Everyone is learning to deal with the threat of the new coronavirus, but for people with cancer, the virus is even more concerning.
Cancer can increase people's risk of catching the coronavirus. It increases the odds of complications from the infection as well.
"Patients with cancer are at a higher risk, especially if treatment is active or recent. It's hard to give a one-size-fits-all answer, but the closer you are to treatment, the more impact," said Dr Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.
Lichtenfeld said the type of treatment affects a patient's risk, and those receiving chemotherapy typically have the highest infection risk. But other treatments also affect immune response – even surgery, he said.
Radiation can suppress immunity
"How long the immune-suppressing effects of cancer treatment may last, we don't know," Lichtenfeld said. "We don't have really good tests to give us a birds-eye view of immune response. But, it's not a matter of weeks, probably not a matter of months, it may be years after treatment."
Oncologist Dr Joshua Sasine, from the Jonsson Comprehensive Cancer Center at University of California, Los Angeles, said people who have had a bone marrow transplant, especially those who received donor marrow, probably face the greatest risk. Patients receive high-dose chemotherapy before a bone marrow transplant.
Their infection risk is highest in the first year after transplant. Immune response probably gets close to normal by about two years out, though patients who receive donor marrow never get fully back to normal, Sasine said.
People with cancers of the immune system, leukaemia or lymphoma also have a higher infection risk, he said.
Radiation can suppress the immune system, though typically just in the area being treated. Targeted cancer treatments are less likely to dampen immune response, he said. And, ongoing hormone treatments to prevent recurrence of breast cancer and prostate cancer "typically don't affect the immune system", Sasine said.
If you're unsure about your infection risk, talk with your cancer care team.
"Ultimately, cancer therapy is very individualised," Sasine said. "The best place to start is by asking your doctor."
Reasonable to expect disruptions
Lichtenfeld agreed that there are many variables to consider.
"There are no hard and fast rules," he said. "If you've had any chemotherapy or drug treatment in the last year, be very cautious."
It's reasonable to expect disruptions in your cancer care for at least the next few weeks or so, Lichtenfeld said.
"Have patience," he suggested. "Make sure you have the phone number of someone on your care team that you can reach if you have a question or any symptoms" from the virus or from treatment.
If you have a routine follow-up appointment scheduled, check with your doctor to see if it can be done by phone, online or rescheduled. If you have imaging tests scheduled, he suggested confirming in advance to avoid unnecessary hospital visits.
A false sense of security
But most treatment should continue – at least for now, both experts agreed.
Sasine said there aren't many steps above and beyond what's recommended for everyone that can help protect cancer patients.
"Good hygiene and hand-washing, avoiding people who might be infected, minimising social contact are important," he said.
Sasine said wearing a mask isn't necessary and may give people a false sense of security. He added that people should wash their hands frequently, and that's more effective than repeatedly using hand sanitiser.
He advised people with cancer not to travel right now, and like everyone else, to avoid crowds.
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