Chemotherapy and Coronavirus

The coronavirus (COVID-19) pandemic is causing great concern to people around the world because it poses a potentially significant risk to their health. It has also put healthcare systems under huge pressure.

Healthcare professionals and others are working tirelessly to provide the best possible care to people affected by the virus in addition to all those with existing conditions and others who become unwell.

People with lung cancer are in a group “at risk” of being seriously unwell if infected by coronavirus (COVID-19). The NHS has to manage new and ongoing treatment for people’s lung cancer alongside a risk of infection from the virus.

While there are guidelines in place, they cannot cover all possible medical situations. Local doctors and other healthcare professionals will make decisions about your care and treatment based on what is most appropriate for you within the constraints of the current situation.

If you have lung cancer and you are due to have chemotherapy, or chemotherapy is likely to be an option for you, this may be a particularly anxious time. Doctors take decisions about your treatment and care seriously.

As the pandemic becomes more manageable, cancer services are, where possible, returning to normal in many areas. Many health authorities are managing their services by having “COVID-19 free” sites or areas for treatment and care services to enable those services to be provided and to reduce risk of infection.

Safety will always remain a high priority, and decisions about the timing and location of tests, assessments and treatment will be made while weighing up possible risk from COVID-19.

Guidelines are changing all the time in response to new evidence about what is the best approach. Here are some answers to questions we have been asked on our Ask the nurse service (call free on 0800 358 7200, or email lungcancerhelp@roycastle.org), and our online lung cancer forum (www.healthunlocked.com/lungcancer).

I am currently waiting for chemotherapy – what can I expect?

You will notice a difference in the service you will receive. It may be that tests and assessments will be delayed, or take place in a different hospital site. Rather than visit the hospital, you may be asked to speak to your doctors and other staff over the telephone or by video-link through Skype or another messaging app if you have access to them.

Doctors and other healthcare professionals are also being advised to work ‘virtually’ or remotely, that is, over Internet connections on conference calls and video links. This is to protect their health so they can continue to provide services, and reduce the risk of transmitting infection to the people they are treating.

Before you start your chemotherapy treatment, you will be asked to practice isolation, known as shielding, for 14 days.  If, during that time, you or a household member develops symptoms of COVID, you need to tell your medical team.

While you are in hospital for your treatment, you will notice staff using protective equipment such as face masks, gown and eye protectors.  You may be asked to wear a mask at times during your treatment.

To minimise the risk of spreading COVID, most hospitals do not currently allow visitors except in exceptional circumstances.

If you don’t develop COVID then your chemotherapy will be no more risky than in normal circumstances, so it is important to do as much as possible to avoid infection around the time of your treatment.

Why might my chemotherapy not start as planned?

Reduced capacity in some hospitals might delay your chemotherapy.  If you or members of your household have symptoms of COVID in the 14 days before your treatment, it is likely to be postponed for your safety.

Chemotherapy will weaken your immune system making you more vulnerable to the virus and immediately put you into the “most vulnerable” group for shielding at home.

Factors about your health that affect decisions:

  • The risk to you of being infected by coronavirus and its associated complications make it safer to delay your chemotherapy compared to the risks and benefits of going ahead, particularly if your lung cancer is growing slowly.
  • Your general health may place you at more risk of serious infection if you develop COVID, for example:
    • your age (70 or over)
    • if you are a smoker
    • the extent and type of your cancer, and
    • if you have other breathing or heart conditions (such as asthma, COPD or angina)
    • if you are overweight or have diabetes

Factors about the healthcare system that affect decisions:

  • Chemotherapy treatment needs hospital visits, sometimes for a whole day. There is currently more pressure on these services due to coronavirus (COVID-19).
  • Fewer oncologists, nurses and other medical staff may be available to carry out operations due to many being absent from work.
  • Some staff are being redeployed to other medical areas (such as respiratory care) where there is urgent need for more support.
  • Additional precautions against potential coronavirus (COVID-19) infections in chemotherapy wards and imaging centres may mean fewer procedures and treatments can take place.

Why might my chemotherapy NOT be delayed?

Many people’s chemotherapy is likely to be delayed. However, in some situations, risks to your health and longer-term care may mean treatment for your lung cancer is better sooner rather than later.

Doctors could recommend going ahead with chemotherapy if:

  • your cancer is likely to grow or spread quickly
  • you have symptoms that need to be treated, such as pain or breathlessness
  • a delay to your chemotherapy may mean that your cancer becomes untreatable
  • the risks to your health from coronavirus are less significant than those from not going ahead
  • cancer services in your area are recovering and chemotherapy is possible

Starting treatment now or delaying it is an important decision. Take your time and talk it through with your medical team, family and others important to you.

Your chemotherapy treatment is likely to be organised in a way that minimises your time in hospital.

If my chemotherapy is not going ahead, are there any alternative treatments?

If you have been offered or recommended chemotherapy, that is because doctors consider it to be the best course of treatment for you. Under current circumstances, any delay is primarily because going ahead with it would put you at more risk of harm (from being ill from COVID-19) than not having any treatment if your cancer is not growing quickly.

In some circumstances, radiotherapy or other treatment may be considered to reduce problematic symptoms.

I have recently had chemotherapy – what should I do?

Having had chemotherapy, you are likely to remain in an “at risk” group depending on how long it has been since your treatment stopped and how well you have recovered. You should have received a letter from the NHS if you need to practise “shielding”. If your treatment ended within the past three months, you will be advised to shield yourself.

If not check with your medical team if you are advised to follow other social distancing guidelines.

Your doctors, nurses and physiotherapists will probably have stressed how important it is for you to follow any instructions they may have given to you for your recovery period.

If you do have to shield yourself, keep in touch (remotely or at a distance) with family and friends. Use phone calls, conference calls and video chats to help you through the coming days and weeks where you are isolating yourself physically from other people. You may also prefer to write emails, texts, or letters.

I am on my maintenance chemotherapy. What will happen next?

Under the current circumstances, maintenance chemotherapy with pemetrexed may stop or not start depending on how your doctors assess any risks to you from COVID-19 compared to not have this treatment.

Your cancer team will speak to you about how this may affect your treatment and care going forward and how your medical condition will be monitored. Decisions about your future treatment will depend on if your condition changes and how long the coronavirus situation affects your hospital’s capacity to deliver service.

I am due to talk to my surgeon or oncologist about follow up chemotherapy after my surgery. Will this be postponed?

Follow-up appointments with surgeons and cancer doctors may be delayed and they will most often take place over the telephone. Your medical team will be doing everything they can to assess the outcome of your surgery and the relative risks and benefits of starting a course of chemotherapy.

Decisions are made on a case-by-case basis.

What is “shielding” and why should I do it?

Shielding is a way of protecting people who are at greatest risk from coronavirus (COVID-19) by reducing to an absolute minimum their interaction with others. People who are receiving, or are recovering from, chemotherapy are in this group.

Several weeks ago, the UK Government and the devolved administrations published guidelines to help people understand what to do.

Please see our shielding advice for more information.

If you are due to start treatment, your clinicians may advise you to have a COVID-19 test and ask that you self-isolate for 14 days before your treatment.

The UK Government and devolved administrations provide guidance on shielding so you can make informed choices about looking after your health. It is up to you to make decisions about what is right for you to do, taking into account your own physical and mental wellbeing.

We recognise this can be complicated and difficult. Both your clinical team and our Ask the nurse service are able to talk this through with you so you can make the right decisions for you and your family.

Why can’t I have my chemotherapy at home?

While some types of chemotherapy may be suitable for home treatment, the resources to do this for your lung cancer chemotherapy are not available just now. It is given by intravenous drip (IV) in your arm and you will need careful monitoring. If your chemotherapy treatment is to go ahead, you will need to go to your chemotherapy day unit.

What changes in my health should I report to my lung cancer team?

It is important to speak to your GP or lung cancer medical team if you start to notice some new symptoms that may be related to your lung cancer, to COVID-19 or to other health conditions for which you may need to be checked out. Symptoms of an infection or another illness could include:

  • a high temperature (37.8°C or above)
  • difficulty breathing
  • pain in chest or shoulder
  • a new or persistent cough

You can also call 111 for advice, or call 999 in an emergency.

What can I do to help myself?

It is very important that you follow the guidelines about self isolating and shielding. You are in an “at risk” group and so you need to do everything you can to avoid being infected by coronavirus (COVID-19). Your chemotherapy will definitely not go ahead if you have an infection, including coronavirus (COVID-19).

If you have a date for chemotherapy treatment, be particularly careful during the 14 days before it to reduce your risk of being infected.

Take the time before your treatment, or during any delay, to do some exercise if you can. People who do exercise to strengthen their breathing and improve their stamina respond to treatment better and recover quicker with fewer complications. Doing exercise like this before treatment is known as prehabilitation.

Contact your lung cancer team or physiotherapist for advice.

If you are waiting for chemotherapy or are recovering from treatment, eat a healthy nutritious diet with plenty calories to keep your weight and overall health steady.

You can also find some suggestions about exercise and nutrition in our Living with lung cancer booklet online at: www.roycastle.org/livingwithlungcancerbooklet

Remember to adapt the suggestions to follow the guidelines for self isolation or shielding, so do the exercises indoors or in your own garden if you have one.

If you are a smoker, it is very important that you stop as soon as you can. Smoking is associated with increased risk with coronavirus (COVID-19).

You can also join our online forum where you can get support from others who have stopped smoking or are trying to stop: www.healthunlocked/quitsupport

Where can I seek advice?

Your medical team is your best source of information about your treatment and recovery. Keep their phone numbers and emails addresses nearby so you can get in touch whenever you need to.

You can also call the Roy Castle Lung Cancer Foundation’s Ask the nurse service free on 0800 358 7200 , or email them at lungcancerhelp@roycastle.org, for other advice about lung cancer. Using the same number, you can also be connected to our Keep in touch support service for one-off or regular telephone chats with our team, or email info@roycastle.org and ask for a call.