COVID-19 introduced concerns for individuals with a history of cancer, particularly those in remission. This article clarifies the implications of COVID-19 for patients in cancer remission, covering immune considerations, potential impacts on remission status, and practical strategies for prevention and management.
Understanding Cancer Remission and Immune Vulnerability
Cancer remission refers to a period when the signs and symptoms of cancer are reduced or have disappeared. Complete remission means no detectable signs of cancer, while partial remission indicates a decrease in tumor size or cancer cells. Even in remission, individuals can have varying levels of immune vulnerability.
Past cancer treatments, such as chemotherapy, radiation therapy, or stem cell transplants, can affect the immune system. These therapies might reduce immune cells or impair their function, leaving the body less capable of fighting new infections. Cancer itself, even in remission, can sometimes alter immune responses, contributing to increased susceptibility to viruses like SARS-CoV-2. Patients with blood cancers, for example, often experience lower seroconversion rates after COVID-19 vaccination compared to those with solid tumors, highlighting varying immune responses.
Impact of COVID-19 on Remission Status
The direct influence of COVID-19 on cancer remission status is complex. Some research indicates that factors activated during infection, such as systemic inflammation, hypoxia (low oxygen levels), and elevated levels of cytokines like Interleukin 6, could theoretically contribute to tumor relapse or metastasis. These inflammatory responses might create an environment favorable for dormant cancer cells to reawaken. Delayed or missed follow-up care due to the pandemic could also interfere with consistent cancer monitoring, potentially impacting early detection of recurrence.
Conversely, the immune response to COVID-19 may, in rare cases, be associated with cancer regression. Scientists have found that SARS-CoV-2 RNA can activate white blood cells, transforming them into “inducible nonclassical monocytes” (I-NCMs) that can target and attack cancer cells in preclinical models. While these findings are in early stages and require further clinical trials, they open new avenues for potential cancer treatments. It is important to note that while some studies suggest a higher chance of disease recurrence in cancer patients who develop COVID-19, other reports and proposed mechanisms argue against this, emphasizing the need for further research.
Preventive Strategies for Patients in Remission
Patients in cancer remission can reduce their risk of COVID-19 infection. Staying up-to-date with COVID-19 vaccinations and booster shots is highly recommended, as vaccines decrease the risk of hospitalization and death, even for individuals with cancer. While some cancer treatments or types of cancer, particularly blood cancers, may lead to less effective vaccine responses, additional doses can help improve immune responses.
Non-pharmacological interventions also help. These include consistent masking in public or crowded settings, maintaining physical distancing, and practicing thorough hand hygiene. Regular communication with the oncology team is advised to discuss individual risk profiles and receive personalized recommendations for precautions. This ongoing dialogue ensures preventive measures are tailored to each patient’s specific health status and treatment history.
Navigating COVID-19 Infection While in Remission
If an individual in cancer remission contracts COVID-19, immediate communication with their healthcare provider or oncology team is important. Early testing is advised to confirm the infection, followed by careful monitoring for symptoms. Patients with cancer are at a higher risk for severe illness and mortality from COVID-19 compared to the general population.
Eligibility for antiviral treatments, such as Paxlovid (nirmatrelvir/ritonavir) or molnupiravir, should be discussed with a doctor. These oral antiviral medications lessen symptoms in patients with mild or moderate COVID-19 and are prescribed for those at risk of severe progression, including immunocompromised individuals. They work by inhibiting the virus from replicating in the body. Monoclonal antibody treatments may also be considered for high-risk individuals. Post-infection follow-up is important to monitor for any long-term effects of COVID-19.