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  1. #1
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    COVID-19 and Cancer

    COVID-19 101
    By Christina Bach, MSW, LCSW, OSW-C, Oncolink.org
    March 17th, 2020

    As we start our blog series, I think it's important to start off with what we do know. This information was gathered from trusted, evidence-based resources listed at the end of this article. Be careful about where you are getting your information. Always check your sources (we will cover this more later this week).

    What is COVID-19?
    COVID-19 is a type of Coronavirus. It is also sometimes referred to as SARS-CoV-2. There are many different types of coronaviruses. They can cause illness in both humans and animals. Coronaviruses have been present all over the world for some time. They are known to cause upper respiratory symptoms like a cough or runny nose. They can also cause more serious illness.

    COVID-19 is the novel (new) coronavirus that we are currently coping with. It was first identified in Wuhan, China in late 2019. It is now a worldwide pandemic. A pandemic means a global outbreak of disease. The World Health Organization (WHO) will declare a pandemic when a new disease, for which humans do not have any immunity, spreads around the world. In order for there to be a pandemic, there must be evidence of community spread. Community spread is the spread of an infection from one person to others in the community.

    Pandemic is NOT meant to spark panic and hoarding of goods. It is meant to encourage action by countries to "detect, test, treat, isolate, trace and mobilize (theguardian.com)."

    This is where we are now.

    How is it spread? What are the symptoms?
    COVID-19 spreads through droplets produced when someone with the virus coughs or sneezes on someone. It also tends to occur when people are close to each other (6 feet or less). This is why handwashing, not touching your face, wiping down surfaces and social distancing are so important.

    Symptoms of infection include fever, cough, and shortness of breath. Symptoms can appear 2-14 days after exposure. This is why you are hearing about folks being quarantined for 14 days (especially after travel). Some people who are exposed and would have a positive test for COVID-19 will never show any symptoms. Others can get very sick. These tend to be individuals in higher-risk categories including people with cancer.

    What does it mean to be a high risk?
    High risk means you have a higher risk of getting seriously ill if you are exposed. So far, we have seen serious illness in people over 70 as well as those who have pre-existing health conditions like heart disease, diabetes, and cancer. These folks typically have suppressed immune systems. There is some evidence that those with blood cancers (leukemia, lymphoma and multiple myeloma) are at an even higher risk due to the disease's effect on their immune system.

    Since this virus and its associated disease and impacts are still fairly new, there is very little evidence about how COVID-19 will specifically affect cancer patients. There are some early studies from China that have shown that cancer patients may be at a higher risk for "severe events." However, the data comes from a very small sample size. Read more about this study here.

    Tomorrow, we will address continuing cancer treatment through the pandemic and what you need to know about going to your treatment center. We will also provide some suggestions for staying safe while navigating our new pandemic normal.

    References and Resources

    CDC Coronavirus (COVID-19) website https://www.cdc.gov/coronavirus/2019-ncov/index.html

    World Health Organization https://www.who.int/emergencies/dise...ronavirus-2019

    Cancer Support Community
    What cancer patients, survivors and caregivers need to know about the coronavirus. https://www.cancersupportcommunity.o...aregivers-need

    American Society of Clinical Oncology(ASCO)
    Coronavirus Resources. https://www.asco.org/asco-coronavirus-information

    Leukemia and Lymphoma Society
    Coronavirus: resources and what you should know. https://www.lls.org/public-health/coronavirus

    European Society of Blood and Marrow Transplantation
    Coronavirus Disease COVID-19: EMBT Recommendations. https://www.ebmt.org/ebmt/news/coron...-march-16-2020

    Fred Hutchinson Cancer Center
    Coronavirus: what cancer patients need to know. https://www.fredhutch.org/en/news/ce...d-to-know.html

    American Cancer Society
    Common questions about the new coronavirus outbreak. https://www.cancer.org/latest-news/c...-outbreak.html

  2. #2
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    Re: COVID-19 and Cancer

    Cancer Treatment in the Age of COVID-19
    By Christina Bach, MSW, LCSW, OSW-C,OncoLink.org
    March 18th, 2020

    Many patients are wondering if they should continue their cancer treatment in light of the current COVID-19 pandemic. The answer for most is “yes.” But there are some things to think about and plan for before going to your center.

    Should I still go to treatment?
    Currently, the American Society of Clinical Oncology (ASCO) states that “at this time, there is no specific evidence or published guidance to support delaying or interrupting adjuvant chemotherapy.”

    As of today, the only treatment ASCO is recommending for the potential delay (especially if your disease is currently under control) is for a planned allogeneic stem cell transplant. Donors may need to be screened for COVID-19 prior to collection as well. Patients with stable disease who are considering autologous stem cell transplant should also talk to their team about a potential delay in this procedure. The European Society for Blood and Marrow Transplantation (EMBT) is recommending delay of transplant procedures for at least three months.

    What can I expect at the treatment center?

    • Confirm your appointment. Always check in with your healthcare team BEFORE traveling to your cancer treatment in case there are changes to the schedule.
    • You will most likely be screened for fever and symptoms of COVID-19 upon arrival.
    • If you are feeling sick DO NOT come to the treatment center. Call your team for personalized planning and instructions.
    • Write down your symptoms and concerns before you call so you are organized and can stay on track when talking to your team.

    Remember that hospitals and treatment centers have shifted their primary focus to “detect, test, treat, isolate, trace and mobilize” for COVID19. Healthcare workers are being stretched in many different directions. Give them space and time to respond.

    • Centers are also staggering appointments to limit the number of people in the waiting area at any given time.
    • The number of people permitted to come to appointments with you will also likely be limited. Many centers are allowing one family member or support person to accompany patients. Think about using technology (calls, Facetime, Skype) if other family members want to participate in a provider visit.
    • Treatment centers are also using space differently – moving chairs six feet apart, setting up screening areas in hallways/entryways, removing magazines and other materials from the waiting areas that could harbor the virus. Be prepared for change when you come to your visit.
    • Be sure to continue to wash your hands throughout your time at the treatment center. Be sure to have sanitizer and wipes in your car or your bag.
    • Continue to practice social distancing. Stay about 6 feet away from others. Try to avoid crowded elevators and touching escalator railings.

    What about follow-up appointments?
    If you do not need to go to your treatment center now, don’t. Most of these appointments are being rescheduled or moved to telemedicine (phone calls, SYKPE, Zoom). It’s OK if you aren’t tech-savvy. Just communicate this with your healthcare team if the phone is more comfortable for you.

    How about getting to my treatment center?
    If at all possible, avoid public transportation. If you must use public transportation, practice social distancing and don’t sit near folks who appear sick or who are coughing. Try not to touch surfaces and carry wipes and sanitizer with you. If you use Lyft, Uber or other car-sharing services, you have no idea of who was in the car before you. Ask your driver, before getting in the car, if you can wipe surfaces down before you get in the car. They may have preferred products to use. Try to touch as little as possible. The same goes for taxis.

    What if I’m feeling sick?
    Call your team if you are having symptoms. Stay home. Sick caregivers should also stay at home.

    If a family member develops symptoms, it’s important to practice social distancing within the home. Your family member should isolate themselves from you and other family members. They should sleep in a separate area. Be sure to wipe down surfaces, doorknobs, faucet handles and other common areas. Wash your hands frequently and try to avoid touching your face, nose, and eyes.

    Know that your cancer team is working hard to keep things on track and to keep you safe. If you have questions, reach out to them.

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