What Every Cancer Survivor Needs to Know about COVID-19

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Talk to your doctor about your risk for COVID-19 after cancer treatment.

The ongoing COVID-19 pandemic may bring up fears and questions for people who have been through cancer treatment.

As Director of Memorial Sloan Kettering’s Adult Long-Term Follow-Up Program, Emily Tonorezos oversees the care of adults who had a pediatric cancer. We spoke with her about what cancer survivors should know about COVID-19 and how they can stay safe through these uncertain times.

What are you telling patients who come to you with concerns about their COVID-19 risk?

People are scared right now, and those who have had cancer might be more worried. That’s understandable. Cancer survivors should talk with their doctors about their personal risk and how their cancer and treatments may have affected that risk. We know that cancer and its treatment can weaken the immune system. After treatment ends, the immune system usually recovers, but the degree of recovery can vary from person to person.

Emily Tonorezos

Emily Tonorezos

One treatment that particularly affects the immune system is a bone marrow transplant, which is also known as a stem cell transplant or a hematopoietic cell transplant. Those wipe out the entire white blood cell system and then replace it. Some patients don’t fully regain a fully functional immune system after that, and illnesses you were immune to beforehand might not carry over to the new immune system. Those patients can be at risk for a range of infections.

But the biggest risk factor for getting COVID-19 is being exposed to COVID-19. If you are social distancing and washing your hands, that weighs more than any other factor in terms of getting the virus. There are so many things worrying people right now, and I try to stay positive.

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Do people with a history of cancer have a higher risk of complications from COVID-19?

We know that people with certain preexisting health conditions have more serious cases of COVID-19. There is very limited data on cancer survivors, and it’s not helpful that they tend to be lumped all together — people who have survived breast cancer, prostate cancer, adults who survived childhood leukemia, and so on. One thing we do know is that some cancer treatments, such as radiation to the chest or surgery on the lung, put you at risk for pneumonia, which is a complication of severe COVID-19.

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Does the time removed from treatment matter? For example, does someone who finished treatment one year ago have different risks than someone who finished five or ten years ago?

It does matter. White blood cell counts improve over time, which means the immune system is coming back. Side effects lessen over time, too. Say you got a type of chemotherapy that caused inflammation in your lungs. You can recover from that, and maybe two to three years from treatment it’s no longer problematic. Again, talk to your doctor about your individual risk for getting COVID-19 or getting a more serious case of it.

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The virus is causing a lot of anxiety in the cancer community. What good news can you share?

There is a lot of good news. While this virus is very easy to transmit, we can significantly reduce the risk of infection with simple actions, such as handwashing with soap and water. Handwashing works no matter the state of your immune system.

Managing Stress and Anxiety Caused by COVID-19
This information explains how you can manage stress and anxiety caused by COVID-19.
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Do you have any advice for cancer survivors, or parents of cancer survivors, who are feeling anxious these days?

Yes. It’s very normal to feel anxious, sad, or stressed right now. Those feelings might bring up memories of you or your child going through cancer. Everyone copes with difficult emotions differently, but the one common denominator is it’s important to take care of body and mind. Physically, that could mean trying to eat healthy, getting plenty of rest, doing some light exercise, and finding ways to relieve stress.
One way you can emotionally take care of yourself and your child is by limiting your news intake and only reading information from trusted sources such as the Centers for Disease Control and Prevention (www.cdc.gov) and the New York City Department of Health and Mental Hygiene (www1.nyc.gov). After cancer treatment, you and your family are already well prepared to follow health and safety precautions such as hand-washing. If you’re a parent, find information on how to talk to your child about COVID-19. You can also always speak with your MSK care team about individual risk after cancer treatment.
It’s important to validate feelings and acknowledge that while this is a difficult time, it will pass. Staying connected to family and friends, as well as keeping routines, can help instill a sense of grounding too.
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Aside from medical care, how else can survivors get help from MSK in navigating these challenging times?

First, it is important to recognize when you are having trouble coping. This is a concerning time for so many of us. But MSK is here to help all our patients and survivors. We have many resources that can help you cope. Look to us and we can help you.

— Meredith Begley

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