Doctors' guide to navigating the COVID-19 pandemic as a cancer patient

Oct. 22—Patients who have put off their routine cancer screenings or treatments because of fear and uncertainty caused by the COVID-19 pandemic are being encouraged by local medical providers to resume their appointments.

The COVID-19 pandemic has had a devastating impact on screening. At the height of the pandemic, some cancer screenings declined by 90%, according to the American Cancer Society. This year, the health organization estimates there will be 1.9 million new cancer cases diagnosed and 608,570 cancer deaths nationwide.

"The beginning of the COVID-19 pandemic brought about dramatic declines in screening rates for breast, cervical, colorectal and lung cancers, which means that many cancers could be going undiagnosed and untreated," Dr. Karen Knudsen, chief executive officer of the American Cancer Society, said in a statement. "As a result, the American Cancer Society foresees that pandemic-related decreases in health care access and cancer screenings will result in a short-term drop in cancer diagnoses and an increase in late-stage diagnoses and potentially preventable deaths."

Oncologists and hematologists at Joplin's two largest hospital systems — Mercy Hospital and Freeman Health — spoke with the Globe about cancer patients' concerns and ways to navigate the pandemic safely.

Q. What are some concerns you've heard from cancer patients throughout the COVID-19 pandemic?

Health care facilities have enacted several safety protocols since the onset of the pandemic, including limited visitors and vaccine mandates. Mercy became the first major health care provider in the Joplin area to require employees to be vaccinated against COVID-19 by Sept. 30 in an effort to protect patients.

"In most health care facilities like ours, we have all our patients and co-workers wear a mask or have a face shield on," said Dr. Samir Dalia, a medical oncologist and hematologist at Mercy Hospital Joplin. "We have very good cleaning protocols. It's very safe to get a screening mammogram, and we recommend it for everybody."

Dr. Anisa Hassan, an oncologist and hematologist at Freeman Cornell-Beshore Cancer Institute, said she's also heard concerns from patients who are immunocompromised or have a weakened immune system because they're at higher risk of developing COVID-19 or serious illness.

People with certain medical conditions, such as cancer, are more likely to get severely ill from COVID-19, according to the Centers for Disease Control and Prevention. Hassan and the CDC still recommend that people with underlying medical conditions be vaccinated as well as continue to practice hand-washing, social distancing and wearing masks while out in public.

Q. Should I forgo or delay my breast cancer screening during the pandemic?

Doctors say no, and this is why:

Breast cancer that's found early, when it's small and has not spread, is easier to treat successfully. When breast cancer is detected early and is in the localized stage, the five-year relative survival rate is 99%, according to the American Cancer Society. Getting regular screening tests is the most reliable way to find breast cancer early.

Dalia said that the risk of catching COVID-19 while undergoing a screening mammogram is regionally and nationally low. It takes approximately 15 to 30 minutes to complete a mammogram screening.

"We're encouraging women not to delay their screening mammograms because, if we can catch breast cancer earlier, that's how we can potentially cure it better," said Dalia. "The same thing with cancer treatment. We have put in policies in our infusion centers where no visitors are allowed, and it's only patients receiving chemotherapy. There are less people in our infusion centers, which makes it a safer environment."

Some people might have swelling or tenderness of the lymph nodes under the arm in which they got the injection. In this case, doctors recommend patients being screened for breast cancer to wait several weeks following the COVID-19 vaccine to prevent a false diagnosis.

"For breast cancer patients, they should not get the vaccine on the side where they had the breast cancer," said Hassan. "If they've had both breasts removed, another site may be better. The third thing is because this is a normal phenomenon, they should not get mammograms very close to their vaccination. They should wait at least six to eight weeks because if they see lymph nodes, they may think their cancer is back."

Q.What if I have or had cancer and start showing COVID-19 symptoms?

If cancer patients or survivors exhibit COVID-19 symptoms, they are recommended to contact their doctors immediately to see if they need to be tested, quarantined or receive antibody products. Dalia said monoclonal antibodies can help the body fight the virus or slow the growth of the virus.

The Food and Drug Administration authorized the use of these monoclonal antibody therapies to treat mild- to moderate-COVID-19 in adults and pediatric patients who test positive for the virus and are at high risk for progressing to severe COVID-19, hospitalization or both.

"If they get COVID-19 or have symptoms, then we have instructed our patients to call us to at least let us know if they need to be COVID tested, and we can make a determination if they need to get the monoclonal antibodies to help them through their COVID-19 diagnosis or what they should do as far as quarantining."

Hassan said the monoclonal antibody infusion is administered to high-risk patients through an IV.

"It's an antibody against the COVID antigen and has helped keep people out of the hospital," she said.

Q.Is it safe for cancer patients to receive the vaccine?

Yes. The FDA and CDC have authorized additional doses of Pfizer and Moderna's COVID-19 vaccines for severely immunocompromised individuals.

The COVID-19 vaccine is safe for cancer patients and doctors are recommending a third dose, which follows the initial two-dose vaccines. Dalia and Hassan said cancer patients who have received the vaccine have not reported any major side effects.

"The people who are immunocompromised don't get more side effects than people who aren't immunocompromised," said Hassan. "In fact, they may get less side effects because their immune system is not revving up. I think it's a good thing to have side effects because it means your body is reacting to the vaccine."

For people in general, common vaccine side effects include pain, redness, swelling on the arm of the injection site, as well as a headache, muscle pain, chills, fever and nausea, according to the CDC. Serious side effects, such as blood clots, an allergic reaction or heart inflammation, are very rare.

"We have recommended these vaccines at any time during their cancer treatment," said Dalia. "We do know that some cancer patients may not hold onto their vaccine or have antibodies from the vaccine because of their cancer treatment. Due to this, our practice — and also the American Society of Clinical Oncology — recommends cancer patients receive a third dose of the vaccine."

Hassan said if any patient is experiencing side effects from the COVID-19 vaccine, they should notify their doctor immediately.

Q.What's the difference between a booster shot and an additional dose?

A booster shot is administered when a person has completed their vaccine series and protection against the virus has decreased over time.

Additional doses are administered to people with moderately to severely compromised immune systems. This additional dose of an mRNA-COVID-19 vaccine is intended to improve immunocompromised people's response to their initial vaccine series, according to the CDC.

"I tell cancer patients that they need to get a third dose six months after their last dose," said Hassan. "For people who have had COVID, they have antibodies in their system, and in about three months, the antibodies start to wean off."

Q.Does cancer treatment affect the vaccine's efficacy?

"We don't know fully, yet just because there isn't enough information that certain chemotherapy drugs or certain other drugs potentially lessen the effect of these vaccines," said Dalia. "That is one concern, but this is why we're telling patients that they should continue with their vaccines like we do with other vaccines that we have our patients take, as well."

Hassan said she recommends cancer patients take all precautions against COVID-19, including the vaccine.

"The problem with cancer patients is not that the vaccine is going to harm them; the problem is that they may have less effectiveness from the vaccine," she said. "We recommend they get any protection they can. They may get COVID, but it may not be as serious."

There is currently not enough evidence to suggest that the COVID-19 vaccine can make cancer treatments less effective, said Hassan and Dalia. The initial studies testing the COVID-19 vaccines did not include people getting treatment with drugs that suppress the immune system, such as chemotherapy, or people who have weakened immune systems for other reasons, according to the American Cancer Society.

"Immunocompromised patients were not part of the trial, but we have patients who are on active chemotherapy, patients who are survivors, patients who are on treatment but not active chemotherapy," said Hassan. "They are all classified differently, but all in all, we like to give the vaccine to all of them."

If a patient is undergoing chemotherapy, Hassan said to get the COVID-19 vaccine prior to their next cycle, or about three weeks, to give their immune system enough time to respond. Patients are also encouraged to wear masks despite vaccination status.

"Sometimes people who are in treatment but aren't critical, they should get it on that very day," said Hassan. "We have altered treatments to where they can get something not as immunosuppressive, so we have changed a lot of things while dealing with this pandemic."

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