Corona and Cancer by Dr. Gaurav Khandelwal Best Cancer Surgeon in Indore

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Corona and Cancer by Dr. Gaurav Khandelwal Best Cancer Surgeon in Indore

Corona and Cancer

Corona and Cancer: Queries answered

During this challenging time, I want to highlight many questions of cancer patients, survivors, and caregivers, regarding the recent outbreak of Coronavirus and the illness it causes. This text has been written to help them better understand the impact of the COVID-19 pandemic on cancer care. COVID-19 has impacted every aspect of cancer care right from screening to diagnosis to follow-up visits. Prioritization of different types of treatments and hospital visits done by oncologists may be necessary to keep you safe from infection.

Q 1 Who is at higher risk from COVID-19?

People with underlying health conditions such as chronic lung disease, cardiovascular disease, diabetes, chronic kidney disease, active cancer, and age more than 65 are more vulnerable to complications from COVID-19.

This is because some cancer treatments, and some cancers themselves, can suppress your immune system, which means you may not be able to fight the infection as well as someone without cancer.

Q 2 Are all patients with cancer at equal risk for infection?

No. Patients with a weakened immune system are at the highest risk since their immunity to fight against infection is lowered.  This weakened immune system may result from cancer treatment or from cancer themselves.

Higher risk of severe illness from COVID-19 if you:

  • Are having chemotherapy or have received chemotherapy in the last 3 months
  • Are receiving radiotherapy for lung and head & neck cancers
  • Have had a bone marrow transplant or stem cell transplant in the last 6 months, or are still taking immunosuppressive drugs
  • Have a type of blood or bone marrow cancer which damages the immune system, at any stage of treatment (for example, chronic leukemia, lymphoma, or multiple myeloma)
  • Are having immunotherapy or other continuing antibody treatments for cancer
  • Are having targeted cancer treatments which can affect the immune system

Q 3 Does coronavirus infection produce different symptoms in cancer patients than in others?

Yes sometimes. In the majority of cancer patients, symptoms are the same as in the general population.  Exceptions are the patients who are on steroids or on cancer medications that suppress the immune system of the body. Since the immune system is lowered, few signs of infection such as fever, increased heartbeat (tachycardia) may not get manifested and can result in delayed diagnosis of corona infection.

Q 4 should cancer patients and survivors avoid public transport and public/large event?

Yes. Patients taking active treatment for cancer should try to avoid public transportation when possible. If needed then follow simple tips to avoid exposure such as sit in the back or other areas with less exposure, use of surgical mask, and stay away from others who exhibit respiratory symptoms. When it comes to events, try to avoid and if not likely then limit close interactions. Stay at home when possible.

Q 5 What if a family member develops COVID-19? 

Fortunately, a vast majority of people with COVID-19 will develop only mild to moderate symptoms that will not require hospitalization. If a family member is hospitalized then you try to avoid going to the hospital. If you have to take care of a sick family member, you must also protect yourself. Follow this set of advice to protect yourself

  • Use a separate bedroom and bathroom.
  • If you have to share space, make sure the room has good airflow. Open the window and use a fan to increase air circulation.
  • Avoid having any unnecessary visitors
  • Eat-in separate rooms or areas
  • Wash dishes and utensils using gloves and hot water. Clean hands after taking off gloves or handling used items
  • Do not share dishes, cups/glasses, silverware, towels, bedding, or electronics (like a cell phone) with the person who is sick.
  • Wear gloves when you touch or have contact with the sick person’s blood, stool, or body fluids, such as saliva, mucus, vomit, and urine. Throw out gloves into a trash can and wash hands right away.
  • You should ask the sick person to put on a cloth face covering before entering the room.
  • Clean your hands often and avoid touching your eyes, nose, and mouth with unwashed hands.
  • Clean and disinfect “high-touch” surfaces and items every day: This includes tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics.

Q 6 Can the treatment be postponed due to COVID-19 cases in the community?

The decision for postponing treatment of cancer due to fear of the risk of getting COVID-19 should be discussed with an oncologist.

The risk of postponing treatment must be balanced against the benefit of decreasing COVID infection. In most cancer patients continuing cancer treatment is essential to fight the disease even if this is associated with an increased risk of severe illness from COVID-19. For this to achieve, oncologists can make modifications in treatment planned after considering the stage of cancer and the general condition of the patient. Example include

  • Use of 2 or 3 cycles of chemotherapy before the operation and postponing the operation for 60 -70 days.
  • Intervals of radiotherapy can be changed
  • Dose and frequency of chemotherapy can be changed
  • Non-essential clinic visits can be skipped, re-scheduled, or conducted by telephone or videoconferencing
  • At many centers, a negative COVID-19 test is recommended before surgery and/or chemotherapy. However, some patients with COVID-19 continue to test positive even after recovering from their symptoms. In this difficult scenario, a risk-benefit assessment should be done by the doctor.

Q 7 Is there any evidence that cancer treatment raises the risk of getting COVID 19 infection?

There is no evidence available till now to suggest that any cancer treatments raise your risk of getting COVID-19. However, patients with cancer may experience more complications of COVID-19 infection if they get infected with it. Reasons are weakened immune systems due to cancer and cancer treatment and more interaction with the health care system, so more chances of getting an infection with high viral load.

Q8: I have a central venous catheter/port. What should I do about flushing it regularly?

There is evidence that flushing can occur at intervals of up to every 12 weeks with no increase in adverse events or harms.

Q 9: I am a survivor of cancer who is on regular follow up to detect potential recurrence. Should I need to postpone my next follow up visit?

If you are not having any new symptoms and not at high risk of recurrence, then it is better to avoid 1 or 2 follow-up visits after a discussion with your doctor.

Any clinic visits that can be postponed without risk to the patient should be postponed. This includes routine follow up visits to detect cancer recurrence. In most cases, follow up visit intervals can be safely extended. But if you develop a new symptom that might indicate cancer recurrence you should contact immediately despite the risk of getting COVID-19 infection and should not wait for the next scheduled evaluation.

Q 10: Does smoking and/or tobacco increase the risk of COVID-19?

There is no specific data showing an increased risk of COVID-19 from smoking. However, complications from COVID-19 may be increased if smoking or continuous occupational exposures cause lung injury.

Q 11 Can I get COVID-19 from a blood transfusion?

According to the American Red Cross, there is no evidence that this new coronavirus can be transmitted through a blood transfusion.

Q 12 If I have cancer now or had it in the past, how can I protect myself?

Wash your hands often with soap and water or, if not available, use an alcohol-based hand sanitizer

Avoid contact with sick people, in particular with those with a cough

Avoid touching your face, nose, and eyes

Avoid meetings, events, and other social gatherings in areas with ongoing community transmission

Practice social distancing

The information included in this guide is not intended as a replacement for a doctor’s advice. Therefore, you should remain in close telephone/email contact with the treating physician. If you are feeling anxious, have questions, or need support, please feel free to contact me on mobile/email/whatsapp about Corona and Cancer.

Dr Gaurav Khandelwal Best Cancer Surgeon in Indore

M.S. M.Ch. Surgical oncology (Tata memorial Hospital Mumbai)

EBSQ European Board of Surgical Oncology Qualified

FSRS (Robotic surgery) Roswell park Cancer Centre USA

Mobile no. 8275791751

Email: drgauravkonco@gmail.com

ABOUT THE AUTHOR

Dr Gaurav Khandelwal

M.S. M.Ch. Surgical oncology (Tata memorial Hospital Mumbai)
EBSQ European Board of Surgical Oncology Qualified
FSRS (Robotic surgery) Roswell park Cancer Centre USA
Mobile no. 8275791751
Email: drgauravkonco@gmail.com

Dr. Gaurav Khandelwal, the profound emerald completed his MBBS and MS (General surgery) from renowned MGM Medical College Indore. After post-graduation, he got selected in India’s top-tier Cancer Institute. He is the first surgeon from Indore to get admission for super-specialization in cancer treatment M.Ch. (surgical oncology) in Tata Memorial Hospital Mumbai.

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