Oncology in the context of the COVID-19 pandemic: how to save maximum lives

Coronavirus infection has taken public health care by surprise. And not only the victims of SARS-CoV-2 suffer.

In Russia, the problems were obvious even before the epidemic, but now they are critically aggravated. Dozens of hospitals and departments of various specializations will transform into infectious ones. Because of this, all operations except emergency ones (that is, necessary to save the lives and health of patients) are postponed, hospitalizations are canceled and the planned treatment is stopped for an unknown period.

Thousands of patients in these hospitals were left without help. Some of them will be able to put the treatment on hold and survive quarantine without much damage to health. But there are those to whom it is contraindicated. We are talking about patients with a diagnosis of cancer.

In our “Medicine 24/7” such 90%. Fortunately, the general mobilization for the war with COVID-19 did not affect us – we continue to treat cancer patients. But I had to urgently take measures to cope with the doubled flow and help those who were put out the doors of oncology departments in Moscow and across the country with the words: “Come after quarantine.”

This article is intended to help those who, God forbid, are now dealing with the problems of people at risk. Let us explain how high the danger of COVID-19 is for cancer patients and how to reduce it, what can be done right now if there is no diagnosis, but there are suspicions, and what exactly is not necessary.

Why do we think that coronavirus is “especially dangerous” for cancer patients

1. Immunity. In people with malignant neoplasms, it is very often weakened. There are several reasons for this.

First, the tumor itself is usually trying to suppress the immune response – so as not to be noticed and destroyed by the “guardians” of the body. The processes and mechanisms that are involved in this have not yet been fully studied – but it is known that the functions of T and B lymphocytes, antigen-presenting cells are inhibited, and the production of interleukins is reduced. In general, a diagnosed cancer most likely already indicates that the person has problems with immunity.

Next, treatment begins. In the vast majority of cases, it is very aggressive in itself, and often can lead to immunosuppression (suppression of immunity). Many drugs that are used in oncology for drug treatment (chemotherapy) affect leukocytes, and in some cases provoke neutropenia and lymphocytopenia – a sharp decrease in the blood of the corresponding cells responsible for combating pathogens.

Neutropenia – a decrease in the number of neutrophils in the blood

Surgical operations also become an additional risk of developing infections – even the most successful and performed according to all the rules, they are nevertheless a serious intervention that opens up additional access to the external environment in the patient’s body. A surgical treatment is used in more than 55% of cancers.

Immunity problems affect not so much the likelihood of SARS-CoV-2 infection as the risk of the disease becoming more severe, with complications and a higher risk of death.

2. Statistics. Studies in the largest foci of coronavirus infection, China and Italy, also confirm that cancer patients with COVID-19 have better prognosis than patients without cancer.

In the first, February analysis, published in The Lancet Oncology, our Chinese colleagues have revealed such a pattern between the risk of severe manifestations (up to the need for mechanical ventilation) and the presence of cancer.

People with oncological diagnoses are 4 times more likely to get seriously ill

Moreover, those who underwent chemotherapy or surgery during the last month had a greater risk of serious complications (75%) than those who did not receive active treatment in the last 30 days (43%).

In second study the Chinese showed that the incidence of coronavirus infection in patients with cancer (0.79%) was 2 times higher than the cumulative incidence rate in Wuhan (0.37%).

An Italian study showed that 19.5% of all deaths from pneumonia caused by SARS-CoV-2 had an oncological diagnosis. However, it must be borne in mind that the average age of coronavirus deaths in Italy is close to 80 – there are a lot of cancer patients in this group.

3. Time. Always the most scarce resource in the treatment of cancer, and now it is the most acute problem. The sooner a diagnosis is established and treatment is started, the better the prognosis for the patient and the greater the chances of a stable remission and long life. But without treatment, cancerous tumors most often develop quite rapidly, and stage I can turn into stage III in a few months.

For many patients – for example, with kidney cancer or metastatic cancer of the stomach – the risk of dying from them without treatment is still higher than from COVID-19.

The situation faced by Russian cancer patients in connection with coronavirus, when their treatment facilities stopped receiving, discharged everyone from the hospital and canceled important operations, is a huge risk for them.

Judging by the reports of the administrative structures of health care, “oncological care is rendered in the same mode.” In fact, it looks like this: patients are discharged from hospitals that were given under COVID-19 and are offered to be registered “from scratch” in other oncological treatment facilities.

Photo Interfax

That is, they should try to retake all the tests again in a week or two and “wedge” into the already scheduled queue for treatment, so as not to interrupt the course of chemo- or radiation therapy. They can not be interrupted – this is fraught with the rapid progression of the disease. This means a critical decrease in the chances of further life.

There are also those who received a quota for VMP (high-tech medical care) and were waiting for the operation at the end of March, but it was postponed indefinitely “due to the unfavorable epidemiological situation.”

We know all these details from several dozen new patients who are currently receiving chemotherapy from us or are preparing for surgery. They have very similar stories: everyone came to us after we had to “check out” from other medical institutions and it became clear that there was very little chance of finding an urgent treatment for CHI.

By the way, it is curious that an additional increase in the contingent was given by those who had previously traveled not to therapy abroad. Those accustomed to treatment in Israel, South Korea and Europe found themselves in the same situation as patients in Russian hospitals. Such people are prejudiced against domestic oncologists, and it is more difficult to work with them. However, they quickly realize that we at Medicine 24/7 know and use the same ESMO or NCCN medical protocols, the very latest drugs and equipment that we are accustomed to abroad – and look at Russian doctors differently.

What to do? We do what we can

1. Protection and disinfection. We work under quarantine measures, in accordance with the law: we comply with the instructions of the chief medical officer and the decrees of the mayor of Moscow.

The first thing that was done was transferred to remote work all the administrative staff – those who are not directly related to medical activities.

Doctors, nurses, orderlies, laboratory staff – of course, at work. This work is many times more than in the “peace” time.

The schedule of visits has become more stringent, and no one goes further than the hall in outer clothing, without shoe covers, without a mask or with hands not treated by a sanitizer.

Additional checks and procedures for the thorough processing of surfaces, equipment and premises are carried out several times more often. Quartz irradiators also do not have time to cool.

Masks, gloves and disinfectants, thank God, are enough. We have always had substantial reserves, and the ability to replenish them – fortunately, we, as a private clinic, are not limited to the choice of suppliers.

2. The maximum of personal consultations is online. A significant part of them today takes place on Skype – all the control methods at which we control the treatment. We consider documents, results of studies and analyzes in the form of photos or scanned copies, we talk with patients via video communication.

For example, a woman 53 years old, after 6 courses of chemotherapy and underwent surgery for ovarian cancer in 2019, was told a few days ago that repeated tests and the results of PET-CT without signs of progression are officially healthy. We hope this news will brighten up its self-isolation.

Those who need to be taken in person are booked at a strictly scheduled hour, we ask them not to come long, and we try to make a reception so that people do not intersect.

We ask patients of the hospital not to leave the ward without unnecessary need – the sisters will bring all the necessary things. In the corridors of the clinic it became completely empty – and safe.

3. A free cancer care service for patients and their families. For those who need to understand what their treatment will look like under current conditions; those who, before starting quarantine, were planning to go to an oncologist with suspicions of a formidable diagnosis and now cannot fall asleep from anxiety and suspense; those who want to take a second opinion from an experienced doctor; those with close oncological diagnosis dozens of people daily. Everyone has a ton of questions that are now dangerous, or even impossible, to see a doctor at the place of residence.

All of them can simply send us their medical documents by e-mail: epicrisis, the results of analyzes and studies, images and transcripts of CT / MRI / PET-CT. Or call and sign up for a free consultation on Skype – and get answers to your questions without having to risk your health and come (sometimes from other regions and even countries).

True, one has to work after work, but hunting, as you know, is more than captivity. Doctors in a commercial clinic are doctors, we try to help the maximum number of people.

What can you do?

If your family has an oncological patient (even in a stable remission), or a person with other chronic diseases (cardiovascular, diabetes, hypertension, asthma), or just an elderly owner of the corresponding “bouquet” – remember, he is in the high-risk group for COVID- 19.

It is better for such people not to meet with coronavirus – this is very likely to lead to serious complications. Therefore, monitor its safety.

Minimize travel by public transport, shopping, and doctor visits. The fewer people in contact with a person at risk, the less likely the infection is.

If he is undergoing treatment, for example, chemotherapy, in a hospital – try to arrange it so that it is outpatient, if possible.

Order delivery of food and medicine to your home or bring it yourself – but leave it at the door and say goodbye, but don’t go “for tea at the same time, since we arrived!”

Take charge of his bills – and do it remotely.

Reduce or cancel trips to the clinic for non-urgent matters. If oncologist consultation is urgently needed, you can count on us.

These simple rules can save your loved ones life.

By the way, cancer patients have an advantage in a pandemic – so oncopsychologists consider. People living with cancer have a difficult but invaluable experience in the current situation – they know how to survive anxiety and a state of uncertainty. In addition, they are able to responsibly and carefully treat their health – unlike many of us.

Be healthy and prudent!

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