Cancer patients, Chemotherapy and COVID -19
. Mr. Yogesh underwent surgery for colon cancer about 6 weeks ago. He had recovered fairly smoothly and was sent home well before the lockdown. Now, after a week I had a video-call with him and the first question he asked me is “when do I have to start chemotherapy”?
He was anxious that his therapy should not be delayed. However, he was looking a bit weak and had not gained weight. So I had to advised him that he had to wait for a little more time to pick up weight and eat well and defer chemotherapy
Cancer patients are at a higher risk for contracting COVID 19 as cancer itself produces lower immunity. In addition, many of the patients may also be on chemotherapy.
So what would be the best option for these patients, particularly in solid tumours (colon, stomach etc)
The precautions of ‘social distancing’ are important and we have to make sure that these patients are given extra precautions particularly when the space itself becomes a constraint in families. It goes without saying that they should never be exposed to anything from outside or anyone who has even the mildest of symptoms.
What about chemotherapy?
Many of the patients are on cyclical chemotherapy, may be once in 3 weeks, in solid tumours.
Chemotherapy itself reduces blood counts and normally also they are susceptible to infections. The rational approach would be to shift them on to an oral chemotherapy so that the number of visits to the hospital are less and tide over this period. Many times we find that chemotherapy can be deferred. It is not an absolute time bound period though it is recommended that 6-8 weeks is the time to start chemotherapy after surgery. This can be pushed to a couple of weeks to give more time for recovery
On the whole we need to balance the benefit of the chemotherapy with a possible risk of a patient making multiple trips and also getting immune-suppressed and also getting more susceptible to the current epidemic. So it is better to error on the side caution the benefits of the adjuvant chemotherapy are not of that magnitude to risk infection.
So stay home and stay safe and comfortably wait for a couple of weeks or even more before you start your treatment. Even if there is a gap in between cycles also, it is absolutely fine.