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COVID-19 Cancer Care 101: Top 10 patient and provider Q&A

Lily Tang Contributor

Dr. Tang is currently a medical physicist and faculty at Yale New Haven Hospital/Smilow Cancer Hospital. She was trained at the Harvard Medical School/Massachusetts General Hospital and at the University of California/San Diego. She held faculty appointments at the University of North Carolina/Chapel Hill, and at the Memorial Sloan Kettering Cancer Center. She has rich experience about cancer second opinion.She has extensive domain expertise in cancer care with 13 years of clinical experience.
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Are all cancer patients at risk? Or just those currently getting treatment?
answer
Patients with blood malignancies such as non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute myeloid leukemia, acute lymphoblastic leukemia and multiple myeloma are most at risk.

Those in active treatment for any type of cancer and those who’ve undergone bone marrow transplants are also at risk.
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Can patients and survivors get tested to see if they’re immunosuppressed?
answer
T here’s no easy blood test to check someone’s level of immune suppression, but being in active chemotherapy, having low white-cell or low lymphocyte counts and/or taking immune-suppressive agents (such as prednisone) are all associated with immune suppression and increased risk of infection.
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Should I cancel my treatment or follow-up appointments?
answer
C ancer patients with scheduled appointments should keep them, unless they’re experiencing coronavirus symptoms. If your hospital or clinic postpone your treatment, you can visit Liyfe Clinic to ask questions or telemedicine with your Oncologist.

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Can I see my Oncologist at home as part of normal treatment?
answer
Y es, you get some treatments through telemedicine. In fact, administration expands telemedicine for Medicare and encourages health plans to boost offerings during coronavirus pandemic. People will need to navigate this brave new health care system, especially for cancer patients, time is precious.

Your oncologists can use Skype, Zoom, Liyfe or any synchronized streaming services to deliver telemedicine, those tools are free.
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Should people still get screened for cancer during this pandemic?
answer
H ealth officials are urging everyone to stay home as much as possible to further reduce the risk of being exposed to COVID-19.

If you’re due for your screening to detect breast, colon, cervix, or lung cancer, but the health care facility postpones your appointment for the near future. You should seek alternative ways. Especially if you have symptoms that could be from cancer, you should contact your healthcare provider or visit Liyfe Clinic ASAP.

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What should I do if I have symptoms?
answer
F or symptoms details, you can check out two websites: CDC
Heat map
Call your providers to see whether and how you can get tested in your area.

Go to authority online screening platform such as:
Purchase home test kits:
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What if a family member develops symptoms?
answer
I f someone in your household gets sick, have them sleep in a different room if you can. Wear gloves, masks, and separate meal kits. Make sure you wipe down areas with some sort of bleach wipes and keep washing your hands regularly. It’s also crucial not to bring a sick family member into your cancer treatment center.
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If I were due routine follow-up visits and not feeling ill? When a physical exam is important and telehealth is not a good option, should I be proactive and reschedule or should I keep my appointment as scheduled?
answer
F rom currently available data, almost all cancer patients are at higher risk of COVID-19 related mortality, and older people (men more than women) appear to be at higher risk of COVID-19 related mortality than younger people. Thus, efforts to reduce the risk of exposure of COVID-19 to all patients are needed, for example with reduction in the frequency of follow-up visits and replacing in-person visits with telephone or remote telemedicine (Skype, Zoom, Liyfe are some free ones) follow-up.

All asymptomatic routine follow-up patients may be rescheduled for three months or longer. The majority of patients who have recently completed chemo therapy or radiotherapy can safely have their follow-up extended by two to three months or more, with telemedicine as needed.

There are published data on nurse-led telephone follow-up and virtual PSA monitoring suggesting that prostate cancer patients can be monitored remotely unless symptomatic or with concerns for clinical progression.

A small study randomizing lung cancer patients to symptom-based follow-up versus routine imaging found a survival benefit favoring symptom-based strategy. Whether telephone follow-ups can substitute in the short term for in-person visits is unknown.
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What to do if test positive with COVID-19?
answer
T he answer to this is complex and evolving. It will require physician discretion personalized to each patient. Ask oncologist to reassess the patient’s goals of care. Depends on the situation, cancelling or delaying cancer treatment might be necessary until the patient has recovered.

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