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Coronavirus and cancer: What you need to know

Medical oncologists from Parkway Cancer Centre answer the most pressing questions for patients undergoing cancer treatment during the COVID-19 (Coronavirus Disease 2019) outbreak.

What is the coronavirus and how will it affect me as a cancer patient?

Dr Richard Quek: Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). The current novel coronavirus (COVID-19) is a new strain that has not been previously identified in humans.

Coronaviruses can affect anyone including healthy people. But it is thought that patients with chronic medical diseases that result in a weakened immune system may be at a higher risk of catching the infection as well as developing more severe complications to the virus. Cancer is one such disease.

Additionally, cancer patients may be receiving chemotherapy during this time, which may further weaken one’s immune system. Thus all in all, there would be an impact of the COVID-19 outbreak on cancer patients.

Should I still go to the hospital/clinic for my cancer treatment during the COVID-19 outbreak? Why?

Dr Quek: There are three groups of patients to be considered when answering this question.

• Cancer patients who are currently receiving treatment for cancer:
  For this group of patients, they should continue their treatment on time as advised. Take the necessary precautions as listed, observe personal hygiene, hand washing, wear a mask, etc. While this is a very small risk related to the community spread of COVID-19, and the natural inclination is to avoid going to hospitals and clinics, this risk is deemed to be very small when compared to the bigger issue of the cancer worsening or a relapse, should treatment be delayed unnecessarily.
• Patients who do not have any known cancer but have suspicious symptoms suggestive of cancer:
  These patients should have their symptoms checked out early. These symptoms may include blood in stools, new breast lumps, unusual swelling of the lymph glands, etc. As with all cancers, the key is discovering the cancer early for more effective treatment. Pushing back clinical visits may result in undue delay in the diagnosis which may then impact on the outcomes of patients, should these symptoms really turn out to be cancerous. Again, take the necessary precautions, but life goes on.
• Patients who had cancer, had been treated, and now in remission:
  This group of patients have some flexibility in terms of scheduling of clinical visits. For them, it is not unreasonable to delay the routine appointments to a slightly later date.

Should I wear a mask to protect myself against COVID-19 even though I don’t have a fever?

Dr Quek: This would be advisable. In the case of cancer patients, especially those on chemotherapy treatment whose immune system may be low, the risk of catching any infection is higher than that of a healthy person. My advice for our cancer patients would be to wear a mask when going out or visiting crowded places to reduce the risks of catching a respiratory infection.

What are some general precautions that cancer patients with weakened immune systems can take while travelling to the hospital/clinic for treatment?

Dr Colin Phipps Diong: In general, cancer patients who have received intensive chemotherapy or bone marrow trans-plantation should avoid crowded places. This does not rule out the use of public transportation if the patients manage to avoid peak-hour travel. If patients are taking the MRT, buses or taxis, one should practise good hand hygiene and if advised by the doctor, to wear a mask.

When walking through a crowd on my way to the hospital/clinic, what can I do to protect myself from COVID-19?

Dr Phipps: My advice is based on what I would do myself in the hospital. I practise regular hand hygiene – thorough washing of palms, wrists and fingers, wearing a mask, and avoid persons who are openly coughing.

What is currently being done in the clinic in terms of precautionary measures? What are the control measures and how will they help?

Dr Phipps: There are guidelines from the Ministry of Health for healthcare providers in accordance to the DORSCON alert level of the COVID-19 outbreak situation in Singapore. All hospitals and clinics will follow these guidelines to prevent and reduce the impact of infections. These include (but are not limited to) installation of thermal scanners at facility entrances, filling out of Health Declaration forms, screening for travel history, and surveillance of all hospital and clinic staff.

Is there a difference in the way cancer treatments are being carried out during this period?

Dr Chin Tan Min: Treatment of patients with ongoing chemotherapy, oral medications and immunotherapy should continue as planned. This will help to ensure minimal disruption of the intended treatment of cancer.

Concurrently, measures are being instituted in every hospital to ensure adequate screening of all patients and visitors, to allow detection of any possible infection, so as to minimise possible spread of COVID-19.

Similarly, to help contain possible infection, doctors and nurses are encouraged to minimise movement between different hospitals.

Are there symptoms that I should be particularly wary of? If I develop a fever during my cancer treatment for example, am I at higher risk of contracting COVID-19?

Dr Chin: Chemotherapy can compromise the immunity and as a result, patients on chemotherapy may be more prone to developing fever.

If fever happens in those who had recent chemotherapy, they should follow the usual advice of returning to the clinic/hospital for a blood check to decide if they need antibiotics. Antibiotics will help in fever arising from low white blood cell count due to chemotherapy.

Review with a doctor and evaluation with other tests such as chest X-ray and nose/throat swabs may also help exclude the fever from possible COVID-19.

For the various types of cancer, what is the greatest risk or one thing patients should look out for?

Dr Phipps: The risk is that an immune compromised state after intensive chemotherapy may render the patient more susceptible to a severe viral infection.

This is not specific to COVID-19 but we need to be aware of the current case definitions.

In managing patients receiving intensive chemotherapy for blood cancers and bone marrow transplantation in hospital, we will continue with our routine practices of regular hand hygiene, treating patients in single rooms, wearing masks, and gowning up where certain infections are suspected.

Dr Chin: Lung cancer patients may already have existent symptoms (such as cough), from the underlying cancer. I would advise that new and/or worsening symptoms of cough and fever to be further evaluated.

Dr Quek: With most types of cancer treatment, there is always a risk of weakening of one’s immune system. This, then predisposes a cancer patient to infections. Should a cancer patient, especially one on active treatment, develop a fever, it is very important for the patient to contact his or her doctor for further advice early.