Fearing the deadly combination of COVID-19 and cancer

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Three Tuesdays a month, Katherine O’Brien dons her face mask and travels about half an hour on the Metra train to Northwestern University’s Lurie Cancer Center.

What were once packed train cars driving into Chicago are now eerily empty as those who habitually commute to towering skyscrapers weather the pandemic from home. But for O’Brien, the excursion is mandatory. She is one of millions of Americans battling cancer and depends on chemotherapy to treat the breast cancer that has spread to her bones and liver.

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“At first I was nervous because I had to go to the center for my treatment,” said O’Brien, who lives in suburban La Grange and is concerned about contracting the coronavirus. “Family and friends have offered to drive me, but I want to minimize everyone’s exposure.”

Although her treatment has not changed since the new coronavirus spread across the United States, the 54-year-old is at high risk for serious complications if she becomes infected. Those risks have not decreased significantly for her, despite the Illinois governor’s easing of COVID-related restrictions.

She’s not alone in fear of the deadly combination of COVID-19 and cancer. a study, which reviewed data from more than 1,000 adult cancer patients who tested positive for COVID-19, found that 13% had died. That’s compared to the overall U.S. death rate of 5.9%, according to: Johns Hopkins.

In addition to caring for cancer patients – with their already depleted immune systems – who contract the virus, many doctors worry about people delaying their scans and checkups and missing time-sensitive diagnoses. A KFF poll discovered that nearly half of Americans had skipped or delayed medical care because of the outbreak. Cancer patients seeking care face a range of hurdles as states reopen, including severely limited hospital appointments and new clinical trials that have been put on hold. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)

“Cancer doesn’t care that a coronavirus pandemic is happening,” said Dr. Robert Figlin, chairman of hematology-oncology at Cedars-Sinai in Los Angeles. “We don’t want people with abnormalities to delay their evaluation.”

While nursing her own breast cancer, Megan-Claire Chase takes her mother to regular blood cancer treatments at Northside Hospital Forsyth in Cumming, Georgia. As a caretaker, Chase receives a green wristband and is allowed inside.

In late March, Megan-Claire Chase, 43, of Dunwoody, Georgia, was fired from her job as a project manager for an employment agency, losing the associated health benefits. Her main concern was paying for a diagnostic mammogram and MRI, which were two days off the calendar before her benefit was due to end. Chase is currently in remission from stage 2A breast cancer, scheduling scans well in advance for every six months at Breast Care Specialists in Atlanta.

β€œWhen I got there, it was really disturbing. You almost feel like a leper,” Chase said, noting the socially distancing waiting room and heavily disinfected clipboards. Chase has been hyper-cautious since her days of chemotherapy, carrying her own pens in her purse, along with gloves and extra masks.

Cancer centers across the country are taking extra precautions. At Northwestern, patients are taken through a single entrance, where masks are required, and met by a security guard and a temperature checker before signing in with receptionists behind plastic shields, O’Brien said. No visitors or accompanying family members are allowed in the building, and the cafeteria and waiting rooms are devoid of unnecessary germs – not a magazine or coffee maker in sight. The cubicle where she receives Abraxane infusions could accommodate four patients; now there are only two in space.

dr. Mark Lewis, director of gastrointestinal oncology for Intermountain Healthcare, explains pancreatic cancer to a telehealth patient.

Where they can, many doctors are turning to telemedicine to limit the travel of cancer patients to the hospital. In Salt Lake City, Dr. Mark Lewis, director of gastrointestinal oncology for Intermountain Healthcare, a 23 hospital system serving Utah and the surrounding states, that about half of his patient visits are now virtual. He also makes some patients’ treatments less intense and less frequent. As in Northwestern, patients should only come to the hospital for appointments unless assistance is physically necessary. It’s a major shift for Lewis, who has had up to 30 family members in his office for appointments alongside his patients for mental support.

“We’re writing the lines as we go, trying to keep patients’ immune systems up and keep the cancer at bay,” Lewis said. Still, he is concerned about a later spike in cancer deaths due to the coronavirus pandemic. Aside from the coronavirus, the National Cancer Institute estimates more than 600,000 Americans will die of cancer this year.

New clinical trials have also largely stalled in this new era, when traveling long distances for treatment is less of an option. Linnea Olson, who lives in Amesbury, Massachusetts and has stage 4 lung cancer, is concerned that there are far fewer treatment options for her, as trials have been her “lifeline.”

Linnea Olson stands in front of a photo of herself on the “Wall of Hope” at Massachusetts General Hospital in Boston.

About four months ago, Olson, 60, enrolled in her fourth phase 1 clinical trial at Massachusetts General Hospital’s Termeer Center for Targeted Therapies. The treatment was associated with intense side effects, such as a sore mouth and throat from mucositis, also a sign of COVID-19. Before a recent infusion, plastic-shielded nurses put Olson on a back entrance for a COVID test. It was negative.

The intensity of her treatment, coupled with the extreme social distancing measures, has left Olson, who lives alone, feeling depressed and unsure whether she should continue the process.

“It’s too much at once β€” the isolation and the difficult side effects,” Olson said.

Rudy Fischmann takes a daily stroll through his neighborhood of Knoxville, Tennessee, past a colorful house decorated in chalk.(Thanks to Rudy Fischmann)

The walks are key to working on his balance issues due to brain cancer. (Thanks to Rudy Fischmann)

Rudy Fischmann, a brain cancer patient and former true crime TV producer, is battling balance problems that started after his first series of surgeries two years ago. Daily walks and physical therapy are part of his treatment regimen. But walks through his neighborhood in Knoxville, Tennessee, are already getting more stressful as the state begins to open up.

“It’s getting harder, with more and more people outside every day,” says Fischmann, 48. “I don’t like walking around in circles around my kitchen, so I find myself having to change my routes almost daily.”

As the father of two young children who are now home around the clock, Fischmann finds that all of the family’s time drains his limited energy. He is also afraid of the germs they will bring from school in the fall.

“The thought of, if I did contract the virus, would I get a different standard of care?” he said. “I’m used to staying at home and not doing much, but now it’s nerve-wracking.”

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