key: cord-1052626-zry16stu authors: Mitchell, Edith Peterson title: COVID-19 and the Cancer Patient: What Every Physician Needs to Know date: 2021-02-12 journal: J Natl Med Assoc DOI: 10.1016/j.jnma.2021.01.002 sha: 623f800b60420c7850081e009551c8ec042a1b44 doc_id: 1052626 cord_uid: zry16stu nan C OVID-19 is a disease caused by the coronavirus SARS-CoV-2 that was first described in Wuhan, China in December 2019 and rapidly spread to other countries. Fewer adults are undergoing routine preventive healthcare and cancer screening during the COVID-19 pandemic in the United States (US). More than one third of adults have not received recommended screenings for associated age and risks during the pandemic and many have avoided or delayed cancer treatments in the US. Moreover, forty-three percent of patients missed routine preventive healthcare appointments because of COVID-19. Therefore, it is most important that physicians know and understand recommendations for patients regarding screening, treatment, and survivorship of cancer, as well as treatment of patients suffering dual consequences of cancer and concurrent COVID-19. 1 The virus is highly contagious and believed to spread mainly by person-to-person contact by respiratory droplets. Spread can occur by touching objects or surfaces that have COVID-19 and then touching the eye, mouth, or nose. The virus that causes COVID-19 can be can be viable for up to 72 h on plastic, 48 h on stainless steel, 24 h cardboard, and 4 h on copper. 2 Physicians should provide information on COVID-19 preventive strategies to their patients such as staying away from high risk situations, social distancing, handwashing, wearing masks, and washing frequently used surfaces in the home. In an observational study, the Cancer Consortium (CCC19) examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment in laboratory-confirmed SARS-CoV-2 infection in patients receiving, or having recently completed cancer treatment compared with non-cancer patients with infection. Results of this study demonstrated that cancer patients die at three times the rate of non-cancer patients with COVID-19. The registry is compiled cancer researchers from more than 100 worldwide institutions and has been tracking in near real time, the impact of the novel coronaviruses on cancer patients. Enormous data has been amassed on promising as well as problematic therapeutic interventions, mortality rates, comorbidities and other information. In a report on this CCC19 study during a meeting of the American Society of Cancer Research and later reported in Cancer Discovery, information included data on 2200 patients with COVID-19 and revealed an increase in cancer patients after thirty days. 3 Those patients whose cancer was progressing while receiving cancer treatment had a mortality rate of 26 percent. Patients 75 years and older had a mortality rate of 27 percent. Those patients with poor performance status, defined as Eastern Cooperative Oncology Group (ECOG) rating of 2 or higher, indicating inability to work or provide self-care, were confined to bed, or were disabled experienced worse outcomes with a mortality rate of thirty-five percent from COVID-19 disease. Comorbidities also increased the risk of poor outcomes from infection of the coronavirus. The opportunity for receipt of remdesivir COVID-19 treatment, which during the time period of the study, was mainly available on clinical trials, demonstrated effectiveness in patients with cancer. However, African Americans and Black patients suffering from coronavirus infection were less likely to receive remdesivir. It is well recognized that cancer screening allows for earlier diagnosis of cancer and prevention in some cases, and is a major contributing factor to decreased cancer mortality rates. Thus cancer screening saves lives. Early in the pandemic, many states and localities issued stay-athome orders to reduce viral transmission risks. Healthcare institutions and facilities have developed protocols for managing COVID-19 risks for patients and staff, thus allowing for resumption of screening and diagnostic procedures. Physicians should know individual patient cancer risks and local screening guidelines for multiple common ยช 2020 Published by Elsevier Inc. on behalf of the National Medical Association. https://doi.org/10.1016/j.jnma.2021.01.002 cancers, including breast, cervical, colorectal and lung cancer, and provide recommendations to patients. 1 For most patients, cancer treatment, follow-up and surveillance, as well as survivorship are ongoing as planned during the pandemic. Cancer treatment strategies were implemented to protect patients and caretakers, providers, and staff at most medical centers. Telemedicine offers additional advantages, however, the lack of technology by some patients may limit its universal utility. Physicians should be aware of these local facility guidelines and processes and discuss the safety of cancer treatments with patients. Consideration of the level of COVID-19 in the community, whether treatment is needed urgently, available options for therapeutic intervention, and coping with the stress of cancer treatment during the pandemic. Collaborative care between primary care physicians and those involved in cancer diagnostics and treatments is an absolute necessity. The American Society of Clinical Oncology (ASCO) recommends that patients with a history of cancer and/or undergoing current cancer treatment can and should receive vaccinations against COVID-19. ASCO further recommends physicians should ensure that components of the vaccine are not contraindicated for the individual patient. 4 Additional information on vaccines can be found on the US CDC website. Physicians and healthcare teams must be aware that people with cancer and cancer survivors, particularly those with compromised immune systems, are concerned about the potential impact of COVID-19 on the success of their treatment and overall healthcare. Physicians must discuss options with patients and their caretakers to ensure that patients receive the best and right cancer treatment at the right time and to protect them from coronavirus infection. Declines in cancer screening during COVID-19 pandemic Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1 Utilization of COVID-19 treatments and clinical outcomes among patients with cancer: a COVID-19 and cancer Consortium (CCC19) Cohort study ASCO COVID-19 Vaccine & Patients with Cancer. (2020)