COVID is scary. COVID with cancer is terrifying. What if I'm in remission, mid treatment? As doctors on the frontline at MSK, we've learned a lot in recent months. Let's talk about the facts. What we know is working, and not.
hello. I'm Dr. Diane Reidy Lagunes from Memorial Sloan Kettering cancer center, and welcome to Cancer Straight Talk. We're bringing together national experts and patients fighting these diseases to have straightforward evidence-based conversations. Our mission is to educate and empower you and your family members to make the right decisions and live happier, healthier lives. For more information about the topics discussed here, or to send your questions, please visit us at mskcc.org/podcast.
Today I'm honored to have my esteemed colleague and friend Dr. Monika Shah, who is an infectious disease specialist at MSK. Monika and I have spent time together on the COVID battlefield since early 2020. We've seen wave after wave of virus impacting our patients, and we have some intel to share with you. Monika, welcome to the show,
Diane, thank you so much for having me. It’s really my pleasure to be joining you today.
Monika, as you know, most of our patients have been touched by cancer. And what are the big issues that are really important to discuss when COVID affects patients with cancer?
I think some of the biggest issues our, our cancer patients face is what's going to happen to my treatment journey? Is my treatment going to be delayed, interrupted and what impact is that going to actually have on my illness?
If I get sick with COVID, um, cancer patients being in a high risk group, there's genuine concern and fear, getting COVID while on active cancer treatment. And that certainly was a fear for us and our patients early on. Luckily, we've, we've learned quite a bit since then.
DR //349 I do want to briefly just talk about the vaccine, um, and is it safe for cancer patients? Let's just address that because that is something that my patients are asking a lot about.
MS MS: (03:54)
Based on what we know they all appear to be, largely safe. The most serious side effects appear to be, something sort of worse than a flu shot in terms of having a fever, feeling unwell for a day or two and having some soreness and maybe some serious soreness in arm, but nothing really beyond that. That has been based on all the studies and thousands and thousands of clinical trial volunteers.
There's no reason to suspect that the vaccine would, would be less safe in cancer patients.
Let's get to the patients on active treatment. Cause I think we would think that this is the most vulnerable patient population that may be at risk for severe COVID symptoms if they were to get it. Do we have any data or any science that suggests that's the case that these patients are in fact more at risk for more severe symptoms?
Yes, we do. We know from data, from our own experience with our own patients, that cancer patients are certainly at risk for more serious illness, including hospitalization and death.And so that obviously makes us very concerned and we, um, really work very hard to assure that we, um, are keeping our patients safe while they are on treatment. And of course, um, having, um, our treatment protocols in place to best support our patients, if they were to get sick with COVID and require hospitalization.
Is there a higher category? Cause I think amongst our cancer patient populations, I think there's no question that they're all potentially at higher risk to be more vulnerable. But when we looked at our patient populations, for example, the solid tumor patients, breast cancer, colon cancer that were receiving chemotherapy during COVID and went on to get COVID, it didn't look like, they necessarily had more severe symptoms if you will. But the blood cancers, I think, did. Can we talk a little bit about that?
Diane, thanks. Thanks for clarifying that. Um, yes, absolutely. So when we looked at our dataset, the, the patient groups that seemed to really, have the more severe disease and prolonged illness were our patients with blood cancers
We've learned a lot, and that's really helped inform a lot of our protocols. So, we know that we can deliver, um, treatment fairly safely to a large majority of our patients and that for certain more at-risk patients, we have to just do some extra cross checks and assurances to make sure that they're not infected prior to getting really intensive therapy.
So to recap, as you said, you know, our patient population is more vulnerable. Having said that those patients that need surgery, which is often curative, are safe. Thankfully our patients that are undergoing surgery actually did quite well with our current protocols
, but in general, those patients that have the blood cancers were more at risk.
You bring up such an important point because early on in the pandemic, that, that fear right. Can prevent people from coming in, right. To go to the doctor to get their screenings, or like come back for their treatment, come back for their surgery. And, you know, just to sort of reassure, um, our patients and our community that we, we know a lot now. The risk of not getting a treatment is, is, is actually sometimes a lot more consequential than, getting the treatment in the setting of COVID.
I think that's such an important point. Absolutely. Can we switch gears and talk a little bit about the treatment options for COVID like, will we be able to treat this like the flu and get a Tamiflu and have over the counter drugs?
Let me first off by start by saying, you know, I think for the flu and for COVID actually the, the vast majority of people aren't going to need anything specific, right? It is mostly reducing your fever, controlling your cough with suppressants, doing things to make you feel better to manage through the illness.
Are we ever going to have a drug like Tamiflu for influenza?
I don't think so. In some ways Tamiflu is an important drug in influenza, but it's not, it's not a cure all either. It shortens the duration of illness by an average of one day. But, um, I don't know that we're going to ever be at a point with this, um, illness, with the coronavirus of having, having just, uh, an effective one-stop shop, sort of oral medication.
Early on in the COVID, there was this sort of thought that thou shall not use ibuprofen. I mean, anything that panned out on, on that side.
Yeah. That, that, that was debunked. Use ibuprofen, if the ibuprofen makes your fever go down.
So my next question could be a whole entire podcast, the role of testing. Where should we be now on testing for the, for example, the asymptomatic patient, and is there a difference with this antigen testing versus PCR testing versus now we assume we'll have a home test. Um, so can we talk just a little bit about the nuts and bolts there?
Testing broadly, I think about it in 2 simple buckets, right? There's an individual, testing consideration, especially when somebody has symptoms, right. And the reason to get tested when somebody has symptoms is that if you can identify your illness earlier, you are potentially engaging in care earlier. Especially if you have serious symptoms, there are pathways for that. Um, and also if you know that you're positive with symptoms, then contact tracing can begin. Your contacts can be isolated or quarantined, and that will help prevent the chain of transmission to others. So, then that segues into the second reason that testing occurs, the public health surveillance piece of this, whether it's at, in the hospital or in other settings, community settings, school settings, et cetera, that is another major reason to get tested and to get tested routinely.
So that we are aware of, who is infected, as we all know, there's a large percentage of people who may have the virus who can transmit the virus to others but who are asymptomatic or very mildly symptomatic, right. May have had a sore throat for a day or a little bit of a sniffle. And so, um, testing routinely in that setting is important to again, identify people, um, break cycles of transmission by isolating, um, contact tracing and isolating contacts. When we think about diagnostic tests for COVID, we are talking about PCRs and antigens, and when you compare the two, a PCR test is a much more sensitive test.
It's what we call a molecular test that detects the genetic code of the virus and an antigen test detects a protein part of the virus. Those antigen tests are actually helpful in certain situations, but they are a little bit more variable in terms of their sensitivity. So, we don't necessarily rely on them to make a diagnosis of COVID. We don't have antigen tests here.
So, I want to talk a little bit, um, one of the most common questions I've been getting is about schools and in particular, the cancer patient who has children that want to be in school and that need to be in school. So how, how safe are we to allow the kids to go to school if they have a cancer patient at home, or an elderly patient at home. Can we talk a little bit about the school situation?
Yeah. It's such a timely question for all of us in this country, and it's been a little mind-boggling and maddening, um, because every school district and every school district within States or across state lines have had an across countries have had sort of a different approach to this, but in some ways that's given us a lot of information as well. So, what I can say right is that we don't think that schools and school aged children, so, I'm talking about K through 12, appear to be large vectors, um, of the illness. And those school re-openings have not prompted large scale or even small scale, um, clustered outbreaks of COVID in the community. That those haven't been the situations that have been the problem. So the kids themselves, aren't getting sick and don't necessarily seem to be the spreaders of illness.
So we've learned a little bit that you can, open schools and open schools safely. And that, of course you have to balance that with one's individual consideration, everybody's home situation is a bit different. So if you have a highly vulnerable, um, person at home, you know, depending on sort of the school protocols in terms of testing and or social distancing, you got to factor all of that in, I think in terms of making an individual decision, but from sort of a public health systems level, look at it. Um, we have some reason, I think, to be very cautiously optimistic that we can open or at least maintain school opening safely for these kids where the, I think the consequences of not going to school we're learning are, are actually, you know, very great for, for our kids.
So we thought we'd end with a couple of debunking the myths, true or false, very quick answers here.
Mouthwash prevents COVID, true or false?
False.(laugh over) No, there was this funny study that was out, um, about it, um, that sort of got a lot of press, you know, as these things go, but, no.
Masks are a relatively easy thing for most people to do to protect themselves and others. And, and we have pretty good conclusive evidence of that. There's a lot of misinformation and skepticism around masks in our society. Um, frankly it puzzles me, um, why there is, um, but we know this, um, to be, um, pretty in controvertible at this point,
Washing surfaces and cleaning your groceries will prevent COVID infection?
That doesn't actually seem to be a huge factor with COVID, which is good to know.That being said, it's good practice to make sure that common surfaces are disinfected and cleaned routinely. I would advise on doing that. I think the grocery thing, probably not as important. And if people feel comfortable doing it. There's no danger in doing it, but I don't think that's so important.
Hospitals and healthcare environments are safe during COVID?
True with a capital T yes. We have learned so much, um, these many, many months to assure the safety of our patients, our staff, our visitors, and we do a lot. Some of it can be, um, exasperating. I know. So, yes –hospitals, clinics all are safe. And in fact, I would say, because we have protocols in place that have been standardized, we're safer than a lot of other venus and places right now.
Last question. When do you think we'll get back to normal?
Um, it's a tough, it’s a tough question with no clear answer, but the simple answer is I think it's going to take a while. We have a long, I think, dark winter ahead of us. As we have cold weather that forces us inside more. And although we have really promising, um, vaccine candidates, it's going to take a while to implement it. And so, I think, uh, we're, we're living with masks. We're living with social distancing, certainly, I think through the summer, fall of 2021. And I guess the other thing I would say is, um, you know, your original question was, you know, when are we going to get back to normal? I think we've learned that there's probably gonna be a new normal. We've learned some things about how we function as a society, how we operate our businesses, um, you know, certain things that are beneficial, um, that we may continue to embrace and implement, um, and others where we can't wait to get back to what we were doing pre pandemic. So you know, life may look a little bit different moving forward for all of us.
Speaker 3: (41:07)
Absolutely. Monika, thank you so much for joining us today,
Diane, it was really my pleasure to be with you and a privilege to be speaking with you today. Thank you so much for having me.
Thank you for listening to cancer straight talk from Memorial Sloan Kettering cancer center. Stay safe, everyone, no matter where you are and let's protect each other
For more information, or to send us any questions you may have, please visit mskcc.org/podcast. Help other people find this helpful resource by rating and reviewing this podcast at Apple podcasts or wherever you listen to your podcasts. These episodes are for you but are not intended to be a medical substitute. Remember to consult your doctor with any questions you have regarding medical conditions. I'm Dr. Diane Reidy Lagunes onward and upward.