In the past year, COVID-19 has made life significantly more complicated for most, but few people have been as profoundly impacted as those managing cancer. Beyond the stress and anxiety that a diagnosis brings at any time, they have had to deal with a number of additional uncertainties. Patients are often immunocompromised, meaning they can be at risk of severe COVID-19 complications and need to take extra precautions to prevent infection. That challenge becomes that much more difficult when patients require continuity of care, as those with cancer do, so seeking treatment compounds stress and anxiety.
But there is hope.
Healthcare facilities and public health experts have created safety protocols to reduce the spread of the virus to vulnerable populations, including those with cancer. And, despite the global pandemic, cancer care, including leading-edge clinical trials, has never stopped.
For those who have received a recent cancer diagnosis, a number of questions immediately arise. Here are answers to some of the most common ones received by our team at the John Theurer Cancer Center, at Hackensack Meridian Hackensack University Medical Center:
Why does having cancer put people at higher risk of COVID complications?
Cancer occurs when the immune system's surveillance function fails to detect and attack cancer cells. This immune dysfunction is one reason why people with cancer may be even more vulnerable to COVID-19.
In addition, cancer treatments can lead to reduced immune function. However, the type and severity of immune dysfunction varies by treatment type. For example, as a lymphoma specialist, I prescribe many therapies that specifically target cancerous B cells, a type of blood cell. Normal B cells help the body create antibodies, and can remain sluggish after B-cell lymphoma treatments are complete. It can take months or longer for normal B-cell function to improve after treatment stops. The length of immune dysfunction after many other types of cancer treatment, including many chemotherapies, may be much shorter.
What enhanced safety measures have been implemented to protect people with cancer?
When the pandemic first arrived in the New York metropolitan area, one of our top priorities at the John Theurer Cancer Center was to implement safety precautions to reduce the risk of COVID-19 transmission at our facility. We also developed procedures to treat patients who developed COVID-19 during cancer treatment.
From temperature screenings to universal masking policies to physical distancing and rapid implementation of telemedicine, our team worked to ensure cancer care could safely continue during the pandemic. These safety measures remain in place today.
What steps can I take to protect myself during cancer treatment?
Following public health guidelines for handwashing, social distancing and masking are the best things you can do to protect yourself or a loved one who is undergoing cancer treatment or in early survivorship. Under the guidance of your healthcare provider, vaccination is another important opportunity to reduce the risk of poor outcomes if exposed to COVID-19. Keeping your immune system healthy through a well-balanced diet, exercise, sleep hygiene and stress reduction remains a crucial part of staying healthy during and after cancer treatment.
With more people staying home, wearing masks and social distancing, many patients with cancer actually found that the world around them felt a little safer, since people are now practicing the habits that will keep them safe from COVID-19 and other infections. Please note, however, that the current CDC recommendations regarding COVID-19 restrictions may not apply to those with weak immune systems, so it is always best to consult your doctor.
What should I do if I am exposed to COVID-19 during cancer treatment?
If you are exposed to COVID-19 during cancer treatment—or even after your treatment stops—you should reach out to your healthcare provider immediately.
Because patients with cancer are at high risk of COVID-19 complications, your health care provider may recommend treatment such as monoclonal antibodies or convalescent plasma to slow or stop the progression of a COVID-19 infection.
Monoclonal antibody therapy is typically given as an outpatient intravenous (IV) infusion. It blocks the COVID-19 virus from entering human cells and causing infection, which halts the disease's progression and reduces the risk of hospitalization or emergency room visits. However, monoclonal antibody therapy must be given early in the course of a COVID-19 infection. This makes it vital that patients reach out immediately with symptoms or a positive COVID-19 test. That’s the only way to ensure that antibody therapy, if appropriate, can be given within the required time window.
Convalescent plasma is also given as an IV infusion. The plasma, which is derived from the blood of patients who have recovered from the illness, contains COVID-19 antibodies that can suppress the virus and modify the body’s inflammatory response. Although current data is not definitive, a recent study showed that high-titer convalescent plasma — plasma that contains a larger amount of anti-COVID-19 antibodies — delayed the progression of infection in older patients with mild symptoms.
Your healthcare provider may also prescribe medications to treat inflammation, respiratory problems or bacterial infections that may develop as a complication of COVID-19.
Can I get a COVID-19 vaccine if I currently have or recently had cancer?
Research is ongoing, but early evidence shows that mRNA COVID-19 vaccines are safe for patients with cancer. However, it is important to talk with your oncologist about when you should get the vaccine to maximize the benefits.
For example, people with compromised immune systems due to high-dose chemotherapy, stem cell transplantation or B-cell targeted medications, such as rituximab, may be advised to wait several months prior to vaccination to allow their immune systems to recover enough to mount a protective response to the vaccine. Others may be advised to proceed during active cancer therapy, or as short as two weeks after completion of cancer therapy.
If patients receive the vaccine before their immune system recovers, they may not mount a sufficient immune response. A reduced immune response would make the vaccine less effective and provide a lower protection level. Optimal timing should be discussed with your healthcare professional.
Two of the currently authorized COVID-19 vaccines contain mRNA, a type of genetic material that helps the body manufacture harmless viral proteins that lead to the development of COVID-19 antibodies. However, vaccines that contain live viruses are not appropriate for patients with cancer; their weakened immune systems place them at a higher risk of developing the infection itself.
Did COVID-19 affect cancer clinical trials?
We never put cancer research on the back burner during the pandemic. Clinical trials for cancers have continued as usual, and the well-established infrastructure for cancer research allowed us to continue opening COVID-19 clinical trials early in the pandemic.
We have also seen enhanced global collaboration among pharmaceutical companies, researchers in basic science, and clinical investigators. That has led to increased flexibility for clinical trial participation and increased speed of scientific discovery. For patients interested in participating in a clinical trial, this has meant more flexibility in scheduling, telehealth visits, and option for off-site imaging.
What else is important for patients with cancer to know?
Progress in cancer treatment hasn’t stopped during COVID-19. In fact, researchers and clinicians have come together to strengthen partnerships and collaboration in the face of a public health emergency. The unprecedented effects of the pandemic have also sparked new treatments that were quickly put into use. By staying hopeful and staying vigilant during a difficult time, we will soon get back to a new version of normal.
Lori Leslie, MD, is the Director of Indolent Lymphoma and Chronic Lymphocytic Leukemia Research Programs at the John Theurer Cancer Center at Hackensack University Medical Center. She is also the co-director of medical oncology at Mountainside Medical Center and assistant professor of medicine at the Hackensack Meridian School of Medicine.
