since last month coronovirus testing is built into this system, which allows to detect early signs of the virus,
– offering 50% discount on medical food through their online store with delivery;
– online patients education activities with leading experts in oncology;
– a second opinion about treatment options;
– assistance with hospitalisation;
– and a hot line for those in need of legal and psychological support.

www.onco-plan.ro

This website provides information support to cancer patients in Romania

Medical Nutrition Industry

Why is nutritional care important for patients with COVID-19 across the healthcare continuum?

Georgetown University School of Medicine, Wasington DC:

Laryngectomee guide for COVD-19 pandemic 

The Laryngectomee guide 

Transforming Breast Cancer Together:

Statement

ABC Global Alliance:

Coronavirus 2019 and Cancer

COVID-19 AND BREAST CANCER: ASK THE EXPERTS

COVID-19: Impact on Cancer Patient Organisations Worldwide in 2020

ONCA Community Forum:

Live discussions on Nutritional Care & COVID-19, don’t hesitate to participate.

WHO – World Health Organization:

Coronavirus disease (COVID-19) Pandemic 

2019 Novel Coronavirus (2019‑nCoV): Strategic Preparedness and Response Plan

Influenza in the time of COVID-19

Covid-19

ESMO – European Society of Medical Oncology:

Covid-19 and Cancer 

CORONAVIRUS: Update From ESMO 

ESMO Guidelines for Patients

Cancer Patient Management During The COVID-19 Pandemic

First Report On The Prognosis Of COVID-19 Patients With Cancer In The US

Cancer Core Europe Urges To Close Key Knowledge  Gaps On COVID-19 In Cancer Patients

Помощь пациентам в период пандемии COVID-19: руководство European Society for Medical Oncology (ESMO)

ASCO – American Society of Oncology:

Coronavirus Response

ASCO Coronavirus Resources 

JAMA Network:

Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy

The Lancet:

‘Risk of COVID-19 for Patients with Cancer’

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

ECDC – European Centre for Disease Prevention and Control:

Considerations relating to social distancing measures in response to COVID-19 – second update

EAU – European Association of Urology:

Coronavirus web hub

EMA – European Medicines Agency:

Coronavirus disease (COVID-19)

COVID-19: Beware of falsified medicines from unregistered websites

European Vaccination Information Portal (available in different languages)

AstraZeneca COVID-19 vaccine: review of very rare cases of unusual blood clots continues

AstraZeneca COVID-19 vaccine: EMA finds possible link to very rare cases of unusual blood clots with low blood platelets

Increase in vaccine manufacturing capacity and supply for COVID-19 vaccines from AstraZeneca, BioNTech/Pfizer and Moderna

29 March 2021 Safety updates for COVID-19 vaccines:

• Comirnaty
• Moderna
• Vaxzevria (AstraZeneca)

All the latest updates on COVID-19 vaccines are available by clicking here.

Medscape:

Guidelines for Radiotherapy in Prostate Cancer During the Pandemic

All.Can:

All.Can statement regarding continuity of cancer care during the COVID-19 pandemic

United Nations:

Covid-19 Public Service Announcement

FEAM – Federation of European Academies of Medicine:

Covid-19

Repository of publications for Clinical Trials in relation to COVID-19

EFPIA – European Federation of Pharmaceutical Industries and Associations:

European pharmaceutical industry response to COVID-19

Cancer & COVID-19: a delicate balancing act – An interview with Antonella Cardone

OECD:

Tackling coronavirus (COVID‑19) – Contributing to a global effort

ScienceDirect:

Recommendations for Triage, Prioritization and Treatment of Breast Cancer Patients During the COVID-19 Pandemic

European Disability Forum:

Resources and statement 

Inclusion Europe:

Easy-to-read information about COVID-19

ESTRO:

COVID-19 recommendations for RTTS

COVID-19 Resources

ASTRO:

How the pandemic may affect the delivery of radiation treatments

Enterprise Europe Network:

 EU initiatives

Patient View Blog:

Trustworthy patient-group news on Covid-19 under one banner.

OECI – Organisation of European Cancer Institutes:

OECI Magazine

Cancer Collaborative:

Covid-19

European Association of Hospital Pharmacists:

EAHP COVID-19 Resource Centre

Europa Uomo:

Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency

EU4Health:

COVID-19 has shown EU action on health is more urgently needed than ever

WECAN:

Covid-19 support information

Australian Go Back Campaign :

Cancer won’t wait

Cancer Won’t Wait during the COVID-19 pandemic

European Commission Initiative on Breast Cancer (ECIBC):

Information Corner on COVID-19 and breast cancer

European Commission:

Short-term EU health preparedness for COVID-19 outbreaks

European Thrombosis and Haemostasis Alliance:

A Systematic Approach for Managing Venous Thromboembolism in Patients with COVID-19

Eurocan:

OBSERVATIONAL AND TRANSLATIONAL MULTICENTRE STUDY OF CANCER
PATIENTS INFECTED BY COVID‐19: A EUROPEAN STUDY BY EURACAN NETWORK

Pancreatic Cancer Action Network:

COVID-19 Alliance Statement 

English Radio Thursday – ivoox

Covid and Cancer

These visual materials explain in simple terms how these vaccines work:

Viral vector vaccines

• infographic (available in all EU languages)

mRNA vaccines

• infographic  (available in all EU languages)
• video

COVID-19: Impact on Cancer Patient Organisations Worldwide in 2020 – Global Cancer Coalitions Network