COVID-19 and Cancer Treatment: Where Do We Currently Stand?

Mark A. Lewis, MD


May 24, 2021

This transcript has been edited for clarity.

Hello, Medscape. This is Dr Mark Lewis. I'm recording this at the very end of April 2021. We can quibble a little bit about when the COVID-19 pandemic truly began — at least here in the United States — but by almost any measure, we are now more than a year into the contagion.

I have noticed many of my patients asking me the same question: "Have we reached a new normal?" Now, I have to be honest with you. That phrasing doesn't quite sit right with me, partly because over a half million people have died from this disease. For them and for their families, there is no normalcy here.

However, for those of us who are still alive and relatively well and trying to restore some semblance of how our lives looked before SARS-CoV-2, I understand where this question is coming from. I think it's particularly germane to patients who continue to calculate the risk-benefit ratio of ongoing treatment for malignancy.

We continue to learn. As recently as last month, there was a new publication from the COVID-19 and Cancer Consortium that continues to give us valuable insights into the landscape of these two competing risks.

One of the things that this consortium would caution us about is that there remain inequities in how the pandemic affects different groups, both in terms of traditional definitions around cancer and also in terms of ethnicity. Non-Hispanic Black race and Hispanic ethnicity continue to be associated with higher severity of COVID-19. I think it's important that we think about that from a public health perspective.

There are also certain metrics and certain labs that most oncologists obtain during routine practice that also give us hints as to which patients are most vulnerable. Those include indices around high or low lymphocyte count and high neutrophil count. Those will be reported in almost every complete blood count with a differential and give us real-time data by which we can advise our patients on risk.

What was also fascinating about the most recent analysis is that it tells us there are certain anti-cancer therapies that probably do not render our patients more vulnerable. Those include immunotherapy, which is fascinating; endocrine therapy; and most targeted therapies. Traditional cytotoxic agents — chemotherapy — remain something that has to be prescribed quite judiciously.

Many of my patients at this time have undergone vaccination, and as best I can tell have derived immunity from that. I do caution them that, at some point, immunity is going to wear off. Although for most of them, I think they're still safely in a time period of being 6 or less months out from their initial set of injections. I also remind them that not everybody in the community has yet been vaccinated. People who are eligible by age or other criteria may not have accepted the shots.

Taking a slightly brighter view, this is a case of a rising tide lifting all boats. We do know now from multiple studies that the more people who are immunized, the fewer people are capable of transmitting a high viral load. In that manner, every person who gets the shot is, in some small way, contributing to better public health.

When I see my patients in clinic, they are breathing a little bit easier. They have not yet completely, of course, been able to relinquish all the anxieties associated with getting treated at this time. I think I'll end by quoting Churchill, who said, "This is not the end. This is not even the beginning of the end, but it is likely the end of the beginning."

When the history of COVID-19 is written, we'll understand exactly where we sit right now in relation to the start and the finish of the pandemic. For the moment, I think we are in an interesting, intermediate, liminal space where it is not entirely vanquished, so we can't entirely go back to that normal.

Thankfully, we're also seeing — at least in the United States — some better disease control. Be we are still also thinking about the fact that this is a global threat and sending our thoughts to our colleagues and friends in India, who I think right now are dealing with the greatest brunt of this crisis.

On that rather sobering note, I'll sign off and wish you all the best of health. Thank you.

Mark A. Lewis, MD, is director of gastrointestinal oncology at Intermountain Healthcare in Salt Lake City, Utah. He has an interest in neuroendocrine tumors, hereditary cancer syndromes, and patient-physician communication.

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