Breast Cancer During COVID-19

Nobody could have had good enough vision to see what 2020 would hold. The infectious COVID-19 disease took the world by surprise and has spread rapidly across the globe, leading to lockdowns, quarantines, social distancing, and a new reality for everyone.

The pandemic has undoubtedly affected every single one of us, but these effects have been different for everyone. People who already had pre-existing conditions — such as breast cancer and other types of cancer — have had to adapt to many changes. Coping with breast cancer and its treatment has always been difficult. Doing it during a global pandemic is unimaginable, yet hundreds of thousands of people are doing it. If you or someone you know is a breast cancer patient doing the imaginable, read on to learn how to cope with breast cancer during COVID-19.

COVID-19 Risks for Cancer Patients: The Facts

 

Is the risk of catching COVID-19 higher for cancer patients?

While it doesn’t seem like all breast cancer patients have an inherently higher risk of contracting COVID-19, treatments such as chemotherapy, targeted therapies, and immunotherapy can affect your immune system and increase your risk of severe illness. Lung metastases can also increase your risk, since they can lead to respiratory problems. 

 

Should I stop receiving treatments to improve my immune system?

Even if your risk of severe COVID-19 is heightened due to breast cancer or other pre-existing conditions, you shouldn’t stop or modify your treatment without consulting your doctor. The mortality rate of untreated breast cancer is higher than the risks associated with COVID-19, so your physician will most likely suggest that you continue your treatment schedule while taking precautions to prevent catching COVID-19.

 

What is my risk if I am not currently receiving cancer treatments?

Fortunately, your immune system usually recovers shortly after completing chemo treatments. So if you have a history of breast cancer but aren’t currently receiving these treatments, your risk of developing severe COVID-19 is probably the same as for other people.

However, it’s important to remember that this virus can be unpredictable — even young, previously healthy individuals have been known to develop complications and even die from the disease. Therefore, we should all follow safety guidelines to prevent the spread of COVID-19 as much as possible. If you’re worried about your individual risk, reach out to your specialist physician to address these concerns and learn what you can do to prevent getting COVID-19. 


What changes have been enacted in cancer centers and hospitals due to COVID-19?

The answer to this question can vary greatly depending on the specific healthcare center where you’re receiving your treatment; however, in many cancer centers:

  • Strict rules have been placed that don’t allow cancer patients to have someone to accompany them during appointments and treatment.
  • Telemedicine appointments have been used to replace in-person medical consultations.

These measures have been taken to further protect patients, providers, and staff by trying to reduce the amount of people going in and out of facilities as much as possible. But while it’s easy to understand why these rules have been put in place, they can also have a significant impact on patients’ emotional wellbeing. Undergoing any type of cancer treatment is a very taxing experience, both physically and emotionally, and social support has always been an important part of treatment and recovery. While the physical effects of cancer treatments can’t always be avoided, having a familiar face around while you undergo treatment or meet with your doctor can provide great comfort.

Overall, it seems clear that the sooner we can contain this pandemic, the better the outcomes for patients with any type of pre-existing condition, including breast cancer. Returning to “normal” — or something close to it — will allow physicians and healthcare staff to focus their attention on treating patients who require uninterrupted, prioritized treatment.


Has the pandemic delayed breast cancer diagnoses?

Unfortunately, it seems like the answer to this question is “yes”. All around the world, people with emergent health conditions have chosen to delay seeking medical attention out of fear of catching COVID-19 at the hospital or doctor’s office. Healthcare systems and workers have been overwhelmed during the pandemic, which can also make it more difficult to diagnose and treat new cases of breast cancer accordingly.

Research has found that the number of newly-diagnosed cancer cases dropped significantly in many countries during the first months of the pandemic. During this period, many healthcare facilities suspended cancer screening procedures, since they were considered to be elective procedures. 

However, many facilities have started to offer these services again — if you require a screening procedure, such as a mammogram, contact your doctor or local healthcare facility to find out if or when it can be scheduled. Measures such as social distancing, wearing a mask, and washing your hands can make this trip to the doctor safe for you.


Will I still receive my cancer treatment during the pandemic?

 Every case must be individualized and classified into a different priority group to determine whether their treatment must continue as planned or delayed. Approaches have been classified into high-priority, medium-priority, and low-priority groups by different healthcare organizations. Your treatment could also be delayed if you test positive for COVID-19 or come into contact with someone who has the disease.

As stated above, the risks of leaving breast cancer untreated are usually higher than the risk of developing severe COVID-19. However, your team will review each step in your treatment schedule to decide which measures they can take to reduce your risk of getting COVID-19. For example, urgent surgery and chemotherapy probably won’t be delayed; but imaging tests, screening procedures, reconstructive surgery, or follow-up studies could be rescheduled, depending on their level of priority.

 

What should I do if my cancer treatment is delayed?

Finding out that your cancer treatment has been delayed can be understandbly scary; however, it’s important to keep in mind that not all cancers are equally aggresive, and that your medical team will take these decisions with your best interest in mind. Ask your healthcare provider to explain the reasoning behind any treatment delays so that you can feel more confident in these decisions.

A study published in the Journal of the American College of Surgeons in August of 2020 showed that delaying surgery for patients with DCIS or early-stage estrogen-receptor-positive invasive disease found that delaying surgery while taking hormonal therapy didn’t affect sruvival rates for patients included in the study. While this study was conducted before the pandemic, its findings can be very reassuring for patients whose surgeries has been delayed.

 

Will I receive cancer treatments at home?

If possible, your team could also make arrangements for you to receive certain treatments at home so you don’t have to go to the hospital. Preference could also be given to oral treatments rather than intravenous ones, and dosages may be adjusted to reduce side effects while still maintaining their efficacy. One significant example is the FDA approval of Phesgo, a combination injection which contains a single dose of Perjeta and Herceptin. This injection can be given at home, reducing the amount of times a patient may need to visit an infusion center.

Minimizing hospital visits can reduce your risk of getting COVID-19 while also helping decongest the healthcare system in order to treat patients who require urgent care. These decisions are made case-by-case and will largely depend on the stage of your disease, your overall health, and the spread of COVID-19 in your area.


Tips to Cope with Breast Cancer During COVID-19

There are many things we can’t change about the situation that the entire world is going through — however, there are certain strategies which can help you or your loved one cope during these uncertain times. 

 

Healthy habits

  • Eat healthy foods and drink plenty of water.
  • Get enough sleep each night.
  • Try to stay active, if possible. You can search the internet for home workout ideas, and even use everyday items (such as food cans and stairs) as exercise equipment.
  • Get some sunlight everyday, even if it’s just from your window.
  • Invest time in a new hobby that you enjoy.
  • Try relaxation and mindfulness techniques, such as meditation.
  • Practice self-care and be gentle with yourself — this situation is completely new for all of us, and it’s normal to have bad days during this time.

 

Staying connected

  • Stay in touch with friends and family through group chats, phone calls, or video calls.
  • Join online support groups and communities to find others who share your experience.
  • If you live with other people, share fun and lighthearted activities with them.
  • Discuss your feelings with people you love and trust.

 

Health-related tips

  • Follow social distancing and hygiene measures to reduce your risk of catching COVID-19 according to your doctor’s instructions and your local guidelines.
  • Make a plan with your treating physician to know what to do if you develop symptoms of COVID-19.
  • Limit the amount of news related to COVID-19 that you consume each day if you find that they make you anxious or scared.
  • Get your flu shot — this vaccine can’t prevent COVID-19, but preventing the flu can reduce your risk of requiring hospitalization during the flu season, and it can also keep the healthcare system from becoming overloaded.
  • Consider seeking professional help from a therapist or counselor.

 

How has COVID-19 impacted you during Breast Cancer? Share your experience in the comments below.

Sources:

1. Fatima F. Cardoso, MD; Giuseppe Curigliano, MD, PhD. Treating Breast Cancer During COVID-19: 'Indispensable' Medscape,August 06, 2020.  https://www.medscape.com/viewarticle/934667#vp_1

2. Citgez, B., Yigit, B., Capkinoglu, E., & Yetkin, S. G. (2020). Management of Breast Cancer during the COVID-19 Pandemic. Sisli Etfal Hastanesi tip bulteni, 54(2), 132–135. https://doi.org/10.14744/SEMB.2020.23326 

3. Papautsky, E.L., Hamlish, T. Patient-reported treatment delays in breast cancer care during the COVID-19 pandemic. Breast Cancer Res Treat 184, 249–254 (2020). https://doi.org/10.1007/s10549-020-05828-7

4. Kaufman HW, Chen Z, Niles J, Fesko Y. Changes in the Number of US Patients With Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Netw Open. 2020;3(8):e2017267. https://doi.org/10.1001/jamanetworkopen.2020.17267 

5. Christina A Minami, MD, MS, Olga Kantor, MD, MS, Anna Weiss, MD, Faina Nakhlis, MD, FACS, Tari A King, MD, FACS, Elizabeth A Mittendorf, MD, PhD, FACS. Association Between Time to Operation and Pathologic Stage in Ductal Carcinoma in Situ and Early-Stage Hormone Receptor-Positive Breast Cancer. JACS VOLUME 231, ISSUE 4, P434-447.E2, (2020).https://doi.org/10.1016/j.jamcollsurg.2020.06.021

6. Jennifer Bringle. How to Stay Active During Quarantine. Breastcancer.org. October 23, 2020.

https://www.breastcancer.org/tips/covid-19/staying-active 

7. Coping with cancer and COVID-19. Canadian Cancer Society. https://www.cancer.ca/en/support-and-services/support-services/coping-with-cancer-during-the-covid19/?region=on

8. Mayo Clinic. Cancer treatment during a pandemic: How to stay safe. mayoclinic.org, July 21, 2020. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/covid-19-and-cancer-treatment/art-20489810

9. Mayo Clinic.Cancer treatment delays due to COVID-19: How to cope. mayoclinic.org,  July 19, 2020.https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/covid-19-cancer-treatment-delays/art-20489812

10. Food and Drug Administration. FDA News Release: FDA Approves Breast Cancer Treatment That Can Be Administered At Home By Health Care Professional. FDA, June 29, 2020. https://www.fda.gov/news-events/press-announcements/fda-approves-breast-cancer-treatment-can-be-administered-home-health-care-professional