Lung Cancer & Covid 19

Covid 19 has scourged through the world like wildfire. It has affected over 160 million people worldwide and has caused over 3.4 million deaths worldwide. The second wave of covid 19 has been particularly troubling for our nation. The loss of lives and the despair that it has caused needs no word to be described.

Amidst all this tragedy and the raging pandemic, another subset of patients have suffered tremendously. These include patients with various Cancers. These patients are more likely to contract Covid 19 and have a 25-30% higher risk of dying from its complications. However, not all cancers appear to have similar risks of morbidity and mortality, and patients with lung cancer and those with haematological malignancies appear to be at the highest risk of death from SARS-CoV-2 infection. Therefore management of lung cancer represents a unique challenge because of the increased risk of pulmonary complications and high mortality from COVID-19, due to pathophysiological, clinical and treatment-related risk factors.

Two critical aspects need to be considered when discussing the care of Lung cancer patients during the pandemic:
1. Protection from exposure to Covid 19
2. Treatment of Lung Cancer During the pandemic.

1. Protection from Covid 19

The way to protect oneself does not change for cancer patients; it remains the same. Mask, Social Distancing, Hand hygiene, avoiding crowded places and gatherings, and Vaccination are the ways to prevent SARS- CoV2 infection.

The use of double masking with a cloth mask with layers over an appropriate three-ply surgical mask is being recommended for patients given a large number of cases.

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Avoid going out unless absolutely necessary. Mixing with people in gatherings, even with family members, should be avoided. Always maintain a minimum 6 feet distance from others. Frequent hand washing for at least 20 seconds or using a hand sanitiser containing at least 60% alcohol after coughing, sneezing, or blowing your nose or after touching surfaces in a public place is vitally important to protect yourself.

Vaccination for Covid -19

All lung cancer patients need to be vaccinated against Covid 19, except for those with a known severe reaction to vaccine components. The ultimate decision may also be influenced by the patient’s health status and type and timing of their cancer treatment.
It is advisable to wait for 1-2 weeks after surgery for taking the vaccine shot. People who have had chemotherapy recently should wait till the absolute neutrophil counts recover. Patients on Targeted Therapy, Checkpoint inhibitors and other immune therapy and those receiving radiotherapy can take vaccine when available as per the guidelines issued by NCCN.

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So at present in India, Covishield and Covaxin are available, with Sputnik-V coming soon. Whichever vaccine is readily available should be taken.

2. Treatment of Lung Cancer During the pandemic.

The primary goals of the treatment of patients with lung cancer during the COVID-19 pandemic are to minimise the risk of patient exposure as well as the risks of complication should they contract COVID-19, while managing lung cancer, which has a high risk of mortality.

The treatment of lung cancer patients was often delayed, particularly early in the pandemic, due to shortages of personal protective equipment, limited COVID-19 testing supplies, and overwhelmed healthcare system. However, not initiating treatment may have devastating consequences. It is therefore advisable for lung cancer patients to not delay their consultation with expert doctors. The decision about the type and timing of the treatment needs to be individualised for each patient and, hence consulting experienced multi-disciplinary teams is of paramount importance.