Targeted therapies and coronavirus (COVID-19)

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 is also putting 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 an increased risk of infection from the virus.

If you have lung cancer and you are being treated with a targeted therapy, or targeted therapy 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. Capacity to carry out targeted therapies 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.

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 targeted therapy – 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 attend hospital for 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, 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.

If you don’t develop COVID then your targeted therapy 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 targeted therapy not start as planned?

Reduced capacity in some hospitals to provide systemic anti-cancer treatments such as targeted therapy in some hospitals might delay your treatment. 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.

Targeted therapy may make 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 treatment 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:

  • Starting and receiving a targeted therapy may require some hospital visits. There is currently more pressure on hospital services due to coronavirus (COVID-19).
  • Fewer oncologists, nurses and other medical staff may be available to manage your treatment and care 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.

Why might my targeted therapy NOT be delayed?

While some people’s targeted therapy treatment may be delayed, for many others it may go ahead with some changes.

Your targeted treatment will be an oral tablet you take at home. Your ongoing treatment and care is likely to be organised in a way that would minimise your time in hospital so you may have fewer visits than normal. For example, you may have blood tests less often and be given two months’ supply of tablets to reduce the number of hospital visits.

Risks to your health and longer-term care may mean it is better to carry on or start treatment for your lung cancer sooner rather than later.

Doctors could recommend going ahead with treatment if:

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

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

If you have been offered or recommended targeted therapy, that is because your biopsy has shown that you have a type of lung cancer that can respond well to it and 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.

What if doctors decide to stop or interrupt my targeted therapy?

Doctors may decide to stop your treatment if it has stopped working. They may also stop or interrupt your treatment if they decide that continuing it would put you at risk of contracting COVID-19 or being seriously affected by it if you do.

They will make sure you understand their decision and talk through what treatment and care may be available to you in the meantime. They will also discuss next steps and whether restarting your targeted therapy or an alternative is an option in the future.

I have recently had a targeted therapy – what should I do?

Having had a targeted therapy, 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.

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, a targeted therapy treatment 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.

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

It is important to speak to your GP, acute oncology service 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 look after 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 targeted therapy will definitely not go ahead if you have an infection, including coronavirus (COVID-19).

If you have a date for starting targeted therapy 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 targeted therapy 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.