The Latest Reporting: Cancer Treatment During Covid-19
- Top medical centers around the country tell SurvivorNet they are finding new ways to make sure their patients get treatment
- There is significant geographic variation around how intensely cancer centers are feeling the Covid-19 pandemic. Even in New York, many patients are still getting the treatment they need.
- “We don’t want to endanger a cure by delaying treatment,” says one doctor.
- For early stage cancers, doctors say the Covid-19 pandemic does not necessarily mean that there will be a setback for your treatment or overall prognosis
- In later stage cases, or with aggressive cancers, many oncologists say they are still finding ways to get their patients chemotherapy or surgery
- As a patient you need to push to make sure you get answers and are satisfied
In dozens of conversations with oncologists around the country, we have found that top physicians have very quickly started to adapt how they treat patients while meeting the new demands created by the pandemic. Physicians say they are very mindful that conditions in New York City specifically, but also in a number of other hard hit cities, are quite a bit different than the rest of the country. Everyone is quick to acknowledge that doctors in New York are absolutely under a heightened level of stress. However, in New York, a number of doctors, including a top lung cancer surgeon, say that their patients are making it through.
Read MoreSurgeries Are Being Considered
If you’re a cancer patient seeking treatment, Covid-19 and the new guidelines from The American Society of Clinical Oncology (ASCO) may have caused your elective surgery to be delayed. However, physicians explain to SurvivorNet that there’s no easy answer in determining if a surgery can be delayed, and if it is delayed, when it will be rescheduled.
“The question is, what is the risk of doing surgery now in this environment versus waiting until some future time point?” Dr. Stephen Freedland, Director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai, says to SurvivorNet. “…And it’s a very, very case-by-case decision. There’s no easy answer.”
Surgeons are trying to use data from previous studies to guide their decisions around changing the order of treatment, in some cases employing medicines before surgery. In early stage breast and lung cancer, practitioners tell SurvivorNet that many patients will not necessarily do worse when chemotherapy is given first and surgery is delayed.
For aggressive and later stage cancers, surgeries are more urgent and large cancer centers across the country say these procedures are moving forward.
Some Clinical Trials Are Still Open
Despite some doctors telling SurvivorNet that newly launched clinical trials may be halted due to Covid-19, oncologists have reassured the SurvivorNet community that ongoing trials are still being conducted.
Dr. McArthur was quick to point out that every institution is changing on a daily basis on how it approaches care and getting access to regular treatments including experimental treatments through clinical trials.
“We’re expecting that immune therapy will be FDA approved for the treatment of early stage triple negative breast cancer sometime later this year,” Dr. McArthur explains. “And in the meantime, we continue to offer patients immune therapy on clinical trials”
Physicians say that they are particularly willing to enroll patients into clinical trials when there is the potential for very significant progress in their cancer.
“We really want to ensure that we optimize their probability of being cured,” Dr. McArthur said.
Developments In Chemotherapy Are Promising
In many cases, chemotherapy treatment is generally thought to be something that will compromise the immune system, which is considered risky seeing as Covid-19 is a respiratory virus. However, that is not always necessarily the case, and some chemotherapies come in pill form making treatment more accessible for the patient. So, the order of treatments are often being adjusted to minimize or reduce the risk of exposure.
“There are ways that we can give these chemotherapy drugs that are safe and don’t necessitate immune suppression,” Dr. McArthur says. “In fact there was a cooperative group study that demonstrated that weekly administration of drugs like paclitaxel or docetaxel, the two taxane drugs, is potentially even more effective than giving them at higher doses, less frequently.”
Significant Debate About Immunotherapy And Covid-19
The possibility of getting coronavirus is a scary scenario for any cancer patient, but what's more challenging is that oncologists say that there's very little data to guide specific decisions for coronavirus treatment protocols.
“We really don't know what the interaction of (immunotherapy) is going to be with the virus,” Dr. Stiles tells SurvivorNet. “You could probably argue both ways that it may completely throw your immune system out of whack and predispose you to infection [or] maybe because you're getting an immune stimulus, you might be able to fight off viruses better. We're going to need a lot more data to understand that better.”
Seeing as there’s very little data in fully knowing what the interaction between immunotherapy and Covid-19 will be, this could put patients at risk.
“We don’t know that there is any increased or decreased risk of contracting Covid-19 for patients who are receiving these modern immune therapy drugs,” Dr. McArthur explains. “There are some hypotheses that because these modern immune therapy drugs are essentially boosting the T cells, which are one of the immune cells, and T cells are one of the first lines of attack in attacking viruses, that there could be a hypothetical benefit receiving treatment with these types of drugs. Although that has to be weighed against any potential toxicity and side effects of treatment…because the issue with these immune therapy drugs is that they can cause inflammation of any number of organ systems including lungs.”
Despite impressive developments from researchers and physicians, it’s important to acknowledge that if you’re a cancer patient, anytime you walk out of the house there there is a health risk.
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