Lung surgery 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.

If you have lung cancer and you are due to have surgery, or surgery 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 comes under control, cancer services are, where possible, returning to normal in many areas. Capacity to carry out surgery and other treatments is recovering, although this varies from area to area.

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.

Increasingly, the NHS should be offering services according to the accepted standard of care unless there is a significant second wave in the pandemic, locally or nationally.

Concerns about your safety remain, however. If doctors decide not to go ahead with your surgery, this decision has not been taken lightly. They will make sure that you understand and are involved in the decision. Any treatment decisions are about weighing up risk from COVID-19 and no treatment against going ahead with your treatment.

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):

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). It helps to keep people safe by reducing to an absolute minimum their interaction with others. People who have had lung surgery 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.

I am currently waiting for lung surgery – 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.  Some NHS cancer surgery is being done in independent hospitals. 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 are admitted to hospital for surgery, you will be asked to practise isolation, known as shielding, for 14 days. If, during that time, you or a household member develops symptoms of COVID-19, you need to tell your medical team. In the days immediately before admission, you will be asked to attend for swab testing, to be as sure as possible that you do not have COVID-19 before your surgery.

While you are in hospital, 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-19, most hospitals do not currently allow visitors except in exceptional circumstances.  Ask your team if you can bring a smartphone or tablet with you, to keep up to date with your family by phone or video calling while you are in hospital.

If you don’t develop COVID-19 then your surgery 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 surgery.

Why might my surgery be delayed?

Reduced operating capacity in some hospitals might delay your surgery.  If you or members of your household have symptoms of COVID-19 in the 14 days before your surgery, it is likely to be postponed for your safety.

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 operation 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-19, 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:

  • Lung surgery sometimes needs critical care following the operation.  There is currently more pressure on these services due to coronavirus (COVID-19).
  • Fewer surgeons, anaesthetists, 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, or perhaps one of the emergency coronavirus hospitals) where there is urgent need for more support.
  • Additional precautions against potential coronavirus (COVID-19) infections in operating theatres mean fewer operations can take place.

Why might my surgery NOT be delayed?

Until services in your area return to normal, many people’s lung surgery could be delayed. However, in some situations, risks to your health and longer-term care may mean surgery for your lung cancer is better sooner rather than later.

Doctors could recommend going ahead with lung surgery 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 surgery may mean that your cancer becomes inoperable
  • the risks to your health from coronavirus are less significant than those from not going ahead
  • services in your area are recovering and surgery is possible

You will still be able to make the final decision. Take your time and talk it through with your medical team, family and others important to you.

Your surgery is likely to be organised in a way that minimises your time in hospital, and, where possible, will use video- and robotic-assisted thoracic surgery (VATS or RATS). This will obviously depend on your individual lung cancer assessment.

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, so you need to do everything you can to avoid being infected by coronavirus (COVID-19). Your operation will not go ahead if you have an infection, including coronavirus (COVID-19).

If you have a date for lung surgery, be particularly careful during the 14 days before your operation to reduce your risk of being infected.

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

Contact your lung cancer team or physiotherapist for advice.

You can also find some suggestions on pages 45 to 51 of 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

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

If you have been offered or recommended lung surgery, 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 surgery would put you at more risk of harm (from being infected by the coronavirus) than not having any treatment if your cancer is not growing quickly.

In some cases, your lung cancer may be treated with a type of highly focused radiotherapy, called SABR (stereotactic ablative radiotherapy) to try to keep it controlled until surgery is safer. This is available in a few regional centres so may mean you would have further to travel for treatment.

I have recently had lung surgery – what should I do?

Having had lung surgery, you remain in an “at risk” group. The recommendation is that you practice “shielding” irrespective of the extent of your surgery until you are fully recovered.

Your doctors, nurses and physiotherapists will probably have stressed how important it is for you to follow the recovery plan given to you.  Lung surgery is a major operation and the more you follow this plan, the better you will recover.

Make sure you take any medication given to you, including any pain medication, at the times and frequencies recommended. The pain medication will help you be able to breathe, stretch and exercise, all of which are crucial in helping you get better.

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.

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.