We received these questions from the lung cancer community about COVID-19; members of our Scientific Advisory Board have answered them.
Note: The responses have been edited to make them as broadly applicable as possible and are for informational use only―they are not meant to substitute for medical advice. If you have specific questions about your own situation, please consult your treating physician.
GENERAL INFORMATION | SURGERY | INFUSION TREATMENTS | RADIATION THERAPY | CLINICAL TRIALS
General Information on COVID-19
How is COVID-19 contracted?
COVID-19 is spread via wet droplets containing the virus that someone already infected with SARS-CoV-2 (coronavirus) coughs or sneezes out. The droplets can be taken in by an unaffected person through their mouth, nose, or eyes. The droplets can also be picked up by touching a surface where the droplets have landed. The virus can then enter the body through contact of the hand with the mouth, nose, or eyes.
Are there treatments for COVID-19?
Right now the main treatments for COVID-19 are what we refer to as supportive measures - helping your own body fight the infection. There are no proven antiviral treatments for this infection.
How long is it between when a person is exposed to the virus and when they start showing symptoms?
The median incubation period, or time between when someone is exposed and when they start showing symptoms, is about 5 days. The estimated range is 2 to 14 days.
Are people with lung cancer more likely to get COVID-19?
Our understanding is that lung cancer patients are NOT more susceptible to the virus, but if they get it, they are more likely to get complications from it because of their underlying disease. Because of their risk of experiencing complications, lung cancer patients should be extremely vigilant about preventing the disease.
How can we (lung cancer patients) protect ourselves?
Lung cancer patients can protect themselves by following guidelines published by the CDC on preventing transmission of the virus. This includes washing your hands often for at least 20 seconds or using a hand sanitizer that contains at least 60% alcohol after coughing, sneezing, or blowing your nose or after touching surfaces in a public place. To the extent that it is possible, social distancing (e.g., staying at home or avoiding public transportation and events) is recommended, particularly in communities where COVID-19 is spreading.
Should I use homemade masks to protect myself?
YES! Recent findings show that some people with COVID-19 have no symptoms, and even those who will eventually develop symptoms can transmit the virus to others before showing symptoms. This means that the virus can spread between people—for example, by speaking, coughing, or sneezing—even if those people are not aware they are infected. In light of this new evidence, the CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (eg, grocery stores and pharmacies). Even with masks, social distancing should be maintained whenever possible. These face masks are not surgical masks or N95 masks (those are to be used primarily by healthcare workers). Please watch this handy video to make your own homemade masks.
Do I continue to social distance?
YES, social distancing is currently the only known public health measure that can protect us from SARS-CoV-2 (the virus that causes COVID-19). Social distancing minimizes risk of exposure to the virus. Remember, social distancing is NOT the same as social isolation—do keep in touch with all your family, friends, and loved ones through phone and video conversations. Also, social distancing is different from self-quarantine. See the COVID-19 Glossary for an explanation of quarantine.
Do I leave my city to go to someplace safe—such as a rural area?
NO! You should not be leaving your urban apartment or home and moving to a rural area for the following reasons: -- You do not know if you or a loved one has been infected with SARS-CoV-2. An infected individual might not have any symptoms but still can continue to infect others. -- You may not have access to your regular doctors and healthcare in a rural setting. -- Small rural areas are not equipped to handle an influx of people. They may not have an adequate number of grocery and produce stores. More importantly, they may not have adequate medical care facilities should there be an emergency. It is our duty to keep rural communities insulated from this disease as much as possible.
If I am in active treatment, am I more susceptible to contracting the disease?
Concerns about becoming sick from infections are higher when a patient is on chemotherapy, particularly as it relates to your body’s ability to mount an immune response to fight certain infections and the reserves that your body has to fight an infection. This is not different for COVID-19 in general terms, but it’s important to note that we do not know how treatment might interact with COVID-19 specifically. In short, if your treatment is immunosuppressive, this is likely a risk factor.
How can patients maintain lung health while at home?
It can be helpful to start a regular routine of exercise at home. Include core exercises, upper extremity exercises, and breathing exercises, such as those you may have learned in your pulmonary rehabilitation program. Have a dedicated area in your home where you do this every day. Also, do not allow yourself to become sedentary; keep walking around, even if only indoors.
Should I still get a flu shot, or is it too late?
You should get a flu shot. People who have had COVID-19 can become sick from other infections, so receiving a flu shot would increase your protection against becoming sick from the flu. If you didn’t have one in fall 2019, you should get one now.
Should we try to get what meds we can and have some extra on hand?
You should, as recommended by the CDC, try to obtain a supply of important medications in case there are issues that prevent your from refilling prescriptions later on. You should talk to your doctor about what might be possible, as the amount of medication that can be dispensed within a specific time period varies, depending on both the type of medication and the insurance plan you have.
What are your thoughts on wearing disposable gloves while traveling?
This may provide false security to the person wearing the gloves. Wearing gloves is not generally recommended, and, absent the rigorous contact precaution measures exercised in a hospital setting, would be substantially less protective than one would think. It is much more important to stay vigilant about cleaning your hands often with either soap or hand sanitizer, avoiding contact with your face, and avoiding places where COVID-19 is known to be spreading.
Should we be concerned about drug shortages?
As of now, we have not heard about any manufacturing concerns regarding cancer drugs. Your doctor will be the first to share this information with you should shortages arise.
I am currently on a TKI for my lung cancer and am relatively young and healthy. I never had radiation therapy or surgery. Should I be worried?
We do not know what the interaction between TKIs and COVID-19 is specifically, but experience with other viral respiratory illnesses anecdotally suggests that you would not be at greater risk of becoming sick from COVID-19 as a result of receiving TKI therapy. Having said that, cancer patients should take extra precautions, as we aren’t sure how specific types of therapy may affect risk.
If I have had immunotherapy or am currently undergoing chemotherapy for lung cancer, should I be worried?
I have had lung surgery for my cancer. Will the virus affect me differently now?
The patients who have gotten sickest from COVID-19 are those who have had existing chronic issues, including respiratory issues. Relatively recent surgery from which you are still recovering may mean that you are at greater risk for becoming sicker as a result of COVID-19. Similarly, chronic respiratory issues from surgery may mean that you are at greater risk for becoming sicker as a result of COVID-19. Also, a history of surgery may mean you have less pulmonary reserve (the maximum amount of air your lungs can inhale) in case of an infection.
Should patients who are scheduled for lung surgery delay it?
There are many factors that go into making that decision. At this point, here are some general recommendations: (1) Patients with stage I tumors less than 1.5 cm should be able to defer surgery for several weeks. (2) For patients with stage II or III, each institution is creating its own guidelines, which may take into account the patient's individual characteristics and the hospital's resource utilization on a day-by-day basis. In some cases a stage III patient may be treated with non-operative therapy.
How do you define what surgeries are elective now?
Cancer surgeries never have been and are still not considered "elective." It's an important way to treat cancer, but that doesn't mean it has to be done immediately. It is important to know that our tumor boards (the groups of healthcare providers who meet regularly to discuss our current cases) are still functioning. They provide input in cases of medically necessary time-sensitive procedures.
Should patients who have already undergone surgery and are supposed to go on adjuvant chemotherapy wait before going to an infusion center?
Infusion centers are being asked to prioritize resources the same way surgeries are being prioritized, treating those patients with the greatest need first. Because different parts of the country are in different stages of the pandemic, there will be different recommendations about whether to start chemotherapy. Patients should have a discussion with their oncologists about the resources available, the protection that has been put in place, etc.
Should patients who have already undergone surgery and are supposed to get radiation therapy wait before having it?
Infusion Treatments (Chemotherapy and Immunotherapy)
I am in the middle of my infusion therapy. Should I stop or delay my treatments now?
Clinics are taking significant precautions to protect patients and staff, and while there is still a risk, it's probably best to stay on your treatment schedule as much as possible. A delay of a week or two is probably safe, but beyond that, you should speak with your medical team to help you make the decision.
A patient who travels to the city for her infusions wonders whether she can take her infusion at her local center. If so, should she be worried about changing her place of infusion?
Because this treatment is medical, it does not require the same level of technical expertise as surgery or radiation, so getting the infusion closer to home may make sense. The biggest obstacle is that many of these treatments are expensive and require insurance approval; the previous authorization was for the city hospital and doesn't automatically apply to the local hospital. Getting that transfer of authorization may be possible, but it requires coordination between the insurance company and the treating doctor. If the patient is not on a protocol and if they can accomplish that transfer of authorization, it’s reasonable to get these treatments at a local center.
Are patients on immunotherapy at higher risk of getting a more severe form of COVID-19?
That is a really good question, and the answer is not clear. It’s conceivable that the disease severity could be less if a person is on immunotherapy. There’s now an international consortium to collect data on lung cancer patients undergoing various therapies. However, a person with lung cancer has a higher risk of dying of lung cancer than of COVID-19, so we need to continue to do the best we can to treat the lung cancer.
I was supposed to start SRS for my brain metastases. Can it wait?
SRS (stereotactic radiosurgery) is focal or pinpoint radiation used to treat brain metastasis. It is typically delivered in just one treatment, except in some large tumors where it is given over the course of five treatments. If you do not treat brain tumors, they grow and cause your brain to swell. The swelling can cause seizures and other neurologic symptoms that can be devastating. Generally speaking, for brain metastases, if you had SRS scheduled, go ahead and get it.
I am in the middle of my radiation therapy. If I stop now, what will happen?
With radiation, it is very important that the treatments be given for the entire planned schedule because an incomplete course of treatment is not effective. The efficacy of treatment depends on adherence to the schedule, so it is critical that you do not stop. Your medical team is making the environment in which the radiation is delivered as safe as possible for you, and they do not want you to lose ground.
I finished radiation therapy last year. Are my lungs now healthy enough to withstand COVID-19?
Though we don’t know for sure the impact of radiation therapy on COVID-19 infections, any patient who has had radiation in their lungs before would be in a high-risk group. It is critical that you practice social distancing and follow the recommendations of your healthcare team.
I am a small cell lung cancer patient on a clinical trial of radiation and immunotherapy. Should I stop the trial? Will my cancer grow if I do?
For many patients, treatment on a clinical trial is the best option for their cancer, and it is recommended that you not stop the clinical trial. The National Cancer Institute is working hard to make protocols as easy as possible to carry out, for example, looking at the possibility of allowing remote follow-up. If you are in a clinical trial, get in touch with your healthcare team and ask them the questions that are concerning you, but know that throughout the country, clinical trials are continuing for lung cancer.
I am on a clinical trial and need to travel to another city. Will this be allowed?
It’s best to speak with your doctor and study team about your particular travel plans and what risks there might be, relating to both your health and the logistics.
What do you tell your patients who are on clinical trials right now or who are considering a clinical trial in the era of COVID-19?
That depends on where the trial is - whether it is in a COVID-19 hot spot - and it should also be recognized that policies, procedures, approaches, and recommendations can change literally daily based on what’s going on. Patients are being encouraged to continue (or start) participation in clinical trials that are of clear clinical benefit for patients or involve no additional risk to staff compared to the standard of care. There are also drugs that have excellent phase II data, better than anything available through standard of care, that are still only available in clinical trials, so patients are still encouraged to consider those.
I am in a phase III trial of a targeted therapy. Can I get my blood drawn or have scans done at my local cancer center so I don't have to travel?
Often you can have scans done locally as long as digital copies of the scans can be obtained. Blood work is a little more of a problem because generally for trials a particular lab has to be registered for participation in that study. Check with the study coordinators at the site where you are currently getting treatment to see what would be allowed with that study.
If a patient with stage IV lung cancer was considering a clinical trial before COVID-19 delayed the start of the trial, should the patient wait for the clinical trial or start some other treatment, like chemotherapy?
Time is not your friend in metastatic lung cancer, and waiting months for a trial to open is probably not a good idea. Although each case is different, on average waiting more than a month or two for the possibility of a trial to start is probably a bad idea, especially because now it could be months before things return to normal.
Our experts recommend using the following websites for updates and information:
- A list of state department of health websites can be found here:
- A list of local health department websites can be found here:
- The American Medical Association is also maintaining a resource website for healthcare providers: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians