To Chemo or Not To Chemo...

Here's a quick review of yesterday's post... 

Short, sweet and straight to the point...
In the midst of this current pandemic,

Get yourself Home and Stay There! 

And that's just a start for everyone... During this time of unprecedented uncertainty with the COVID-19 pandemic, many cancer patients are struggling with decisions on their care and treatment.

It's not enough to just stay home and shelter in place... our pancreatic cancer patients are fighting their terminal diagnosis 24/7.  The cancer treatment plan does not take days off while we shelter-in-place.

I can remember a well-meaning friend stopping by to visit mom during the early months of her treatment.  The friend asked mom how long she would be on the chemo.  Mom, emotions still raw from the recent terminal diagnosis, bluntly stated that she would be on chemo until she died...  the proverbial pin could be heard for miles.  

Grief tore our hearts open wide to realize the truth of her words.  Mom's chemotherapy treatment was all we had to hold the pancreatic cancer at bay.  And the chemo's track record didn't foster a lot of confidence.

So... with that really terrible seque... (I just don't know how else to get from there to here!)  What's a pancreatic cancer patient to do during this prolonged and uncertain time?  It's hard enough to deal with the harsh side effects of the treatment, but what about the hit to your immune system... is it safe to even go in to the clinics/hospitals for the chemo and radiation??  On the flip side, is it advisable to postphone the treatment, perhaps the only thing holding the cancer in check??

The questions and indecision can turn a world upside-down.

Whenever mom was struggling with a problem, she would start researching the issue for pros and cons, taking the emotions out of the decision. It turned the churning chaos down a notch and allowed reasonable debate over a subject.   We can do the same...

And first up is to call your cancer team/doctors and discuss your questions and concerns.  If you don't know where to start, or what questions to ask, read on...

The National Comprehensive Cancer Network addresses many of these concerns in a recent report on Managing Cancer Care During the COVID-19 Pandemic. This article is a good resource to begin the discussion for each cancer patient.

While the article is very detailed, the authors' share a very compassionate and honest review about the effects this novel coronavirus is having on cancer care today:

"The potential threat of COVID-19 to our immunocompromised patients as a result of their disease or the treatment we provide is thought to be significant, tipping the usual risk/benefit balance in extreme ways.  There are limited data on immunosuppressed hosts, but early published reports from China on the outcomes of patients with cancer infected with COVID-19 indicated a 3.5 times higher risk of needed mechanical ventilation or ICU admission or dying compared with patients without cancer."

This is difficult to read, let alone absorb... cancer patients are likely to be impacted by the virus much more significantly than patients without cancer.  Especially when the chemo/radiation treatments have hollowed out their immune system.

Cancer Health also shares this concern in a recent article on their website, appropriately titled Should I Continue My Cancer Treatment During the Coronavirus Pandemic?

"Oncologists ask themselves, 'Should we continue to give immune-system-suppressing cancer treatments to patients during the COVID-19 pandemic?' On the other hand, patients ask, 'What happens to me and my cancer if I stop treatment altogether?"

Exactly!!  There are no easy answers for the cancer patient!

Cancer Health continues,  "The problem is, chemotherapy drugs damage healthy white blood cells, which are the body's defense against viruses like the novel coronavirus.  But stopping treatment could also put people living with cancer at risk for even more problems, including tumor progression and shorter survival times."

The American Society of Clinical Oncology has issued a comprehensive guideline entitled COVID-19 Patient Care Information.  It covers many of the questions that cancer patients and their loved ones might have.  I would encourage you to read through their information and keep checking back as they are updating their COVID-19 reports as new data emerges in the ongoing pandemic we are facing.

The ASCO has made the following recommendation (as of March 26, 2020) for cancer patients:

"At this time, there is no direct evidence to support changing or withholding chemotherapy or immunotherapy in patients with cancer.  Therefore, routinely withholding critical anticancer or immunosuppressive therapy is not recommended."

However, while encouraging the cancer patients to continue their treatments during this uncertain time, the ASCO also recommends that health care providers make treatment decisions based on each individual as well as factors such as cancer stage, chemotherapy type and the risk of cancer recurrence (or spread) should treatment be delayed.

And that circles us back to our very first point... it's imperative for each one of us to talk with our cancer team, discuss our individual case with the doctor that knows us best...

I am beginning to believe that this Coronavirus pandemic is the health care challenge of our generation.  And for those of us in the cancer trenches, it is a challenge that our modern cancer treatments have never had to face.  We are all on untried, unproven ground.  What we do today may have ramifications on all future steps.

So, talking it a step at a time... Today's Goal:  Talk with your Cancer Team!

And then wash your hands ;-)

Love you!

Jane