“Can definitely be classified as a risk group”: oncologist - about the increased risk of coronavirus for cancer patients

- Many experts say that coronavirus infection COVID-19 is especially dangerous for cancer patients. What is known about this?

- Our colleagues from China have done (and continue to do!) An incredible job: having coped with the epidemic in their own country, they analyze many aspects of their activities in those extreme conditions, including exploring how the virus affects cancer patients.

Indeed, our patients can safely be considered a risk group. Chinese colleagues, albeit with the help of a relatively small number of patients with coronavirus who had cancer, found that the frequency of serious complications (up to death) in our patients is 5 times higher than those who never had a malignant tumor.

These results confirm that it is necessary to be especially wary of both us (oncologists. - RT ), and, above all, the patients with oncology themselves.

- What is the vulnerability of cancer patients to?

- The complex, immunosuppressive (artificially depressing immunity. - RT ) and extremely toxic treatment against cancer that our patients receive and which is fraught with many complications even in successful epidemiological periods, significantly weakens the body's own resources. For example, in the conditions of leukopenia (a decrease in the number of leukocytes) and lymphopenia (a decrease in the number of lymphocytes) arising from chemotherapy and radiation (and even more so during simultaneous chemoradiotherapy), the body will be extremely difficult to cope with the virus.

- That is, it is also a matter of reduced immunity, right?

- We can talk about "reduced immunity" if we examine the patient accordingly - we make an immunogram, determine the number of T and B lymphocytes (cells of the immune system. - RT ), the level of immunoglobulins and we see deviations. In cancer patients, this is usually not done.

But in many cases, the development of the malignant process already implies a certain immune failure, and the addition of complications, such as leukopenia (after chemotherapy or radiation), greatly aggravates the overall picture. Do not forget about the need for regular visits to the oncological institution for the purpose of treatment or control. Therefore, I repeat once again: our patients are indeed at increased risk in terms of infection and the severity of the disease.

- Patients with what oncological diseases are more at risk?

- I believe that any cancer patient who is in the stage of active antitumor treatment or is subject to it (according to the results of the examination) is at increased risk. If there are complications of treatment, the risk increases.

A patient who has already undergone the proper treatment, whose complications have been safely resolved or did not exist at all, who will simply have a dynamic observation in the absence of signs of an active tumor process should also not relax.

- Is coronavirus able to increase the risk of disease return in patients who currently have cancer in remission?

- I think no. Coronavirus has a chance of becoming a seasonal infection, wave-waving across regions, and possibly with a more severe course than regular flu. If such an infection stimulated a surge in cancer, in the spring cancer centers would choke on the number of recurring patients. But this does not happen.

- If a coronavirus is found in a patient with oncology, is it worth interrupting the antitumor treatment?

- I believe that there is no way for a cancer patient to find out about any continuation of antitumor treatment when a coronavirus infection is detected.

Such a patient should be isolated and receive the usual supportive treatment at home in case of a mild course of the disease, or be hospitalized in an infectious diseases hospital with more serious forms of the disease. The risk of serious complications up to death will be too high in most cases.

- Are antiviral drugs not dangerous for cancer patients? Can they be taken to prevent coronavirus?

- Any drug can carry a potential risk of side effects: from allergic reactions to toxic effects on the liver or other organs.

There is no point in taking any antiviral drugs to prevent coronavirus. Firstly, until none of them proved to be effective in coronavirus, many hopes were not realized. And secondly, due to possible toxicity.

We know the basic prophylaxis perfectly: distance or isolation, frequent and thorough washing of hands, treatment of all contact surfaces with antiseptics, and so on.

- Do you recommend a more strict quarantine regime for patients with oncology than for the rest of the population?

- Definitely. Finding a home is the best measure to prevent big problems, not only for cancer patients. Patients themselves should not organize their antitumor treatment. They do this under the guidance and strict supervision of oncologists. Their task is to strictly comply with all recommendations.

- In many countries, the procedure for providing assistance to cancer patients is changing due to the coronavirus pandemic. Has anything changed in the work of oncologists in our country?

- Oncology centers provide routine care, leaving our patients without routine, requiring compliance with certain deadlines and regimens, no one is going to treatment, but certain measures must be taken. They are primarily associated with the vulnerability of cancer patients.

Each oncologist on his “front line” —surgeon, chemotherapist, radiotherapist — reorganizes the work in a certain way: perhaps it cancels particularly traumatic operations, transfers patients to tablet chemotherapy, and so on.

For example, in the radiation therapy department of the Ulyanovsk Regional Oncology Center, which I head, we have been working in a special mode for three weeks now. All patients who were planned for this period were admitted for treatment. But at the same time, we tried to clearly distinguish between the flows of patients, to prevent crowding in the ward, to conduct cleaning in the ward with a greater frequency, and, if possible, to shorten, albeit slightly more intensive, radiation therapy courses - of course, if this allows us not to exceed the permissible doses for healthy organs.

In addition, we temporarily refuse simultaneous chemoradiotherapy in order not to provoke the development of more pronounced complications in patients, primarily from the blood side. In those situations where the course of radiation therapy can be delayed painlessly, we do this.

However, communication with colleagues from other regions shows that far from all centers have taken any organizational measures, both to protect patients and to protect staff. How could this inertia (or hope for the Russian "maybe"?) Not come sideways.