Coronavirus (COVID-19) information for cancer patients, survivors and caregivers

Hello, I'm Dr. Sonali Smith. And I'm currently the interim section chief of Hematology and Oncology at the University of Chicago. Part of our mission is to take outstanding care of our patients with cancer. And during this current coronavirus pandemic, there are many questions and concerns you have specifically related to your diagnosis and the treatment for your diagnosis of cancer.

One of the first questions is, what is coronavirus? What is COVID-19? And how does that apply to me? 
So although you may have read quite a bit about this, just as a background, this new coronavirus, more properly called SARS-CoV-2 is a new coronavirus that is extremely contagious and can cause a very severe disease called COVID-19.

My name is Dr. Nita Lee, and I'm a GYN oncologist at University of Chicago. I'm here to help today to answer some questions about how the coronavirus pandemic can affect cancer patients that we're caring for.

What we do know from other countries is that patients who have cancer, especially those under recent treatment, may have a higher risk of getting sicker with COVID-19. We're not sure if they're all at higher risk for getting it. But it's very important to think about in terms of any immunocompromised and how your immunity is.

There are some patients with cancer, specifically with blood cancers who have a higher risk because their immune systems have been weakened, patients who have been through stem cell transplant, CAR T therapy, or other treatments that are designed to knock down the immune system do have an increased risk of complications related to the disease. However, in general, we caution all patients to follow the guidelines in terms of frequent and prolonged handwashing and avoiding sick contacts as we don't feel the actual risk of getting the disease is higher, just the severity of the disease if it should happen.

Right now, this is a very personalized plan. Each of the providers and all of the oncology, GYN oncology, radiation oncology, and surgery are, really, making decisions on a case by case basis. We are continuing with chemotherapy.

We are looking at all of the patients to see what's going to be the most appropriate course. And most of all of our patients are getting personal calls from our nursing teams or the physicians themselves to help us make those decisions. We want to do what's safest and best.

At this time, the situation with clinical trials is changing nearly on a daily or weekly basis. For right now, the majority of our trials are still open for patients who have already been enrolled. However, we are cutting back on trials that do not have a clear treatment component.

So for example, if there are registry studies or clinical trials, where there is extra tissue required or extra visits to the campus, those particular trials are being slowed down and, hopefully, will be available again down the road. However, if you are already consented to a clinical trial or part of a clinical trial, it's really important for you to communicate with your health care team to know when you should or should not come to the medical center. Many, potentially, optional parts of the trial are being put on hold for the safety of you and others around you.

I think you can expect that we're here just to sort of take care of you and to make sure that you're going to continue to do well. For patients who are doing well and are not on active treatment right now, we still care about how you're doing. But we want to also do what's safest and makes the most sense.

This may mean, if you're feeling well and without any specific new symptoms, we will likely postpone your visit and reschedule you or do a telemedicine visit and talk to you about all of these things. If you don't have any new symptoms, we really do feel that it's the safest thing for us to postpone visits and make sure that we touch base with you in a different way. This may help us reorganize when you lab work, imaging, or exams as well.

While patients who are on chemotherapy will, obviously, sometimes be in the process of getting their white blood cell counts tested to see if they're particularly immunocompromised such as neutropenia, but there's not another specific test that we would do unless it was part of your treatment plan. Patients who are not on current treatment and are cancer survivors don't have any other specific testing that we would warrant them taking.

While we always think that cancer screening for the cancers that we can screen for, colorectal, breast, and cervical, are really important, this is actually a public health time where we do not recommend that usual screening gets done. So that means, if you are not having any symptoms in those organs and you are just going for a screening mammogram, colonoscopy, or pap smear test, those are not recommended to be done at this time. And those, you can reach-- talk to your provider about when those would eventually be rescheduled.

I think, right now, if you have an appointment and you're due for a cancer screening, especially University of Chicago, you're going to be called by the provider group or the care team to, really, reschedule your appointment. And we are keeping track of all of our patients that we are rescheduling and making sure they're aware of their care plan as well going forward as, especially, as all of this changes so quickly.

So even though cancer patients may be at slightly higher risk, we do not think that there is any recommendation for COVID-19 testing in that circumstance unless patients have symptoms of the disease, which include fever, flu-like illness, cough, some GI symptoms, some cluster that makes it indicated. If you're not having any symptoms, there is no reason to leave your house or leave your-- you know, where you are and come to get tested.

It wouldn't be appropriate. If you are having symptoms, we recommend that you call your provider. Let them know so they can best help you decide whether testing is appropriate and how to handle that situation.

If you develop any symptoms of a respiratory infection-- and this includes fever, headache, body aches, cough, or chills-- It's important for you to contact your health care provider and talk through these symptoms with them. If they are very severe, you should call 911. But in most cases, it's important to talk to your provider first who can direct you whether or not you need to be tested for COVID-19. If you need to be tested, you will be provided with a phone number along with the specific details on how to get tested.

I think the main thing that we're asking our patients to do is what we're asking everyone to do, which all of us should be doing, which is social distancing, so making sure that you're avoiding sort of public spaces, group meetings, or forums, even if that means things that you normally attend such as church. There is a lot of different ways that you can stay not socially isolated but, really, making sure that you're not close to people in your own home, also just doing good handwashing if you have to go outside, frequent hand washing, hygiene using alcohol based hand sanitizer, as well. Those are really all important elements.

I think that, for patients with cancer, you may want to also make sure that you're up-to-date with having enough medications at home and talking to your provider and your pharmacist about making sure you have everything that you need. We are always going to be here and available and, you know, for our patients in terms of questions and concerns. But just making sure you have enough supplies in terms of those kinds of things would be important. And then just following along with any guidelines that come out from any of our public health officials.

University of Chicago Medicine medical oncologist and Interim Section Chief of Hematology and Oncology, Sonali M. Smith, MD, and gynecologic oncologist Nita Karnik Lee, MD, MPH, answer common questions about coronavirus for cancer patients, cancer survivors and their loved ones. 

What is coronavirus? What is COVID-19? And how does that apply to me? 

Coronavirus, more properly called SARS-CoV-2, is a new coronavirus that is extremely contagious and can cause a very severe disease called COVID-19.

As a patient with cancer, how much higher is my risk of severe consequences with COVID-19?

Cancer patients are among those at high risk of serious illness from an infection because their immune systems are often weakened by cancer and its treatments. Cancer patients who finished treatment a few years ago or longer have immune systems that have most likely recovered, but each person is different. It's important that all cancer patients and survivors, whether currently in treatment or not, talk with a doctor who understands their situation and medical history.

Are some cancer patients more vulnerable than others?

Patients with hematologic (blood) malignancies such as non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute myeloid leukemia, acute lymphoblastic leukemia and multiple myeloma are most at risk.  Those are the ones with the most profound immune deficits.

Are all cancer patients at risk? Or just those currently getting treatment?

Patients in active treatment for any type of cancer are at risk. Active treatment is usually defined as surgery, radiation, chemotherapy and other treatments such as immunotherapies.
The after-effects of treatment don’t end when people finish their last course of therapy or leave the hospital after surgery. The after-effects of cancer and the immunosuppressive effects of treatment can be long term.

Can patients and survivors get tested to see if they’re immunosuppressed?

There’s no easy blood test to check someone’s level of immune suppression, but being in active chemotherapy, having low white-cell or low lymphocyte counts and/or taking immune-suppressive agents (such as prednisone) are all associated with immune suppression and increased risk of infection.

Should people still get screened for cancer during this pandemic?

While screening for cancers such as colorectal, breast and cervical cancers are really important, we do not recommend getting usual screening tests during a public health emergency. If you are not having any symptoms in those organs and are already scheduled for a mammogram, colonoscopy or pap smear test, those tests are not recommended to be done at this time. Talk to your healthcare provider about when those would eventually be rescheduled.

What should I do if I'm due for a cancer screening?

If you have an appointment and you're due for a cancer screening, especially at the University of Chicago Medicine, you're going to be called by the provider group or your care team to reschedule your appointment. We are keeping track of all of our patients that we are rescheduling and making sure they're aware of their care plan going forward.

Should I delay my treatment, surgery or radiation therapy at UChicago Medicine?

Right now, this is a very personalized plan. Each of the providers and all of the oncology, gynecologic oncology, radiation oncology and surgical teams making decisions on a case by case basis. We are continuing with chemotherapy. We are looking at all of our patients to see what's going to be the most appropriate course for care. Our patients are getting personal calls from our nursing teams or their physicians to help us make those decisions. We want to do what's safest and best.

Will COVID-19 change what I can expect in my clinical trial?

At this time, the situation with clinical trials is changing nearly on a daily or weekly basis. For right now, the majority of our trials are still open for patients who have already been enrolled. However, we are cutting back on trials that do not have a clear treatment component.

For example, if there are registry studies or clinical trials, where there is extra tissue required or extra visits to the campus, those particular trials are being slowed down and, hopefully, will be available again down the road. However, if you are already consented to a clinical trial or part of a clinical trial, it's really important for you to communicate with your care team to know when you should or should not come to the medical center. Many potentially optional parts of the trial are being put on hold for the safety of you and others around you.

If I'm on surveillance, what can I expect from my healthcare team?

We're here to care for you and to make sure you're going to continue to do well. For patients who are doing well and are not on active treatment right now, we still care about how you're doing. But we want to also do what's safest and makes the most sense.

If you're feeling well and are without any specific new symptoms, we will likely postpone your visit and reschedule you or do a telemedicine visit. If you don't have any new symptoms, we  feel that it's the safest thing for us to postpone visits and make sure that we touch base with you in a different way. This may help us reorganize when you get lab work, imaging or exams.

Should I be tested for COVID-19 because I have cancer?

Even though cancer patients may be at slightly higher risk, we do not think that there is any recommendation for COVID-19 testing in that circumstance unless patients have symptoms of the disease, which include fever, flu-like illness, cough, some GI symptoms, some cluster that makes it indicated. If you're not having any symptoms, there is no reason to leave your house and come to get tested.

If you are having symptoms, we recommend that you call your provider. Let them know so they can best help you decide whether COVID-19 testing is appropriate for you.

What should I do if I develop symptoms of a respiratory infection?

If you develop any symptoms of a respiratory infection — and this includes fever, headache, body aches, cough or chills — It's important for you to contact your health care provider and talk through these symptoms with them. If they are very severe, you should call 911. But in most cases, it's important to talk to your provider first who can direct you whether or not you need to be tested for COVID-19. If you need to be tested, you will be provided with a phone number along with the specific details on how to get tested.

What should people with cancer do to prepare for COVID-19?

The main thing we're asking our patients to do is what we're asking everyone to do, which is to maintain social distancing. Be sure to avoid public spaces, group meetings and forums — even if that means gatherings you normally attend such as church. There are a lot of different ways that you can stay not socially isolated while making sure you're not close to people in your own home. Be sure to do thorough  and frequent hand-washing  or use alcohol-based hand sanitizer, especially if you have to go outside. Those are all important elements to reducing the spread of coronavirus.

In addition, for patients with cancer, be sure you're up-to-date with your supply of medications at home. Talk to your provider and your pharmacist about making sure you have everything you need. At UChicago Medicine, we will always be here and be available to answer questions and discuss concerns. 

Be sure to follow any guidelines that from our public health officials, such as the Centers for Disease Control and Prevention (CDC).

Helpful Resources

Online Programs for Cancer Patients (Wellness House for Living with Cancer)

Online and Phone Mental Health Support, and Additional Programming (The Cancer Support Center)

Coronavirus Response Center (City of Chicago) 

Coronavirus In-Language Information for Asian Americans, Native Hawaiians and Pacific Islanders

Leukemia & Lymphoma Society COVID-19 Patient Financial Program
This program provides a one-time $250 donation to provide relief to blood cancer patients experiencing financial hardship as a result of their disease and circumstances related to the COVID-19 pandemic.

Susan G. Komen Foundation COVID-19 Resources for Breast Cancer Patients 

 

COVID-19 continues to spread rapidly across the globe, so some information may be outdated from our publish date. For our latest updates, read our most recent coronavirus coverage.

Medical professional with gloved hands holding patient's hand

Support UChicago Medicine's COVID-19 Response Funds

Help support our dedicated healthcare workers on the frontlines of the COVID-19 pandemic, as well as the patients and families who are affected.

Donate Now