Terminal cancer presents a health challenge, and the emergence of COVID-19 introduced additional concerns for individuals facing this diagnosis. The intersection of these two conditions raises considerations regarding patient well-being and care strategies. Understanding the combined effects of cancer and COVID-19 is important for patients, families, and healthcare providers.
Increased Risks and Vulnerability
Individuals with terminal cancer face a higher risk of severe COVID-19 outcomes. Their immune systems are often weakened by the cancer itself and by treatments such as chemotherapy, radiation therapy, or immunotherapy. This compromised immune response makes them less capable of fighting off infections effectively. Studies have shown that cancer patients with COVID-19 have a higher risk of intensive care unit (ICU) admission, with reported rates around 14.5% to 40%, compared to 8.42% in non-cancer patients.
Pre-existing organ damage, such as lung involvement from cancer or prior radiation, can further exacerbate the effects of a respiratory virus like SARS-CoV-2. The general debilitation associated with advanced cancer, including malnutrition and muscle wasting, also contributes to increased vulnerability. This heightened susceptibility translates into more severe disease, with cancer patients facing a significantly elevated risk of severe or critical COVID-19, estimated at 45.4%, and a higher mortality rate, around 20.83% to 21.1%, compared to the general population. Younger cancer patients (under 50 years old) on treatment have also shown a higher risk of in-hospital death when compared to non-cancer patients of the same age.
Consequences for Cancer Treatment
COVID-19 can impact the management of terminal cancer. Patients might experience delays or modifications to their planned cancer treatments, including chemotherapy, radiation therapy, targeted therapies, or surgeries. These disruptions can occur due to the need for isolation, hospital resource limitations, or the patient’s acute illness from COVID-19. Over 50% of cancer treatment disruptions were attributed to COVID-19, with most occurring within the first 30 days of infection.
Decisions may arise regarding continuing aggressive cancer treatment versus prioritizing the management of acute COVID-19 symptoms. Some patients may experience prolonged viral shedding due to their immunosuppression, leading to extended treatment delays or even cessation of cancer therapy. A survey indicated that half of cancer patients and survivors reported changes, delays, or disruptions in their care, with 24% experiencing delays in care or treatment. This includes impacts on in-person provider visits, supportive services, and imaging procedures to monitor tumor growth.
Integrated Symptom Management and Palliative Care
Managing symptoms becomes more complex when both terminal cancer and COVID-19 are present. Palliative care principles are valuable in this situation, focusing on comfort and improving quality of life. This holistic approach addresses overlapping symptoms common to both conditions, such as fatigue, shortness of breath, pain, and nausea. For instance, morphine is an effective treatment for refractory breathlessness, a symptom that can be prominent in both advanced cancer and severe COVID-19.
Palliative care teams provide essential support by offering pharmacological treatments, like opioids for pain and breathlessness, and non-pharmacological interventions, such as controlled breathing techniques. Early integration of palliative care has been shown to improve quality of life and mood for cancer patients. Advance care planning is also important, ensuring that patient wishes regarding their care are discussed and documented, which helps guide decisions during periods of acute illness.
Protective Measures and Comprehensive Support
Protective measures are important for individuals with terminal cancer and their caregivers. Vaccination against COVID-19 is recommended for cancer patients, including those who are immunocompromised, as it reduces the risk of severe illness and hospitalization. While vaccine efficacy can vary depending on the type of cancer and treatment, particularly for those with blood cancers or receiving B-cell depleting therapies, booster doses can increase antibody responses.
Beyond vaccination, adherence to other prevention strategies remains important. This includes wearing masks in indoor and outdoor settings when around others not in the immediate household, practicing frequent hand hygiene for at least 20 seconds, and maintaining physical distancing. Avoiding crowds and poorly ventilated indoor spaces minimizes exposure risk. Comprehensive support also extends to addressing the emotional and psychological well-being of patients and their families, fostering open communication with healthcare teams, and connecting with community resources for additional assistance.