Amid the ongoing coronavirus pandemic, many cancer patients are facing a series of dilemmas, including whether or not to keep receiving treatment, Vox reports.

According to the Centers for Disease Control and Prevention, about 650,000 cancer patients are treated with chemotherapy in an outpatient oncology clinic in the United States each year.

But many people living with cancer have compromised immune systems and are among the groups of people at greater risk of contracting the novel coronavirus that causes COVID-19, a respiratory disease whose symptoms can range from mild to severe.

A recent report from the National Comprehensive Cancer Network found that cancer patients in China with COVID-19 had a 3.5 times higher risk of mechanical ventilation, ICU admission and death compared with those without the disease.

This puts both patients and oncologists in a difficult predicament. Oncologists ask themselves, “Should we continue to give immune-system-suppressing cancer treatments to patients during the COVID-19 pandemic?” On the other hand, patients ask, “What happens to me and my cancer if I stop treatment altogether?”

The problem is, chemotherapy drugs damage healthy white blood cells, which are the body’s defense against viruses like the novel coronavirus. But stopping treatment could also put people living with cancer at risk for even more problems, including tumor progression and shorter survival times.

What’s more, it’s unclear how long this pandemic will last. Although some patients have expressed a willingness to skip one or two chemo treatments, as Vox puts it, “If a patient were to delay their chemo treatment right now, it might not be any safer to resume the treatment should they reschedule it for the coming weeks or months.”

According to the American Society of Clinical Oncology (ASCO), “At this time, there is no direct evidence to support changing or withholding chemotherapy or immunotherapy in patients with cancer. Therefore, routinely withholding critical anticancer or immunosuppressive therapy is not recommended.”

The situation is further complicated when the treatment prescription is an autologous stem transplant, aka a bone marrow transplant, which can send certain cancers into remission but entails wiping out the immune system and rebuilding it.

The Vox article chronicles the treatment of Jamie Hecker, a 54-year-old man with a bone marrow cancer called myelofibrosis. His current chemo regimen is working well, but if it ceases to be effective, which is common with this type of treatment after a year or two, the only other available option is a bone marrow transplant. Given the risks of COVID-19, the American Society for Transplantation and Cellular Therapy lists these transplants as unique cases for which deferrals may be appropriate.

ASCO recommends that health care providers make treatment decisions based on each individual as well as factors such as cancer stage, chemotherapy type and the risk of cancer recurrence should treatment be delayed.

What if someone with cancer tests positive for COVID-19? Right now, according to an ASCO statement, “There is no specific guidance with respect to COVID-19 testing in patients with cancer. Local and state public health directives and guidance on who should be tested and how the tests should be conducted should be followed.”

Oncologists ask what a positive COVID-19 diagnosis would mean for chemotherapy treatment. Should patients wait until they’ve recovered to resume chemo? The answer is unclear. If more testing kits were readily available, oncologists could test all patients before beginning treatment, whether or not they had symptoms, to determine their status before compromising their immune systems.  

Only time will tell what cancer patients and doctors should do. But for those looking for some answers, check out “What People With Cancer Need to Know About the New Coronavirus” and consider talking with members of the cancer community in our Cancer Health Forums.

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