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COVID 19 infection and lung cancer

Dr Sreenivas B J, Senior Consultant – Department of Medical Oncology, HCG Cancer Hospital Bangalore, gives insight on the treatment modalities to be followed for lung cancer patients amidst COVID-19 pandemic

We are all in the middle of the ongoing pandemic with COVID-19 infection and lung cancer patients are at the receiving end as the immunity is compromised. COVID-19 mainly causes infection in the lungs (viral pneumonia). Severity may be mild to severe, depending on the several factors such as the age of the patient, pre-existing diseases such as diabetes, heart disease, cancer or any other illness which may compromise the immunity of the patient.

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When we talk about cancer patients, they are more susceptible to COVID-19, it may be any active cancer in the body, anyone taking active chemotherapy or radiation for any cancer. There is so
much that is left unknown, particularly about the recovery, immunisation, transmission, and links with other existing conditions as data and research on this infection are still fairly new. There is a
lack of formal study between coronavirus and lung cancer, but studies or observations done till now can throw some light on this.

Is it true that Lung cancer patients are always at more risk of getting infection and complications? Lung cancer occurs more commonly in the elderly population. These group also have many pre-existing
diseases such as diabetes, or heart disease. Lung cancer damages the lung and decreased lung capacity. Moreover, when these patients take chemotherapy, it further compromises their immunity.

Because of all these factors, when these patients acquire COVID infection, lung complication is more rather than lung cancer itself. In other forms of cancers, when the lung is not involved, lung-related
complications may be less but chances of acquiring infection may be similar as these patients are also immunocompromised.

It is difficult to diagnose coronavirus in lung cancer patients. Many of the symptoms are same, such as cough and shortness of breath.
Fever may or may not be there. So, lung cancer patients and their caregivers should be aware of getting evaluated for any fever, persistent or new cough, or worsening breathing difficulty.

The treatment of COVID infection in lung cancer patients is not different. The treatment is similar to any other patients without having cancer. The only difference is that the treating doctor will be more watchful for lung-related complications.

Hospitalisation is needed even if it is a mild infection, rather than home isolation. Oncologists treat lung cancer differently to avoid COVID infection. The modification of treatment is recommended worldwide, not only for Lung cancer but for even other cancer. This will not guarantee of not getting the infection, but these are the efforts to make patient’s immunity less compromised.

These modifications include – avoiding or postponing the radiation treatment as it may further damage the lung, use of biological therapy or using immunotherapy. Reducing the dose of chemotherapy or giving a single drug rather than two or more drugs and increasing the frequency
between chemotherapy, cycles are done as per presently established global guidelines.

Any active treatment including chemotherapy is avoided when there is active COVID infection. The treatment for lung cancer should start when the patient has recovered completely without any complications, inflammatory markers having normalised, repeat throat swab test for COVID is negative and or the patient has developed IgG antibodies in the blood, which may take around three to four weeks.
Lung cancer patients should follow universal precautions such as social distancing, isolation, hand hygiene, wearing masks, avoiding the crowded place or hot zone of infection in their locality like any other general population. They can limit their hospital visits by teleconsultation or video
consultation for minor health problems and follow the treating doctors’ advice as and when required.

Smoking may reduce the effectiveness of lung cancer treatment and as well increase the risk of acquiring the COVID infection.

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