Very few countries and health systems took the news from China seriously in January, and when the World Health Organisation (WHO) declared the rapidly spreading coronavirus outbreak a pandemic, the need for information about how to deal with this new situation concerned all, and was strongly felt by cancer patients and survivors alike.

In the meantime, national health authorities in EU member states and national medical oncology societies have published guidance for their citizens, which cancer patients and survivors should follow, together with the instructions of their doctor. Leading scientific medical societies, the American Society of Oncology (ASCO), the European Association of Medical Oncology (ESMO), the European CanCer Organisation (ECCO) and others have by now issued relevant information, FAQs, and advice also. ECPC presents below a short update from the above trustworthy sources.

The causes of COVID-19–related deaths are not clearly defined in the international reports available so far, but data from Italy, where +20% of all COVID-19 mortality was among cancer patients, amplify the importance of the #StayHome request of national health authorities. This confirms the WHO indication that older people are more vulnerable, particularly when they have underlying health conditions such as chronic lung disease, cardiovascular disease, diabetes, chronic kidney disease and active cancer.

The pressing question that cancer patients and survivors face is whether they are at increased risk. ECPC have gathered trustworthy information from WHO, ASCO, ECCO and ESMO to inform its members accordingly. The categories of cancer patients at increased risk for #COVID-19 infection are:
  • Patients having chemotherapy, or who have received chemotherapy in the last 3 months
  • Patients receiving extensive radiotherapy
  • People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppressive drugs
  • People with some types of blood or lymphatic system cancer which damage the immune system, even if they have not needed treatment (for example, chronic leukemia, lymphoma or myeloma).
Specific risk groups are cancer patients with an impaired immune system such as:
  • Leukocytopenia
  • Low immunoglobulin levels
  • Long lasting immunosuppression (steroids, antibodies).

Co-infections of the upper airways may increase the risk of an adverse outcome in patients with viral infections; especially, co-infections caused by bacteria and fungi have a significant impact on the outcome of the primary viral infection. Chronic inflammatory and obstructive pulmonary disease can increase the risk of major respiratory complications.

Patients are advised to discuss their individual risk profiles, due to the primary hemato-oncological disease and the above-mentioned factors and comorbidities, with their treating oncologist. Cancer patients should follow the instructions of WHO and of their national health authorities. They should consult their physician regarding continuation of their treatment, diagnostic tests, and most importantly if they develop any symptoms.

Some scientific national medical oncology societies have already issued instructions to patients e.g. which cancer patients should continue treatment or which cancer patient categories are included in national “vulnerable population groups”, therefore in case of doubt, it is always better to check with your national health authorities.

All measures to prevent the risk of infection with SARS-CoV-2 and COVID-19 disease outbreak, as published by the European Centre for Disease Prevention and Control (ECDC) and WHO, as well as any other measures published by national health and disease control authorities, also apply to cancer patients.

Again, if you have any not usual symptoms, you are recommended to contact your oncologist before changing or stopping your treatment.

You may have heard and practiced the following simple precautions, which will help you to reduce the chances of being infected or spreading the virus to others. We strongly recommend to practice them religiously and do not forget that the best medicine in this crisis is #STAYHOME:
  • Regularly and thoroughly clean your hands with warm water and soap or with an alcohol based hand rub.
  • Avoid touching your eyes, nose and mouth.  
  • Maintain at least 1 metre distance between yourself and anyone, particularly if one is coughing or sneezing.
  • Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
  • Stay home if you feel unwell, seek medical attention and call in advance. Mention if you have been travelling recently or have come into contact with travellers. Follow the directions of your local health authorities.
  • You might consider staying in voluntary isolation.
  • Stay informed. Please follow regular updates from WHO and your national and local authorities to learn about the latest developments.
  • Talk with your GP and oncologist whether you should or should NOT get a flu vaccine
  • Be kind and support each other, use the internet and social media to connect with your loved ones and keep a sense of social life.

Let’s recognise and accept that this can be a stressful time, but that the strict measures taken aim at keeping us safe. This is the time to prove our social responsibility: taking care of ourselves and practising social distancing and staying home, keeps us and those around us safe. Remember to check-in on loved ones, gather information from trusted sources (such as the WHO and your national health authorities’ website), maintain a healthy lifestyle and enjoy pastimes that help you relax.

 

For more information:
WHO – World Health Organization:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/docs/default-source/coronaviruse/srp-04022020.pdf

ECCO – European Cancer Organization:
https://www.ecco-org.eu/Global/News/COVID-19/Resources

ESMO – European Society of Medical Oncology:
https://www.esmo.org/newsroom/esmo-society-news/coronavirus-update-from-esmo

ASCO – American Society of Oncology:
https://www.cancer.net/blog/tags/coronavirus
https://www.asco.org/asco-coronavirus-information

JAMA Network: Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy https://jamanetwork.com/journals/jama/fullarticle/2763667

The Lancet:
‘Risk of COVID-19 for Patients with Cancer’

ECDC – European Centre for Disease Prevention and Control: Considerations relating to social distancing measures in response to COVID-19 – second update
https://www.ecdc.europa.eu/en/publications-data/considerations-relating-social-distancing-measures-response-covid-19-second