COVID and Cancer

COVID and Cancer

(All the articles published in past are available at www.shyamhemoncclinic.com/blog/)

Question:  Last time we covered some aspects related to Fentanyl patch, Tramadol, Tapentadol, Buprenorphine patch. Morphine allows much better titration of dose for better pain control, compared to other options. However, other options are often preferred because of better availability, less strict laws related to use, overall more comfort with use for many years. Morphine is safer in case of liver or kidney impaired patients compared to other options. Patch has a significant advantage in patients who cannot swallow. We continue to remind our readers to take help of palliative care centers and pain experts for better pain control. Most of the centers provide free care, hence even the poorest of poor patients need not suffer from pain.

Before we go on to our next topic in palliative care, I would like to ask you some burning questions related to COVID 19 infection. As we are going through severe second wave of pandemic, a lot of questions have come up regarding covid and cancer. Such as, can a cancer patient take vaccine?

Ans: Agree. I think these are important topics where our readers need urgent guidance. Let us answer your first question. Following is what we know today:

1. Cancer patients can take vaccine for covid prevention. We have been giving other vaccines to cancer patients, such as annual flu, hepatitis b, pnemonia etc for many years.
2. Some would prefer to avoid vaccine during active chemotherapy sessions. Or space them in between chemotherapy sessions. Or give vaccine before or after all sessions are completed. For example, after completion of six cycles course. In general, chemotherapy should not be delayed for vaccination, especially if chemotherapy is for a curative indication.
3. Vaccination should preferably be postponed during aggressive chemotherapy, such as for most types of blood cancers.
4. COVID vaccine trials did not include cancer patients and immunocompromised patients. However international societies, such as American Society of Clinical Oncology, and others believe that these vaccines should be safe for cancer patients, same as other vaccines given to cancer patients. They have published guidelines. Cancer is not considered a contraindication. Safety is generally not expected to be an issue in cancer patients.
5. Efficacy of vaccine however can be an issue in patients with active treatment or advance cancer. Since immunocompromised patients may not achieve same high antibody titer. Hence cancer patients should follow same precautions even after vaccination, such as social distancing, restricted travel, mask, hand hygiene. Inadequate response to other vaccines is well known in cancer patients.
6. All available vaccines can be considered equal with regard to above points.
7. mRNA vaccines available in USA, Europe can cause transient lymphadenopathy. This may give false positive results on imaging tests such as mammogram, CT scan.

Que: Another common concern is should patients avoid chemotherapy, radiotherapy etc cancer treatment during pandemic? Since these treatments can reduce immunity.

Ans: We all did this last year, in march, april 2020 during very early days of pandemic, not knowing more details about the virus. Most transplants were also on hold for few months. Thereafter, data came out from USA, Europe regarding this subject. Now it is very clear that all cancer related treatments should be continued as per timetable. Very few cancer patients have died from covid during chemotherapy. In fact, none of my chemotherapy patients in last one year. And most of my colleagues have same experience. Death rate in our patients overall from covid does not seem significantly higher than general population. This is an important relief. After first few months, all Indian centers also started doing transplants. Transplants use highest level of immune suppression, and yet risk of covid is very low, with standard precautions. Most covid deaths in cancer patients have been in very advance stages of cancer, where cancer reduces general immunity to a great extent.

Even with so many covid deaths in USA, cancer deaths were still higher than covid deaths in year 2020 there. This again underscores the importance of continuing our efforts for early diagnosis, timely treatment, and proper follow up of cancer patients. Delays in diagnosis and treatment that we are seeing in India, is a major concern, likely to lead to much higher morbidity and mortality from cancer in next few years.

April 15,2021.  Dr Chirag A. Shah; M.D. Oncology/Hematology (USA), 079 26754001. Diplomate American Board of Oncology and Hematology. Ahmedahbad. drchiragashah@gmail.com