Categories: Coronavirus

Update on Bladder Cancer during COVID-19

Does a bladder cancer diagnosis increase the risk of COVID-19 virus infection?

A diagnosis of bladder cancer does not increase your risk of acquiring the COVID-19 virus. However, there are several concerns that patients and their families should be aware of bladder cancer treatments and the risk of acquiring or developing COVID-19. Because bladder cancer is a solid tumour, it does not directly impact your body’s immune cells as a function of the disease. Bladder cancer patients frequently need to visit the doctor. It is advisable to call your doctor’s office or speak to him or her before going to the hospital or clinic. Talk about your specific need for some of the typical bladder cancer appointments in the current pandemic situation. These visits to medical offices can put you and your families at risk of being infected. It also can expose healthcare professionals to unnecessary risk of acquiring the virus.

Does intravesical treatment with BCG for bladder cancer increase the risk of catching the COVID-19 virus?

There is no such report that patients getting intravesical BCG are getting COVID-19 more than patients who do not. Clinical trials are underway to assess the impact of BCG vaccination on the risk of infection with the COVID-19 virus. It is important to note that coming to a hospital to get this therapy could potentially put patients at risk for catching the COVID-19 infection. If a patient has had four doses of induction, experts feel, it is possible to wait a few weeks before receiving the remaining doses of BCG. The risk of contracting the virus when coming to a healthcare facility for this treatment is higher than any risk of delaying doses five and six for several weeks. If a patient is getting induced and is still on dose number three, experts suggest that they try to get to dose four before they take a break from the remaining treatments. If they’re on maintenance therapy, then getting one and two and skipping dose three completely is acceptable. It is likely that delaying BCG is much less risky than the risk of contracting COVID-19. Speak to the expert to guide in decision making.

Do chemotherapy or immunotherapy for bladder cancer increase the risk of catching the COVID-19 virus?

Chemotherapy may increase your risk. There are two ways to administer chemotherapy for bladder cancer. One is putting the chemotherapy inside the bladder, which is intravesical, and the other is intravenous (IV), which is getting systemic chemotherapy. Systemic chemotherapy has the potential to cause greater immunosuppression. Two different types of chemotherapy that are used, dose-dense MVAC and GemCis. MVAC causes more neutropenia than GemCis. Neutropenia is a condition associated with a low white blood cell count resulting in reduced immunity to fight any infection. But either of those could impair a patient’s system depending on what their baseline health status is (i.e., age and other factors). So, having systemic chemotherapy puts patients at increased risk. Early data from other cancer centres show that patients who had any type of cancer and received chemotherapy who also got the COVID-19 infection had worse outcomes than those who did not have chemotherapy. Immunotherapy helps the immune system to fight cancer. However, one out of six patients who are on immunotherapy may have a treatment-related complication where there is an autoimmune side effect. An autoimmune disease is an illness that causes the immune system to produce antibodies that attack normal body tissues. Those patients may have to have high doses of steroids or immunosuppressive therapy. In that situation, patients can clearly be at risk of catching a COVID-19 infection.

Are my risks increased if I had my bladder removed (Cystectomy)?

Early mortality rates in patients from age sixty, to seventy, to eighty that have been reported from China and Italy, show deaths from COVID-19 increase significantly as we age due. Most bladder cancer patients will fall into these older age groups. Patients this age are already at high risk. Their resilience to an infection like COVID-19 is going to be particularly compromised by recovering from this big surgery. If a patient is doing well, there’s no reason for them to come into the clinic during the peak of this pandemic. Telemedicine can help doctors monitor the incision and stoma through the video visit. Experts agree that everyone needs to be very, very careful about choosing to have radical cystectomies now and for the next few weeks. Many medical teams are not doing any cystectomies for at least another two, three, four weeks. Delaying a month in these difficult times of the pandemic, even delaying six weeks, is not likely to be detrimental to bladder cancer treatment. If you are waiting for a cystectomy, speak with your medical team about your options, including neoadjuvant chemotherapy or other options.

Are patients who have had a cystectomy at higher risk for catching COVID-19?

After surgery, when a patient’s blood counts have recovered and their wounds have healed, and they are on regular follow-up every three months, they are at normal risk for exposure and catching infections from COVID-19.

Is there less risk of contracting COVID-19 for patients coming to a smaller community practice for bladder cancer treatments?

Remember, social distancing helps to reduce your risk. Stay away from people who may not know they are even infected. Early research from China and other countries has suggested that people with a history of cancer may indeed be more vulnerable to infection and severe events related to COVID-19. Some doctors are also proposing “medical distancing” — reducing the number of cancer patients who visit health care facilities wherever possible to decrease the risk of coronavirus exposure and transmission in this population. If you are getting intravesical or other treatments and they can be delayed, especially as we try as a nation to flatten the exposure and incidence of new cases projection curve, you need to stay home, and not put yourself and the medical personnel who take care of you at risk. That’s the bigger overarching issue.

Can patients successfully continue to get their treatments during COVID-19, or can they safely delay some regularly scheduled treatments?

In metastatic disease patients, the goal of chemotherapy or immunotherapy is more palliative or managing symptoms such as pain. Doctors may prioritize patients on therapy with curative intent while reducing visits for patients with metastatic disease. If the intent of their treatment is curative or immediate control of disease, then our choice would be different. As in the case of neoadjuvant chemotherapy, (chemotherapy before the planned removal of the bladder), the goal is a cure. Even though chemotherapy leads to immunosuppression, we would still recommend that a patient come to the clinic and get chemotherapy, despite COVID-19 being an easily transmitted disease. Patients and caregivers need to take good universal precautions. This includes continuing isolation and social distancing and making sure they are washing hands and washing their faces. We can potentially get them through this because the intent is a cure.

How can I get a second opinion about my bladder cancer treatment options if I can’t go to another medical practice during this outbreak?

We encourage patients to think about seeking a second opinion for any cancer treatment. It might be possible to get a second opinion from the comfort and virus-free safety of their own home. You should check with the cancer center you are trying to seek an opinion from if they provide telehealth services to new patients.

Can telehealth help bladder cancer patients?

Telehealth is the use of electronic information and telecommunications to support and promote long-distance clinical health care. For a health care encounter, a telemedicine visit requires live audio and video conferencing. Telemedicine allows bladder cancer patients to have conversations with their medical team and avoids exposing both patients and members of the health care team to COVID-19 positive patients. Screening patients by phone before they come to a clinic may help to eliminate potentially redundant routine follow-up visits and lower the risk of infection.

Dr. Abhay Kumar, Consultant – Oncology, Uro – Oncology, Narayana Superspeciality Hospital, Howrah

Narayana Health

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