As the number of COVID-19 cases in the United States continues to grow, experts — including those in the cancer research community — are attempting to control the spread of the disease by promoting social distancing. For example, many cancer meetings, including those organized by the American Association for Cancer Research (AACR) and the Society of Gynecologic Oncology (SGO), are being canceled or rescheduled.
Some oncologists are also proposing “medical distancing” — reducing the number of cancer patients who visit health care facilities wherever possible — to decrease the risk of coronavirus exposure and transmission in this population. Research from China has suggested that people with a history of cancer may indeed be more vulnerable to infection and severe events related to COVID-19.1
Matthew Katz, MD, a radiation oncologist and a partner in Radiation Oncology Associates, PA, in Lowell, Massachusetts, thinks that screening patients by phone before they come to a clinic may help to eliminate potentially redundant routine follow-up visits and lower the risk of infection. “If we can eliminate unnecessary visits and do remote telephone calls where clinically appropriate, it will decrease the number of cancer patients exposed to COVID-19 at risk of severe complications, stressing our emergency departments and intensive care units,” he said in an email.
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Early research has suggested that remote monitoring works for patients who have been treated for prostate cancer.2 Dr Katz is now in the process of developing disease-specific telephone questions that doctors can ask all cancer patients to determine whether a visit is absolutely necessary and whether it can be postponed until the risk of coronavirus exposure drops.
An analysis of 1590 COVID-19 cases in China showed that both patients living with cancer and cancer survivors face unique risks from COVID-19.1 Of all the people in the study, 18 (1%; 95% CI, 0.61–1.65) had a history of cancer — a proportion higher than the incidence of COVID-19 in the overall population in China (285.83 [0.29%] per 100,000 people). The group included 12 cancer survivors in routine follow-up after primary resection, 4 patients who received chemotherapy or had surgery in the past month, and 2 patients whose treatment status was unknown. The researchers noted that patients with cancer might be more vulnerable to infection than people without the condition for 2 main reasons: the systemic immunosuppressive state caused by the cancer itself and treatments for the condition, such as chemotherapy or surgery.
The same study found that, among the people with COVID-19, those with a history of cancer had a much higher risk of severe events — admission to the intensive care unit requiring invasive ventilation, or death — than those who did not have a history of cancer (7 [39%] of 18 patients vs 124 [8%] of 1572 patients; Fisher’s exact P =.0003).
Although not all patients will qualify for remote visits during the current outbreak, there are certainly subsets that may be eligible, said Kristin Higgins, MD, an associate professor in the department of radiation oncology at Emory University School of Medicine in Atlanta, Georgia. An example would be a survivor of breast cancer who was scheduled to see a radiation oncologist every 6 months or visit their surgeon every year as follow-up, she said.
Dr Higgins noted that some patients may consider advocating for themselves and calling their doctors to see whether they can reschedule their appointments until the risk of coronavirus infection subsides. “If you are a patient and if you are coming for a 6-month or yearly check-up, calling a doctor and asking if you can move the appointment is something that I think would be a good idea,” she said.
References
- Liang W, Guan W, Chen R. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337.
- Brigham Health. Brigham and Women’s Hospital. A nurse’s innovation: “virtual monitoring” increases access, decreases travel. Accessed March 17, 2020.
