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I am a lung cancer patient. Am I at higher risk of getting COVID19? What added precautions should I take apart from those recommended for the general public?

Covid-19 has resulted in a major change to everyone’s daily living, and the key question for cancer patients, is whether they are at a higher risk of getting Covid-19, what they can do to minimise the risk of infection and whether they should continue getting their cancer treatment. We collate the understanding of this topic from currently available data / evidence, and present them here:

Are cancer patients at higher risk of getting Covid-19?

Covid-19 can affect anyone, of any age group. In general however, cancer patients may be at higher risk as they can be immune-compromised due to the underlying cancer, or from chemotherapy.

In addition, lung cancer patients tend to be more elderly, and have other co-existent medical conditions, such as heart problems, or impaired lung function due to existent or a history of smoking. These are known risk factors for Covid-19, and these patients tend to do worse with Covid-19 than younger patients who have no other known medical, heart nor lung problems.

I would also advise to be more vigilant for any new symptoms. The more common symptoms of Covid-19 of fever, cough, shortness of breath, and fatigue can also be seen in lung cancer patients. The reality is it can sometimes be difficult to distinguish clearly. However, cancer related symptoms tend to be more chronic, and if no recent change has occurred, Covid-19 infection is less likely. The general advice is to seek medical attention should cancer patients have new and worsening symptoms, especially in the presence of fever.

What can be done to minimise the risk of infection?

The recommendations and general precautions for the public will serve well for cancer patients as well.

We recommend to:

• Practice good personal hygiene with frequent hand-washing;
• Minimise touching of the face area, to minimise introduction of infection.
• Wear a mask to protect oneself and others as much as possible;
• Practice physical distancing and minimise crowd to “break the circuit of infection”.
• Along the same lines of minimising contact, possibly with either known Covid-19 patients, or asymptomatic carriers, hospital visits and duration of visits to the hospitals should be minimised unless deemed necessary.
• Optimise one’s own health with adequate rest and nutrition.

Should cancer treatment continue?

Unfortunately, there is no one-size-fits-all rule here.

There are many variables that need to be considered here- and I highly encourage that patients discuss with their treating oncologist as it needs to be considered on a case-by-case basis.

Some of the factors that may affect the decision may include:

• Stage of cancer, and type of cancer;
• Whether patients have fast growing cancers; and whether they have many symptoms or problems arising from the cancer;
• To balance the benefit of treatment for cancer versus the risk of hospitalisation from side effects of cancer treatment and risks arising from frequent hospital visits.

Finally, the situation of Covid 19 both locally and internationally is changing rapidly. As the severity of Covid-19 changes, the risk-benefit ratio of cancer treatment may change. Similarly, the condition of cancer patients can also change with time, and it would be prudent to discuss with the patients’ treating oncologist as they would be most familiar with their condition.