What Patients with Lung Cancer Need to Know About COVID-19

Imagine being a patient with cancer and receiving a notice of what treatment might be best for the course of your disease without even seeing your oncologist in person. While that may seem like a dream, the emergence of the new coronavirus has made it a reality.

“In the last two weeks I have not seen any of my patients,” Dr. Chad Pecot, an associate professor at UNC Lineberger Comprehensive Cancer Center, said during a recent webinar hosted by the Lung Cancer Research Foundation. “I’ve had to call them and talk to them on the phone.”

Pecot said he and his colleagues have had to make several decisions based on laboratory values and scans from patients with lung cancer at their center.

“I’ve treated several people with chemotherapy in the last few weeks,” he said. “Something that we would never do as an oncologist [is] to give chemo without seeing a patient. But that's becoming the new norm now is to actually give treatment without examining patients and seeing them in person.”

Pecot recently participated in the question and answer format webinar and addressed topics including if patients who recently received chemotherapy for their lung cancer are more susceptible to the virus, as well as how patients should approach going about getting their scans during these times of uncertainty.

Disinfecting Equipment

Pecot stressed that the spread of the virus can be attributed to direct person-to-person contact, touching surfaces that the virus is on, as well as through droplets transported from personal contact. As a result, Pecot advised patients with lung cancer to ask questions before going in for a scan.

“I would recommend if you are in the process of getting scans and you’re due for scans, [try] to find out [if] the machines [are] being sprayed down with 70% or higher alcohol,” he said. “The other thing is … I’m not seeing any of my patients in person. We’re having them come in, get their blood drawn, get their labs, they get their scans, and then we've actually had them, if they're due for chemo that day, we actually have them stay in an area that they feel comfortable having a private conversation, and we call them and we discuss the results of the labs and the scans, see how they're doing, and make our best guess of … is it safe to do the treatment.”

Patients who were due for either scans or chemotherapy have canceled, Pecot said. “They were too concerned about the virus and chose to stay home, and I understand that,” he said. “It’s a concerning time.”

Chemotherapy’s Effect on Immune System

The easy answer to a question asking if receiving chemotherapy makes patients more susceptible to the virus, according to Pecot, is yes.

“You often are probably being told about your neutrophils,” he said. “Neutrophils are certain types of immune cells that the chemo can lower. And that usually is more important for fighting off bacteria because the concern right now is a virus. Usually, as long as you have your other immune cells, like your T cells, your body is still able to fight that fairly well.”

The ability to fight infections while on chemotherapy can be impaired. But, according to Pecot, he would be more concerned with patients receiving chemotherapy if what was spreading right now were a bacterial infection.

“That’s not to say that there’s no concern while getting chemo that you can get this virus or that it would be worse,” he said. “But I think that you still have an intact immune system that can fight this virus, even if you're getting chemo but certainly the oncologist needs to be following those blood tests if you're actively getting treatment.”

“Best Case” Scenario

Pecot addressed a few instances for patients with lung cancer that, in the current social distancing state, he considers best case scenarios.

“Perhaps several of you all are on pills like targeted therapeutics,” he said. “If you have a lung cancer that, for example, is EGFR mutated, ALK or ROS … that’s probably the best case scenario right now because some of those patients I see every fourth months, and if [they’re] doing well then that makes the treatment and the choices very easy.”

Pecot referenced a conversation he recently had with a patient with EGFR-mutated lung cancer and who is receiving Tagrisso (osimertinib).

The patient came in for routine bloodwork and their scans, after which Pecot called the patient to tell them that everything looked good and that he would see them in four months.

“If you’re on a target therapeutic and you’re tolerating it well, [and] your scans are looking good, then, it's reasonable to consider you're actually not seeing your doctor until three or four months from now,” he said. “But that needs to be a decision that you guys make together.”

As far as patients who recently had surgery, Pecot said they are not at higher risk for getting the virus unless they are routinely coming in and out of the hospital. Some instances that would make patients with lung cancer more susceptible to COVID-19, according to Pecot, would be if they had complications as a result of the surgery or if there’s a discussion about chemotherapy after surgery.

“A decision about getting chemotherapy after surgery needs to be made very carefully right now with the current circumstance.”

Underlying Lung Disease

Pecot said as far as he knows, lung cancer by itself does not increase a patient’s risk for developing COVID-19. But anything wrong with the lungs, such as asthma or any underlying lung disease and a history of smoking could be problematic.

“These kinds of things can obviously affect the lungs before getting the virus,” he said. “If there's any underlying lung disease, then that would be another thing to be concerned about, with getting the virus just to be completely frank.”

He did stress that just because someone has lung cancer, it doesn’t mean that they have unhealthy lungs.

“Many of my patients that are on Tagrisso, or any of these other pills, their lungs otherwise look totally healthy,” he said. “Just because you have lung cancer in the lungs does not mean the lungs themselves are unhealthy. And again, this is speculation, but I don't think that would pose more risk because there's tumors in the lung. It's more to do with is there already any kind of preexisting damage in the lung or inflammation in the lung?”