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Dayton Physicians Network

COVID-19 And Cancer: Implications For Patients

Dayton Physicians NetworkFacing a cancer diagnosis is an enormous challenge under the best of circumstances. When you add in a global pandemic, the physical and mental stressors compound.

Medical oncologist Mark Marinella, MD, FACP, from Dayton Physicians Network, provided insights to Premier Health Now about how people with cancer can best take care of themselves during the COVID-19 (coronavirus) outbreak.

Immune System Challenges

“For people with cancer, there are both disease-related and treatment-related risks of getting the virus or having more serious complications from the virus,” Dr. Marinella explains.

He treats all types of cancer and says people with blood cancers – leukemias, lymphomas, and multiple myeloma – are at the greatest risk concerning coronavirus because these cancers carry an immune system defect with them, and the drugs used to treat them can cause immune suppression. Even in remission, people with blood cancers may have a higher risk of contracting the virus or having serious complications.

People actively receiving cancer treatment also need to consider the effects of a weakened immune system, potentially worsening the effects of COVID-19.

For people who have recovered from solid tumors like breast or colon cancer years ago, Dr. Marinella says their immune systems should be intact, and they probably are not at greater risk of experiencing the virus and its complications.

Taking Extra Precautions

Both Dr. Marinella and the National Cancer Institute recommend steps people with cancer can take to avoid getting COVID-19 and possible serious complications of the virus. The guidelines are similar to suggestions for the general population, but even more critical to follow.

Avoid:

  • Crowds
  • Smoking
  • Excessive alcohol
  • Touching your mouth, nose, and especially eyes (a gateway for coronavirus infection)
  • Handshaking
  • Having visitors if you are in active treatment
  • Non-essential travel

Choose to:

  • Wash hands frequently
  • Wipe down hard surfaces often, especially door handles, faucet handles, and any stainless steel or plastic surfaces
  • Keep several weeks of medication and supplies on hand in case you need to stay home for prolonged periods of time
  • Eat a healthy, plant-based diet
  • Exercise
  • Consider wearing a mask if you have to go out in public places

He recommends that family members and friends stay away if they have a cough, respiratory symptoms, or unusual symptoms like loss of taste or smell.

How Medical Offices Are Adapting Care

To keep people with cancer at home as much as possible, Dr. Marinella says he and other physicians are changing cancer treatment regimens from IV to oral doses whenever appropriate.

“We are minimizing trips in and out of the house for people,” he explains. “When we can, we’re lengthening the amount of time between treatments, for example, treating every four weeks instead of every three weeks.”

Other measures include avoiding steroids, which can deplete the immune system, and using telehealth visits when possible.

For those who do come in for their cancer treatments, he says, “Don’t panic if you have to come in for treatment.”

Medical facilities are taking lots of precautions. Miami Valley Hospital South, where he sees patients, is screening people for fever at the hospital entrance. Nurses, doctors, and phlebotomists are wearing masks to minimize spread of infection. Reduced schedules have eliminated crowds.

Staying Mentally Strong

“Cancer is stressful enough on its own, plus now we have the pandemic,” Dr. Marinella says. “I would suggest that people avoid watching too much news on television and radio.”

He recommends staying connected with friends, family, a faith group, or other groups through Zoom or similar video platforms. Dr. Marinella encourages getting outside when it’s sunny and walking around your yard or neighborhood. Watch funny shows, read a book, or pursue a hobby.

Family members can help by supporting their loved one emotionally, bringing meals, and keeping a positive attitude.

“I’ve seen a lot of toughness in my patients,” Dr. Marinella comments. “I haven’t seen people shrinking back from their treatment. They’ve been pretty positive. I’ve been amazed.”

New Drug Shows Promising Results For Metastatic Breast Cancer

Dayton Physicians NetworkA new cancer drug called tucatinib (Tukysa) recently was approved by the Food and Drug Administration (FDA) to slow tumor progression and prolong life in women with metastatic HER2-positive breast cancer

Oncologist Shamim Jilani, MD, from Dayton Physicians Network describes to Premier Health Now the potential impact of this new drug, saying, “We previously had an unmet need for the group of patients with HER2-positive breast cancer who have brain metastatic disease (cancer that spreads to the brain). There is a substantial population who will benefit from this drug. If I have a patient who is appropriate, I won’t hesitate to use it.”

Dr. Jilani applauds cancer research efforts that continue even as the world battles the COVID-19 pandemic. “The lives of people with advanced cancer may well depend on receiving new treatments without delay,” she says.

The FDA approved tucatinib four months ahead of schedule, based on positive results from clinical trials.

The trial included patients who had already tried one or more other cancer treatments. They received either tucatinib (Tukysa) or a placebo, in combination with chemotherapies trastuzumab (Herceptin) and capecitabine (Xeloda).

“The drug produced a very impressive, amazing result,” Dr. Jilani says.

“Tucatinib, in combination with trastuzumab and capecitabine, versus placebo, reduced the risk of death by one third; reduced the risk of progression or death by half in all patients, including patients with brain metastases; and almost doubled the response rate.”

Dr. Jilani adds, “In patients with brain metastases, there was a 52 percent lower risk of disease progression or death. For this subset of patients, this is very impressive data.

“I am really excited when I look at this. The greatest news is we are prolonging people’s lives,” she says with enthusiasm. “Previously, we had nothing to offer as a standard of care for brain metastatic HER2-positive breast cancer.”

Tucatinib Has Potential To Be First-Line Treatment

Twenty percent of women with breast cancer have HER2-positive breast cancer, an aggressive disease fueling cancer growth through excess HER2 protein on tumor cells. If the cancer is not detected while still confined to the breast, up to 50 percent of these women develop cancer in their brains (metastases).

Since the late 1990s, drugs targeted to stop or slow the progression of HER2-positive breast cancer have continued to emerge. Tucatinib, which is taken by mouth, works in concert with two of these therapies by binding to the HER2 protein inside a cancer cell and prevents it from sending signals that promote cancer cell growth.

Dr. Jilani explains that the new drug regimen with tucatinib is designed to slow cancer progression and prolong a person’s life, but not to cure the cancer. A patient continues to take the treatment as long as it is providing beneficial results.

“Patients are living longer with metastatic breast cancer,” she says. “I am very hopeful this will be the new standard of care, the first-line treatment, in the near future for breast cancer patients with brain metastases.”

New Study Shows COVID-19 Plus Cancer Equals Higher Death Risk

Dayton Physicians NetworkFor people with cancer that is getting worse or spreading, getting COVID-19 makes the chance of dying within a month five times higher, according to data recently presented at a national cancer conference.

In addition, the study found that the virus nearly doubled the risk of dying (as compared to the general public), even if the person’s cancer was not spreading.

To shed light on these findings for cancer patients, Premier Health Now spoke with medical oncologist/hematologist Satheesh Kathula, MD, with Dayton Physicians Network® and certified physician with MD Anderson Cancer Network at Premier Health.

Dr. Kathula says the implications of the study on receiving cancer treatment depend on an individual’s circumstances. “We can’t put all cancer patients into one basket. Talk to your oncologist to make an informed decision. Weigh the benefits and the risks. If you have curable cancer — for example, early stage breast cancer, leukemia, lymphoma — don’t delay the treatment. Also, if you have good performance status [functioning well in everyday life] with a meaningful chance to recover or prolong life, don’t put off the treatment.”

Why Cancer Patients Are At Increased Risk With COVID-19

Dr. Kathula explains that several factors contribute to an increased risk of death for cancer patients. “Many cancer patients are elderly. Many have poor performance status, [bedridden or partially bedridden] with compromised immunity, especially if cancer is spreading. They often have poor nutrition and weight loss due to loss of appetite.”

“I expected this,” Dr. Kathula says of the study results.

The type of cancer a person has also influences the impact of COVID. “Patients with lung cancer tend to have increased mortality. Their lung capacity is compromised because of the disease itself. They tend to be smokers and have COPD [chronic obstructive pulmonary disease]. Patients with blood-related cancers have more risk from COVID, as well.”

He continues, “The type of treatment also matters. Patients on heavy-duty chemotherapy have increased risk because immunity goes down.”

Other types of cancer treatment, such as immunotherapy or targeted therapy with tyrosine kinase inhibitors, did not present a greater risk of death from COVID-19 among people with cancer.

Dr. Kathula also commented on the study’s report that cancer patients who received corticosteroids to reduce inflammation were 1.5 times more likely to die. He explains, “Patients on chronic immunosuppression [from cancer-fighting medications] have a higher chance of infection. If the use of corticosteroids is just short term, however, it can help inflammation.”

He notes that the corticosteroid dexamethasone is actually helping some patients on ventilators who are critically ill with COVID-19.

Preventing COVID-19 In Cancer Patients

One of the best ways to lessen COVID’s impact on cancer patients is to prevent them from getting the virus, Dr. Kathula says.

“We have to educate our patients. Most stay at home and are careful. They wash hands and wear masks. They are disciplined and follow instructions.”

He encourages friends and family members to be extra careful and limit visits, especially if they have been in public gatherings. “We have a responsibility to save vulnerable people. Avoid close contact and take precautions,” he says.

Evaluate When To Get Cancer Screenings

Those who don’t have cancer may be questioning when to resume their cancer screenings.

Dr. Kathula notes, “Everything is open again for cancer screenings – colonoscopy, mammogram, Pap smear.”

Whether to schedule your screening now or wait a few months depends on your individual circumstances and the recommendation of your physician(s), based on factors such as age and other health conditions.

“You have to weigh the benefits and risks,” Dr. Kathula says. “If you’re at high risk for breast cancer, colon cancer, or another type of cancer, but you are otherwise fairly young and healthy, you should get screenings on your regular schedule.”

Get the Facts On Prostate Cancer: Screening, Diagnosis, Treatment

Dayton Physicians NetworkWhat do you know about cancer? For starters, it’s the most common cancer among men, except for skin cancer. An estimated 191,930 American men will be newly diagnosed with prostate cancer this year.

On the positive side, “the outlook for men who have prostate cancer is fantastic,” says David Key, urologist with Dayton Physicians Network and Premier Health. “We have so many things we can offer patients, especially men with advanced cancer.”

Prostate cancer rarely occurs before age 40. The majority of prostate cancers grow slowly, reducing the number of deaths from the disease. Dr. Key explains that often, “you are more likely to die with the disease than die of the disease.”

How To Know If You Have Prostate Cancer

The prostate is a gland in men, about the size of a walnut, located below the bladder and in front of the rectum. As part of the male reproductive system, it makes fluid that mixes with sperm to become semen.

“The majority of men who have prostate cancer have no symptoms or complaints,” Dr. Key says.

Your risk of getting this cancer is higher if you have a father or brother who has prostate cancer. If you are an African-American man, you also have a higher risk of developing prostate cancer. It also may be a more aggressive form and occur at a younger age.

If symptoms are absent, screening becomes important to identify the disease. Dr. Key notes two screening tools that are the “gold standard” for prostate cancer detection: prostate-specific antigen test (PSA) and a digital rectal exam.

The PSA test measures the level in your bloodstream of the PSA protein made by the prostate gland. A high level could be a sign of prostate cancer. It also can be a sign that you have an enlarged prostate, infection, or inflammation of the prostate. So, further testing may be needed.

Dr. Key recommends that men follow the American Urologic Association guidelines for PSA screening,by age:

  • Under 40. No screening needed
  • 40 to 54. Get a PSA if you are at risk due to being African-American, having a family history of prostate cancer, or a family history of BRCA1 or BRCA2 gene defects, which are linked to increased occurrence of breast, ovarian, and prostate cancer
  • 55-69. Get a baseline PSA level, after which you and your doctor will discuss whether you should have a follow-up test in a year or two, based on your overall risk and preferences
  • 70+. No routine screening is recommended. However, some men age 70+ who are in excellent health may benefit from prostate cancer screening. “We don’t want to over-diagnose insignificant cancer or put people through diagnostic procedures (like biopsies) that have risks in themselves and don’t lead to better overall medical care,” Dr. Key says.

See Your Doctor For These Symptoms

Sometimes, prostate cancer does cause symptoms. If you experience any of the following issues, see your primary care physician or urologist to evaluate whether it is a sign of cancer or another condition:

  • Problems with starting to urinate
  • Urine flow that is weak or that stops and starts
  • Frequent urination, especially at night
  • Problems with emptying your bladder completely
  • Pain or burning sensation when you urinate
  • Blood in your urine or semen
  • Pain in your back, hips, or pelvis that doesn’t go away
  • Painful ejaculation

Diagnosis For Prostate Cancer

If you have an elevated PSA level or abnormal digital rectal exam, your doctor is likely to recommend a biopsy – removal of a small tissue sample from the prostate for study. Most commonly, the physician uses a transrectal ultrasound to guide the biopsy removal. 

If greater precision is needed to locate a tumor or area of concern, the urologist may use magnetic resonance imaging (MRI). A combination of MRI and transrectal prostate ultrasound can be used to biopsy the abnormal area on the MRI.

Genomic testing also can be performed on a tissue biopsy. This test can help predict how cancer cells will grow and behave. Identifying genomic markers is important in early stage prostate cancers to decide whether to take action to treat the cancer or carefully monitor the cancer to see if it grows. Monitoring is called active surveillance.

Treatment For Prostate Cancer

There are several options for managing or treating prostate cancer:

Active surveillance. If your cancer is confined to your prostate and slow-growing, your doctor may recommend carefully monitoring it and not actively treating it. Dr. Key says genetic markers help determine if you are a candidate for active surveillance. You will need regular checkups to make sure nothing changes.

“Up to 40 percent of men with prostate cancer can be managed this way initially without any treatment,” Dr. Key says. “If something changes, we can move into potentially curative options.”

Potentially curative options. If found early, before it has spread, prostate cancer is often curable. You will likely have one of these treatment options:

  • Surgery. A robotic-assisted prostatectomy removes the prostate entirely. This requires a brief hospital stay.
  • Radiation therapy. Radiation beams of intense energy are aimed precisely at the tumor from outside the body. The beams travel to the tumor site with minimal or no harm to the skin and surrounding tissue. Often, a hydrogel substance can be injected between your prostate and rectum to spare your rectal area from the radiation beams.

Medical treatment for advanced cancer. A number of options are now available to treat prostate cancer that has spread:

  • Androgen deprivation to stop the production of the male hormone testosterone
  • Oral oncolytics, which is chemotherapy in pill form
  • PARP inhibitors, a targeted cancer therapy that is taken by mouth
  • Provenge immunotherapy, which is a cancer infusion treatment that activates your immune system to fight the cancer cells
  • IV chemotherapy
  • Access to national research study protocols, such as those offered through Premier Health’s affiliation with the MD Anderson Cancer Network®

“We can use these medications to delay the onset of metastases [cancer spread] and provide a longer quality of life,” Dr. Key says.

The Dude’ Has Lymphoma. What That Means

Dayton Physicians NetworkWhen Oscar-winner Jeff Bridges announced this week that he has lymphoma, his multitude of fans were understandably shocked. “Cancer” doesn’t jibe with the actor they affectionately call “The Dude.”

But Bridges’ tweet confirmed the news and treatment has begun for the blood cancer, which attacks the lymphatic system, your body’s army of germ fighters.

Premier Health Now spoke with hematologist/oncologist Satheesh Kathula, MD, to learn more about lymphoma and what the diagnosis may mean for Bridges.

Dr. Kathula explains that lymphoma is not just one disease. It’s a group of diseases that starts in the cells of your lymphatic system. The main types of lymphoma are Hodgkin and Non-Hodgkin, Dr. Kathula explains. Both may produce swollen lymph nodes in your neck, arm pits, and groin. Non-Hodgkin is also sometimes found in the brain, the skin, and other areas throughout the body.

“All lymphomas are not created equal,” says Dr. Kathula. “Your treatment and recovery depend largely on the type that you have, and how advanced it is. Because Jeff Bridges didn’t reveal that information, we can’t predict how he’ll fare.” 

In addition to swollen lymph nodes, symptoms of most lymphomas include fever, night sweats, fatigue, loss of appetite, and unexplained weight loss. “But you may not have any symptoms at all,” says Dr. Kathula. “We might find it during a routine physical or notice it on a CT scan.”

Your likelihood of getting lymphoma increases as you age. Bridges is 70. “You’re more prone to get any cancer as you age, because your cells start to degenerate,” Dr. Kathula adds. Smoking and exposure to chemicals and radiation also increase your chances.