Guide in dealing with the Covid-19 pandemic, especially for cancer patients

Cur­rent infor­ma­ti­on for pati­ents and relatives

Cate­go­ry: Pre­ven­ti­on
Aut­hor: Women’s Cli­nic Cha­ri­té Berlin

Facts about Covid-19 infection

A new virus is going around the world

The novel coro­na virus was most likely trans­mit­ted from ani­mals to humans. And as has often hap­pen­ed in natu­re, this virus can lead to serious ill­nes­ses in humans. One speaks of a zoo­no­sis. This term is deri­ved from the Greek words zoon (living being) and nosos (dise­a­se). Zoo­no­ses are infec­tious dise­a­ses that are cau­sed by bac­te­ria, para­si­tes, fun­gi, pri­ons (dege­ne­ra­te pro­te­ins) or viru­ses and can be mutual­ly trans­mit­ted bet­ween ani­mals and humans.

The­re are various other coro­na virus spe­ci­es: the­se inclu­de MERS (Midd­le East Respi­ra­to­ry Syn­dro­me) and SARS (Seve­re Acu­te Respi­ra­to­ry Syn­dro­me). The lat­ter trig­ge­red an epi­de­mic in 2002/2003 with around 800 deaths. In the­se epi­de­mics and pan­de­mics (2002/2003), too, bats most likely trans­mit­ted the patho­gen to humans via an inter­me­dia­te host — the path that rese­ar­chers now suspect with SARS-CoV‑2.

Viru­ses — what are they?

Viru­ses are not living bein­gs! They have no nucleus and no meta­bo­lism of their own. This is how they dif­fer fun­da­ment­al­ly from bac­te­ria. While bac­te­ria have a nucleus and can repro­du­ce inde­pendent­ly, viru­ses always need a host. In other words, a living cell into which you can implant your gene­tic mate­ri­al (RNA or DNA). Only then can they spread with the help of their host — plant, ani­mal, human. Some­thing else is important to know: Viru­ses are very small. Smal­ler than bac­te­ria or cells. The­re­fo­re, they can only be reco­gni­zed with the help of cer­tain sci­en­ti­fic methods.

But as small as they are, they can be dan­ge­rous. Becau­se in humans they are loo­king for cer­tain cells in which they can spread. The­re they insert their gene­tic mate­ri­al and can repro­du­ce in this way. For the rea­sons descri­bed, anti­bio­tics are not effec­ti­ve against viru­ses, as against bac­te­ria. Spe­cial vac­ci­nes must be deve­lo­ped against viru­ses which, with the help of the virus’ own gene­tic infor­ma­ti­on, enab­le our body — our immu­ne sys­tem — to reco­gni­ze viru­ses and eli­mi­na­te them from the body. This is a long and com­pli­ca­ted pro­cess. That is why it takes so long in the Coro­na peri­od befo­re a vac­ci­ne can be found, deve­lo­ped, tes­ted and brought onto the market.

The influ­en­za vac­ci­nes, which are new­ly deve­lo­ped every year, are the main models for suc­cess­ful vac­ci­nes against viru­ses. The­se vac­ci­na­ti­ons have been estab­lis­hed for deca­des and pro­tect mil­li­ons of peop­le from infec­tion with the dan­ge­rous flu virus every year. Various rese­arch groups are working on the deve­lo­p­ment of a vaccine.

Vaccinate — but when

Vac­ci­na­ti­on even during can­cer the­ra­py that has alrea­dy star­ted After the dia­gno­sis of can­cer, it is gene­ral­ly recom­men­ded to check the vac­ci­na­ti­on sta­tus of the pati­ent at an ear­ly sta­ge and, ide­al­ly, to refresh the respec­ti­ve vac­ci­na­ti­ons befo­re star­ting therapy.

  • So-cal­led live vac­ci­nes such as meas­les, mumps, rubel­la, yel­low fever or vari­cel­la should not be admi­nis­te­red during ongo­ing can­cer the­ra­py (che­mo­the­ra­py), as the immu­ne sys­tem can be weakened.
  • So-cal­led dead vac­ci­nes are gene­ral­ly also allo­wed during ongo­ing can­cer the­ra­py (che­mo­the­ra­py). Examp­les of dead vac­ci­nes are vac­ci­nes against teta­nus, diph­the­ria, who­oping cough (per­tus­sis), polio, menin­go­coc­ci, pneu­mo­coc­ci, TBE, influenza.
  • Annu­al influ­en­za vac­ci­na­ti­on is indi­ca­ted for all can­cer patients.

Does the vac­ci­na­ti­on even work if I am under­go­ing can­cer the­ra­py? As stu­dies show, the immu­ne respon­se to a vac­ci­na­ti­on at the begin­ning of a che­mo­the­ra­py cycle is some­what limi­ted, but usual­ly still good enough. In addi­ti­on, the suc­cess of the vac­ci­na­ti­on with some vac­ci­na­ti­ons can be che­cked by che­cking the titer in the blood.

What is a live vac­ci­ne and what is a dead vaccine?

  • The live vac­ci­ne con­tains “living”, but in the labo­ra­to­ry modi­fied and stron­gly wea­ke­ned (atte­nua­ted) patho­gens, which, becau­se they are ali­ve, can repro­du­ce in the body of the vac­ci­na­ted. (Examp­les: meas­les-mumps-rubel­la vac­ci­na­ti­on, the rota­vi­rus vac­ci­ne and the chi­cken­pox (vari­cel­la) vaccination.
  • In con­trast, dead vac­ci­nes con­tain “kil­led” patho­gens or frag­ments of patho­gens or cer­tain sur­face pro­te­ins or inac­ti­va­ted bac­te­ri­al poi­sons (toxins). Dead vac­ci­nes can­not mul­ti­ply (examp­les: vac­ci­nes against teta­nus, diph­the­ria, who­oping cough, polio, menin­go­coc­ci, pneu­mo­coc­ci, hepa­ti­tis B, hepa­ti­tis A).

Special and general risk factors for corona infections

Can­cer pati­ents can be par­ti­al­ly at risk

The fol­lowing infor­ma­ti­on is publis­hed in cur­rent infor­ma­ti­on from the DKG and the DGHO, espe­cial­ly for can­cer pati­ents (source: DGHO, July 6th, 2020):

Specific risk factors for patients with blood and cancer diseases

In gene­ral, can­cer pati­ents have a hig­her risk of deve­lo­ping pneu­mo­nia from an infec­tion with respi­ra­to­ry viru­ses than non-can­cer pati­ents. This pro­bab­ly also app­lies to infec­tions cau­sed by SARS-CoV‑2.

Poten­ti­al risk fac­tors that play a role in other SARS infec­tions include

  • seve­re immunosuppression
  • Neu­tro­pe­nic phase
  • Lym­pho­cy­to­pe­nia <0.2 x 109 / L.

Pati­ents with her­edita­ry immun­ode­fi­ci­en­ci­es or under cur­rent can­cer the­ra­pies are also to be clas­si­fied as per­sons at risk. Par­ti­cu­lar atten­ti­on should be paid to the­se risk fac­tors, espe­cial­ly given the fact that many pati­ents with seve­re COVID-19 dise­a­se were older and lym­pho­cy­to­pe­nia was fre­quent­ly observed.

General risk factors, including for patients with blood and cancer diseases

Many can­cer pati­ents also have one or more of the gene­ral risk fac­tors for a seve­re cour­se of COVID-19. The­se include:

  • Age ≥65 years
  • Living in a nur­sing home
Specific diseases, especially with pronounced symptoms:
  • Chro­nic lung dise­a­se, or mode­ra­te or seve­re bron­chi­al asthma
  • Seve­re heart disease
  • Immu­no­sup­pres­si­on
  • Obe­si­ty / over­weight (BMI ≥40)
  • Dia­be­tes mellitus
  • Chro­nic renal insuf­fi­ci­en­cy on dia­ly­sis / renal impairment
  • Liver dise­a­se
  • Cur­rent can­cer therapies
Summary assessment:

If pati­ents belong to one of the­se risk groups, the trea­ting doc­tors will pay par­ti­cu­lar atten­ti­on to the usu­al hygie­ne mea­su­res. If necessa­ry, tho­se affec­ted must then be trea­ted in sepa­ra­te rooms with incre­a­sed pro­tec­ti­ve mea­su­res. Can­cer the­ra­py can gene­ral­ly only be inter­rup­ted in the case of seve­re infections.

General principles and hygiene rules for cancer patients

Protect yourself safely — keep your distance

As descri­bed abo­ve, the coro­na viru­ses are main­ly trans­mit­ted by dro­p­let infec­tion. Tiny com­pon­ents of the dro­p­lets, so-cal­led aero­sols, can also infect other peop­le through the air. On the other hand, it is still unclear whe­ther viru­ses can also be trans­mit­ted via sme­ar infec­tions such as door hand­les, shop­ping carts or other sur­faces that have been touched by infec­ted peop­le. It is the­re­fo­re extre­me­ly important to obser­ve the hygie­ne rules drawn up by the government, sci­en­tists and doc­tors. This also and espe­cial­ly app­lies to can­cer pati­ents and their rela­ti­ves and friends.

Here are the most important rules that cancer patients must adhere to under all circumstances:
  • Avoid clo­se con­ta­ct with mul­ti­ple peop­le, espe­cial­ly peop­le who do not come direct­ly from your home environment.
  • If you have to lea­ve the apart­ment, plea­se keep a distance of at least 1.5 meters from other people.
  • Avoid lar­ge crowds.
  • Pay atten­ti­on to the hygie­ne con­cepts of the orga­ni­zers and ask for detail­ed infor­ma­ti­on on this.
  • Wear a face mask consistently.
Maintain good body and hand hygiene:
  • No shaking hands!
  • No hugs!
  • Tho­rough­ly dis­in­fect all objects that you have to touch
  • Regu­lar hand wash with soap for at least 30 seconds. Take advan­ta­ge of hand dis­in­fec­tion opti­ons when you are in medi­cal faci­li­ties. Find out more about the hygie­ne con­cepts on site.

Further precautionary measures

Vac­ci­na­ti­ons

  • This much has been cer­tain for a long time: vac­ci­na­ti­on is the only effec­ti­ve way of pre­ven­ting many virus infec­tions. Of cour­se, this only app­lies if spe­cial vac­ci­nes exist, e.g. against the sea­so­nal flu viru­ses. Sin­ce they are always chan­ging, you have to vac­ci­na­te again every year!
  • Rese­arch groups around the world are rese­ar­ching the deve­lo­p­ment of effec­ti­ve and safe vac­ci­na­ti­on pro­tec­tion for the coro­na virus (SARS-CoV‑2).
  • Then you can also have fur­ther vac­ci­na­ti­ons. And this is espe­cial­ly true for all peop­le who have eit­her chro­nic ill­nes­ses or acu­te ill­nes­ses of the immu­ne system.
  • The Sti­Ko, a sta­te insti­tu­ti­on, wri­tes on its web­site what is cur­r­ent­ly recommended.

Recom­men­da­ti­ons of the Stan­ding Vac­ci­na­ti­on Commission

The recom­men­da­ti­ons of the STIKO are usual­ly publis­hed once a year in the epi­de­mio­lo­gi­cal bul­le­tin of the RKI (Robert Koch Insti­tu­te) and on the RKI web­site. Detail­ed rea­sons for the recom­men­da­ti­ons have been publis­hed sin­ce 2004. Fur­ther state­ments by STIKO on indi­vi­du­al vac­ci­na­ti­ons can be found under the hea­ding “Messages”. On the vac­ci­na­ti­on pages of the RKI the­re are also a num­ber of FAQs on gene­ral topics about vac­ci­na­ti­on and indi­vi­du­al vac­ci­na­ti­ons. The FAQs sum­ma­ri­ze fre­quent­ly asked ques­ti­ons from citi­zens and doc­tors that have been ans­we­red by the Robert Koch Insti­tu­te. The publi­ca­ti­on of the ans­wers is inten­ded to pro­vi­de broad infor­ma­ti­on on the various aspects of vac­ci­na­ti­on for citi­zens and the pro­fes­sio­nal com­mu­ni­ty. The­se are not the recom­men­da­ti­ons publis­hed by STIKO.

(Source: RKI)

And, when things get going again soon: Traveling as a cancer patient — the rules

What do I have to con­si­der if I want to travel?

If the tre­at­ment of the can­cer was a long time ago, the­re is usual­ly no rele­vant incre­a­sed risk of infec­tion com­pa­red to non-can­cer pati­ents or healt­hy peop­le. Nevertheless, the vac­ci­na­ti­ons and hygie­ne mea­su­res offi­cial­ly recom­men­ded for the respec­ti­ve coun­try of tra­vel should be taken. In gene­ral, it is advi­s­able to also refresh the polio, rabies, hepa­ti­tis B and A vac­ci­na­ti­ons. Howe­ver, pati­ents under­go­ing che­mo­the­ra­py can have an incre­a­sed risk of infec­tion. In addi­ti­on, cer­tain vac­ci­na­ti­ons (live vac­ci­nes such as yel­low fever) that may be recom­men­ded can­not be car­ri­ed out. The­re­fo­re, plea­se dis­cuss this with your doc­tor at an ear­ly sta­ge. In addi­ti­on, the­re are usual­ly other important aspects, such as blood tests, that must be taken into account during or after chemotherapy.

The urgent advice:

The­re­fo­re, plea­se dis­cuss all ques­ti­ons about tra­vel with your doctors

How do I know my sym­ptoms are from can­cer and which are from COVID-19 or ano­t­her viral disease?

This can be dif­fi­cult in indi­vi­du­al cases, so we ask you to report all sym­ptoms to your doc­tors, even if you may not asso­cia­te them direct­ly with can­cer, can­cer the­ra­py or a viral dise­a­se pleu­ral effu­si­ons) or can­cer the­ra­pies occur (e.g. poly­neu­ro­pa­thy, tas­te dis­or­ders with pacli­ta­xel). In addi­ti­on, various other viral (flu viru­ses) and bac­te­ri­al dise­a­ses (e.g. pneu­mo­coc­ci) can cau­se various forms of pneu­mo­nia. The­re­fo­re, plea­se go to your doc­tors immedia­te­ly so that they can initia­te the appro­pria­te tre­at­ments with the help of dif­fe­ren­ti­al diagnoses.

Streng­t­he­ning strength — pro­mo­ting well-being!

The­se are the most important rules for all can­cer pati­ents. The tre­at­ments demand a lot of strength from ever­yo­ne. With good pre­pa­ra­ti­on, varie­ty in life and care­ful tre­at­ment of yourself, ever­yo­ne can do a lot to ensu­re that the tre­at­ments work well and lead to the goal. Tra­vel can also sup­port this. You don’t have to go on a trip around the world right away. The­re are many obvious desti­na­ti­ons in our coun­try whe­re you can relax very well.

Your doctor will be more than happy to give you good travel advice.

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