19th March 2020

Advice on coronavirus for people with cancer

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UPDATE: 18 March 2020

This guidance has been produced by the One Cancer Voice* charities in partnership with NHS England.

People living with cancer now

Q1 Do I need to do anything differently as someone who is being treated / in remission from cancer/living with a chronic cancer?

The Government is advising that people with cancer should be particularly stringent in following social distancing measures.  They are:

1 Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough;

2 Avoid non-essential use of public transport, varying your travel times to avoid rush hour, when possible;

3 Work from home, where possible. Your employer should support you to do this. Please refer to employer guidance for more information;

4 Avoid large gatherings, and gatherings in smaller public spaces such as pubs, cinemas, restaurants, theatres, bars, clubs

5 Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media.

6 Use telephone or online services to contact your GP or other essential services.

The detailed advice can be found here: https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Some people with cancer are more at risk of becoming seriously ill if they contract the COVID-19 infection:

  • – People having chemotherapy, or who have received chemotherapy in the last 3 months
  • – People having immunotherapy or other continuing antibody treatments for cancer
  • – People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • – People having intensive (radical) radiotherapy for lung cancer
  • – People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
  • – People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

If you are in this category, next week the NHS in England will directly contact you with advice the more stringent measures you should take in order to keep yourself and others safe. For now, you should rigorously follow the social distancing advice in full.

Q3 What will happen to my cancer treatment? For example:              

  • Will it be postponed?
  • Should I still go to hospital appointments?
  • How will my hospital decide whether I am a priority for treatment? Will there be national rules?
  • If treatment, including stem cell transplants, are deferred and I begin to relapse will this limit my eligibility for future lines of treatment?
  • Should I start chemotherapy treatment (particularly if it is a 2nd/3rd line for “mop up” ) or postpone?
  • As a stage 4 patient will I be given life support if I have breathing difficulties due to the virus?
  • If I get the virus and recover, will this affect my cancer treatment and outlook?

Clinicians will always make decisions to prioritise treatment for those most in need and in consultation with patients.

Many hospitals have started to use more telephone consultations as a way of helping people to avoid long waits in clinics and for treatment. You may be called to arrange your treatments in this way, and planned treatments may need to be moved to help with running a smooth service.

Your clinical team are best placed to talk with you about the effect on your treatment and appointments.  They will work with you to determine the best course of action in each individual situation.  If you have any concerns or questions about your treatment, please speak to your clinical team.

Q3a. I am on chemotherapy. If I experience sweats/ cough/ shivering should I call NHS 111 or the chemotherapy care line?

You should call the chemotherapy care line.

Q3b.  If I need to self-isolate for more than seven days, what will happen in relation to treatment that has to be done weekly?

Your clinical team are best placed to talk with you about the effect on your treatment and appointments.  They will work with you to determine the best course of action in each individual situation.

There is guidance on staying at home if you or someone in your household think you have coronavirus: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection

Q4 What are the symptoms likely to be?/Will the symptoms be different because I have cancer?/What should I look out for? 

The NHS outlines the common symptoms of coronavirus on its website.

Coronavirus can have serious effects on anyone who has a long-term health condition or a weakened immune system, including some people with cancer. Follow the advice on avoiding catching or spreading germs. (see Q1). 

Q4a.  Can you catch this virus more than once?

It is not yet known whether reinfection is possible, although many experts think it is unlikely.

Q5 What should I do if my clinician is diagnosed with coronavirus?

If your clinician is diagnosed with coronavirus and you have not seen them recently, then you are unlikely to have been exposed to coronavirus. 

Health professionals are working to contact anyone who has been in close contact with people who have coronavirus.  If you are concerned about the impact this will have on your treatment, contact your hospital for advice.

Q6 Should I go to work / not see friends / not see friends who’ve travelled from affected areas?

We recommend everyone follows the Government advice on social distancing.  Please see answer to Q1.

Q7 What if I have travel planned or a holiday booked to one of the affected areas – am I more at risk if I do travel?

The Government is currently advising against all non-essential travel.  If you feel your travel is essential, you should talk to your clinical team about any plans.

The Foreign Office has the most up-to-date information about how different countries are affected: www.nhs.uk/conditions/coronavirus-covid-19/advice-for-travellers/

People who have had cancer in the past

Q8 Does having had cancer treatment in the past (for example, stem cell transplants, chemotherapy, radiotherapy) in the past – even if I am now in remission – increase my risk if I get the virus? 

This depends on the type of cancer and the treatment you have had. Most people make a full recovery after cancer treatment and their immune system either recovers fully or is not affected.  (see Q1 response)

Family/friends/carers of people living with cancer

Q9 I have been exposed to the virus and am a carer for someone with cancer. What should I do? Who will look after the person I care for if I am unable to?

The Government is currently advising that if you have symptoms and you live with a vulnerable person, you should try to find somewhere else for them to stay for 14 days.

If you provide essential care (such as help with washing, dressing, or preparing meals), you may find this guidance on Home care provision useful.

It is also a good idea to think about what happens if you become unwell. If you need help with care but you’re not sure who to contact, or if you do not have family or friends who can help, you can contact your local council who should be able to help you.  Carers UK have also produced advice for those currently caring for others: https://www.carersuk.org/help-and-advice/health/looking-after-your-health/coronavirus-covid-19

Q10 I am a carer to someone with cancer. Should I be doing anything differently?

If you provide essential care (such as help with washing, dressing, or preparing meals), you may find this guidance on Home care provision useful.

Q11 Should I consider not sending my child with cancer/sibling of a child with cancer to school?

Current advice is for children to still attend school, and to follow the Public Health England advice to minimise the risk of infection by washing your hands frequently, practicing good hygiene and avoiding contact with people who are unwell www.nhs.uk/conditions/coronavirus-covid-19/.

If you have any concerns, please speak to the clinical team overseeing your child’s care.

The future

Q11 Will cancer patients be a priority for the vaccine if/when it is developed?

There is currently no vaccine for this form of coronavirus. Research is being done to develop a vaccine, but this will take many months.

The best way to reduce your chance of infection is to follow the NHS advice on reducing the risk of picking up infections including thoroughly washing your hands frequently, practicing good hygiene and avoiding contact with people who are unwell: www.nhs.uk/conditions/coronavirus-covid-19/

Q12 If the pressure on the NHS grows, will my treatment be delayed?

See Q3.

Q13 Will there be problems accessing my cancer drugs?

There are currently no medicine shortages as a result of COVID-19. The country is well prepared to deal with any impacts of the coronavirus and we have stockpiles of generic drugs like paracetamol in the event of any supply issues.

The Department of Health and Social Care is working closely with industry, the NHS and others in the supply chain to ensure patients can access the medicines they need and precautions are in place to prevent future shortages.

There is no need for patients to change the way they order prescriptions or take their medicines. Patients should always follow the advice of doctors, pharmacists or other prescribers who prescribe and dispense their medicines and medical products. The NHS has tried-and-tested ways of making sure patients receive their medicines and medical products, even under difficult circumstances. If patients order extra prescriptions, or stockpile, it will put pressure on stocks, meaning that some patients may not get the medicines or medical products they need.

For people worried they have cancer

Q14.  I am worried that I have symptoms of cancer. Should I still go to my GP?

It is important that you seek clinical advice if you have a worrying symptom.  GP surgeries have been advised to offer online consultations and remote triage so that people do not have to attend in person unnecessarily. Please contact your GP surgery directly if you are worried about a possible cancer symptom.

Q15.  I have just been referred by my GP with suspected cancer. Should I attend my diagnostic appointment? 

Please discuss with the clinical team at the hospital. 

In the event of any disruption, hospitals will always make decisions to prioritise tests for those most in need. 

*The following charities have developed this guidance in partnership with NHS England:

Anthony Nolan, Bloodwise, Bowel Cancer UK, The Brain Tumour Charity, Brain Tumour Research, Brains Trust, Breast Cancer Now, Cancer 52, Cancer Research UK, Jo’s Cervical Cancer Trust, Leukaemia Care, Lymphoma Action, Macmillan Cancer Support, Myeloma UK, Ovarian Cancer Action, Pancreatic Cancer UK, Prostate Cancer UK, Roy Castle Lung Cancer Foundation, Sarcoma UK and Teenage Cancer Trust.

This advice will be updated as and when more information becomes available.