COVID Vaccine and Cancer Patients

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
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00:17 --> 00:19Welcome to Yale Cancer Answers with
00:19 --> 00:21your host doctor Anees Chagpar.
00:21 --> 00:23Yale Cancer Answers features the
00:23 --> 00:25latest information on cancer care
00:25 --> 00:27by welcoming oncologists and
00:27 --> 00:28specialists who are on the
00:28 --> 00:30forefront of the battle to fight
00:30 --> 00:32cancer. This week, it's a
00:32 --> 00:33conversation about the Covid
00:33 --> 00:35vaccine and cancer patients with
00:35 --> 00:36Doctor Kerin Adelson. Doctor
00:36 --> 00:38Adelson is the chief quality
00:38 --> 00:40officer and Deputy Chief medical
00:40 --> 00:42officer at Smilow Cancer Hospital
00:42 --> 00:44and an associate professor at the
00:44 --> 00:46Yale School of Medicine where
00:46 --> 00:49Doctor Chagpar is a professor of
00:49 --> 00:50surgical oncology.
00:50 --> 00:53Kerin, let's start by talking
00:53 --> 00:56a little bit about this vaccine.
00:56 --> 00:59You know there's been a lot in the
00:59 --> 01:02news about the vaccine, and many people,
01:02 --> 01:04whether their cancer patients or even
01:04 --> 01:08the general population have a bit of
01:08 --> 01:10trepidation about the vaccine. Can
01:10 --> 01:13you tell us about its safety?
01:13 --> 01:16Yes, this vaccine is very, very safe.
01:18 --> 01:21Both vaccines that are currently approved
01:21 --> 01:24were studied in a randomized
01:24 --> 01:26controlled trial with thousands
01:27 --> 01:29of patients and demonstrated to
01:29 --> 01:31be both very safe and highly
01:31 --> 01:34effective, and so in terms
01:34 --> 01:36of cancer patients,
01:36 --> 01:39I know that they may have a
01:39 --> 01:41lot of concerns themselves
01:41 --> 01:44that may be separate and apart
01:44 --> 01:47from the general population.
01:47 --> 01:50So the first thing is should they
01:50 --> 01:53get the vaccine?
01:53 --> 01:55They may be on treatment, they may
01:55 --> 01:57have just finished treatment.
01:57 --> 01:59Are you recommending the
01:59 --> 02:00vaccine to your patients?
02:01 --> 02:03I most certainly am.
02:03 --> 02:05So patients with cancer
02:05 --> 02:08who have other medical problems,
02:08 --> 02:12patients who are on treatment that
02:12 --> 02:16could make them more vulnerable to
02:16 --> 02:20the effects of COVID-19 are in a
02:20 --> 02:22position where they need the vaccine
02:22 --> 02:25more than the general population.
02:25 --> 02:28Is that because cancer patients are
02:28 --> 02:31more at risk of contracting covid?
02:31 --> 02:34They are not necessarily
02:34 --> 02:36more at risk of catching covid,
02:36 --> 02:39but they are more at risk of
02:39 --> 02:42having a severe course of illness.
02:42 --> 02:45And it's not all patients with cancer,
02:45 --> 02:47but especially patients who have active
02:47 --> 02:51cancer or cancer in the lungs or cancer
02:51 --> 02:53where the cancer itself suppresses
02:53 --> 02:56the immune system like some of the
02:56 --> 02:58blood cancers may be more vulnerable
02:58 --> 03:01to the serious complications that can
03:01 --> 03:03happen with the COVID-19 infection.
03:03 --> 03:06And for those people, it is really,
03:06 --> 03:08really important that they take
03:08 --> 03:10advantage of this opportunity to
03:10 --> 03:12protect themselves with the vaccine.
03:16 --> 03:18Cancer patients are often older now,
03:18 --> 03:21of course not across the board,
03:21 --> 03:23but we know that older patients
03:23 --> 03:26are also more vulnerable to the
03:26 --> 03:27effects of COVID-19.
03:28 --> 03:30A couple of questions to follow
03:30 --> 03:33up on that, you know patients
03:33 --> 03:35who are currently on treatment,
03:35 --> 03:38they are worried about
03:38 --> 03:41the fact that their immune system
03:41 --> 03:44often is repressed with chemotherapy,
03:44 --> 03:47such that sometimes their oncologists
03:47 --> 03:51may even give them things like GCSF
03:51 --> 03:54to kind of boost
03:54 --> 03:56their immunity
03:56 --> 04:00and so they may be
04:00 --> 04:03wondering whether they will mount
04:03 --> 04:06an effective response against
04:06 --> 04:08Covid with the vaccine,
04:08 --> 04:10has that been studied?
04:10 --> 04:12That is a great question,
04:12 --> 04:16so there have not been trials of the
04:16 --> 04:20vaccine in patients with cancer yet.
04:20 --> 04:23And so all of those concerns
04:23 --> 04:24are legitimate concerns.
04:24 --> 04:27And what I would really stress is that
04:27 --> 04:29each patient should talk to their
04:29 --> 04:31treating oncologist or hematologist,
04:31 --> 04:34or even primary care doctor, about when
04:34 --> 04:37in the course of treatment is the
04:37 --> 04:41best time for them to get the vaccine.
04:41 --> 04:44Generally across the country we are erring
04:44 --> 04:47on the side of it's better to get the
04:47 --> 04:50vaccine and hopefully get some protection.
04:50 --> 04:53But we understand that there may be
04:53 --> 04:55patients with a suppressed immune system
04:55 --> 04:59who don't mount as much of a response to
04:59 --> 05:02the vaccine as would be ideal.
05:02 --> 05:04We're not going to know that, though,
05:04 --> 05:07until patients get the vaccine and we
05:07 --> 05:10actually are able to collect their serum
05:10 --> 05:13and study whether or not they are able
05:13 --> 05:16to make the antibodies that they
05:16 --> 05:18will need to be protected from COVID-19.
05:18 --> 05:21But it's really important to point out,
05:21 --> 05:25that even if they don't make a large response
05:25 --> 05:29to protect them from COVID-19 to the vaccine,
05:29 --> 05:32they're not at risk for extra
05:32 --> 05:34complications of getting the vaccine.
05:34 --> 05:37This is not a live vaccine,
05:37 --> 05:39it's not a dangerous vaccine,
05:39 --> 05:42so the recommendations still are
05:42 --> 05:44that people become vaccinated.
05:47 --> 05:51There may be some populations of patients
05:51 --> 05:54who are the most severely immunosuppressed,
05:54 --> 05:57have gone through a recent bone marrow
05:57 --> 06:00transplant for example or Car T cell therapy
06:00 --> 06:04who may it may be recommended by their
06:04 --> 06:07treating doctor that they wait a few
06:07 --> 06:09months before getting the vaccine,
06:09 --> 06:12but that is the vast minority
06:12 --> 06:14of patients on cancer treatment.
06:14 --> 06:17And for patients who are on
06:17 --> 06:19pretty standard
06:19 --> 06:20chemotherapy and immunotherapy,
06:20 --> 06:22we absolutely are recommending
06:22 --> 06:23that they get vaccinated.
06:22 --> 06:23that they get vaccinated.
06:24 --> 06:27So a couple of follow up questions to that.
06:27 --> 06:29One of the concerns that many people
06:29 --> 06:31have not only cancer patients,
06:31 --> 06:33but even the general population
06:33 --> 06:35is whether they can catch
06:35 --> 06:36covid from the vaccine.
06:36 --> 06:38And I know that you
06:38 --> 06:39mentioned that in passing,
06:39 --> 06:41but maybe you'd like to
06:41 --> 06:43just reiterate the point
06:43 --> 06:45that this vaccine will not give you covid.
06:45 --> 06:48It is not a live virus that can
06:48 --> 06:50spread throughout the body.
06:50 --> 06:52It does not have all the mechanics and
06:52 --> 06:55parts it needs to grow and reproduce.
06:55 --> 06:58So when you hear about people developing
06:58 --> 07:00symptoms from the COVID-19 vaccine,
07:00 --> 07:02those symptoms are really
07:02 --> 07:04related to the vaccinee,
07:04 --> 07:08so I think I just made up that word,
07:08 --> 07:11but the vaccinees own immune system
07:11 --> 07:14revving up to begin to
07:14 --> 07:16mount protection
07:16 --> 07:18against the COVID-19 virus.
07:18 --> 07:21But it is not from the vaccine
07:21 --> 07:23itself doing harm or damage.
07:23 --> 07:25And so
07:25 --> 07:28I've already had one dose of
07:28 --> 07:30the vaccine and I definitely
07:30 --> 07:32developed some achiness afterwards,
07:32 --> 07:35the way one might if they
07:35 --> 07:37were fighting a virus,
07:37 --> 07:39but it's mild and it
07:39 --> 07:41lasted a few days and
07:41 --> 07:43now I'm getting ready for
07:43 --> 07:46my second dose.
07:46 --> 07:49The other question has to do with when
07:49 --> 07:52cancer patients should get the vaccine.
07:52 --> 07:55So we talked a little bit about mounting
07:55 --> 07:58an immune response to the vaccine.
07:58 --> 08:00So would you recommend that people
08:00 --> 08:03get it if they haven't yet started chemo
08:03 --> 08:06that they get it before they start chemo?
08:06 --> 08:08We advise
08:11 --> 08:13if there is time for
08:13 --> 08:17them to get at least one dose of the
08:17 --> 08:19vaccine before they start treatment,
08:19 --> 08:23we certainly would recommend that.
08:23 --> 08:26Currently, the state limitations are not
08:26 --> 08:28open to everybody who has cancer yet,
08:28 --> 08:32but I think in the next month we
08:32 --> 08:35will begin to see the sort of parameters
08:35 --> 08:39of who the vaccine is available for
08:39 --> 08:42broadening mostly I would say the really
08:42 --> 08:45most important thing is for
08:45 --> 08:47every patient who's dealing with a cancer
08:47 --> 08:50diagnosis to talk to their treating
08:50 --> 08:53doctor about what timing is ideal.
08:53 --> 08:55But certainly if there's an
08:55 --> 08:57opportunity before they start treatment
08:57 --> 08:58to get vaccinated,
08:58 --> 09:01we would recommend that and then for
09:01 --> 09:03patients who are on cyclical treatment
09:03 --> 09:06or repeated doses of chemotherapy,
09:06 --> 09:08we would recommend that you talk to
09:08 --> 09:11your doctor and figure out with your
09:11 --> 09:14doctor which timing is best given your
09:14 --> 09:16specific regimen.
09:16 --> 09:19And once you get the vaccine, are there
09:19 --> 09:21precautions that you need to take?
09:21 --> 09:23It's very important for everyone
09:23 --> 09:26to realize that the vaccine does
09:26 --> 09:28not confer immediate projective
09:28 --> 09:30action against COVID-19 infection
09:30 --> 09:32even after the first dose,
09:32 --> 09:36it could take 10 days or more to
09:36 --> 09:39mount an immune response and I think
09:39 --> 09:43the estimates are that after one
09:43 --> 09:46vaccine you have about 50% protection,
09:46 --> 09:48so we absolutely recommend that
09:48 --> 09:51people continue to socially isolate,
09:51 --> 09:53continue to wear masks and
09:53 --> 09:56continue to exercise all of the
09:56 --> 09:59precautions that we've learned
09:59 --> 10:00are so protective
10:00 --> 10:02against getting a COVID-19 infection.
10:02 --> 10:05What about families of cancer patients?
10:05 --> 10:08Should they get vaccinated too?
10:08 --> 10:10Does that have any implications
10:10 --> 10:13for the cancer patient themselves?
10:13 --> 10:16So that's a great question.
10:16 --> 10:18We know that COVID-19
10:18 --> 10:20does spread rapidly within families,
10:20 --> 10:23but in terms of family members,
10:23 --> 10:26being able to get the vaccine,
10:26 --> 10:30they currently fall into the group
10:30 --> 10:31that their
10:31 --> 10:33demographic falls into already,
10:33 --> 10:35so family members will be able to
10:35 --> 10:38get the vaccine based on their own
10:38 --> 10:41age and or their profession or their
10:41 --> 10:43degree of medical problems following
10:43 --> 10:46the algorithms that have
10:46 --> 10:48come from all the different states.
10:48 --> 10:51Is it possible that at some point the
10:51 --> 10:54vaccine would be opened up to family
10:54 --> 10:57members of patients who are at higher risk?
10:57 --> 10:58It's possible,
10:58 --> 11:02but that has not been committed to yet
11:02 --> 11:04given the limited number of
11:04 --> 11:06vaccines that have been available
11:06 --> 11:09so far, and that brings me to other
11:09 --> 11:12groups of cancer patients and
11:12 --> 11:15we talked a little bit about cancer
11:15 --> 11:18patients on active treatment too,
11:18 --> 11:20might be at particularly high
11:20 --> 11:23risk for sequelae of covid.
11:23 --> 11:24What about cancer survivors?
11:24 --> 11:27Let's say you had breast
11:27 --> 11:28cancer five years ago.
11:28 --> 11:31You might be taking endocrine therapy,
11:31 --> 11:34but otherwise are pretty well.
11:34 --> 11:36Would you get priority
11:36 --> 11:39in terms of getting the vaccine?
11:39 --> 11:41Is it important for you to
11:41 --> 11:43get the vaccine earlier,
11:43 --> 11:45or should you wait until it's
11:45 --> 11:47open to the general population?
11:47 --> 11:50That's another really good
11:50 --> 11:51question that has some subtlety
11:51 --> 11:54in how patients
11:54 --> 11:57will be selected for the vaccine.
11:57 --> 11:59So for the most part,
11:59 --> 12:01somebody who has been cured of cancer
12:01 --> 12:04who is not on any active treatment
12:04 --> 12:07that would affect their immune system,
12:07 --> 12:10who does not have metastatic cancer is
12:10 --> 12:13not really at higher risk for COVID-19
12:13 --> 12:16or the complications related to it.
12:16 --> 12:20That aside, I think that the state will
12:20 --> 12:23be rolling out the vaccination at some
12:23 --> 12:26point to patients who have comorbidity,
12:26 --> 12:29or another diagnosis that
12:29 --> 12:32could lead to complications of
12:32 --> 12:34COVID-19 and so really all patients
12:34 --> 12:37should be talking to their doctors
12:37 --> 12:40about which group they fall into.
12:41 --> 12:43I think that all of
12:43 --> 12:45these are such important questions
12:45 --> 12:48and we're going to take a short
12:48 --> 12:51break for a medical minute to learn
12:51 --> 12:53more about Covid and the vaccine,
12:53 --> 12:55especially for cancer patients.
12:55 --> 12:57Please stay tuned to learn more
12:57 --> 12:59with my guest Doctor Kerin Adelson.
13:00 --> 13:03Support for Yale Cancer Answers comes from
13:03 --> 13:07AstraZeneca, working to change how cancer
13:07 --> 13:09is treated with personalized medicine.
13:09 --> 13:13Learn more at astrazeneca-us.com.
13:13 --> 13:16This is a medical minute about genetic
13:16 --> 13:19testing which can be useful for
13:19 --> 13:21people with certain types of cancer
13:21 --> 13:24that seem to run in their families.
13:24 --> 13:26Patients that are considered at risk
13:26 --> 13:29receive genetic counseling and testing so
13:29 --> 13:31informed medical decisions can be based
13:31 --> 13:34on their own personal risk assessment.
13:34 --> 13:36Resources for genetic counseling and
13:36 --> 13:37testing are available at federally
13:37 --> 13:40designated comprehensive cancer centers.
13:40 --> 13:41Interdisciplinary teams include geneticists,
13:41 --> 13:42genetic counselors, physicians,
13:42 --> 13:43and nurses
13:43 --> 13:46who work together to provide risk
13:46 --> 13:48assessment and steps to prevent
13:48 --> 13:50the development of cancer.
13:50 --> 13:52More information is available
13:52 --> 13:53at yalecancercenter.org.
13:53 --> 13:56You're listening to Connecticut Public Radio.
13:56 --> 13:57Welcome
13:57 --> 13:59back to Yale cancer Answers.
13:59 --> 14:01This is Doctor Anees Chagpar and
14:01 --> 14:04I'm joined tonight by my guest doctor
14:04 --> 14:06Kerin Adelson and we’re talking about Covid
14:06 --> 14:08and cancer patients and right before
14:08 --> 14:10the break we were talking about
14:10 --> 14:13the covid vaccine and the fact that
14:13 --> 14:15for many of our cancer patients,
14:15 --> 14:17particularly those who are
14:17 --> 14:18on active treatment,
14:18 --> 14:20that the vaccine is still recommended
14:20 --> 14:23and that you should talk to your
14:23 --> 14:25doctor about getting this when it
14:25 --> 14:27is available for cancer patients.
14:27 --> 14:29Kerin, just to kind of tag
14:29 --> 14:32on to the discussion that we
14:32 --> 14:34were having before the break,
14:34 --> 14:36you had mentioned that after
14:36 --> 14:38you get the dose of vaccine,
14:38 --> 14:41your body mounts an immune response
14:41 --> 14:43that can leave you with some sequelae.
14:43 --> 14:47Maybe some achiness, maybe a low grade fever.
14:47 --> 14:50Maybe chills and for a lot of people
14:50 --> 14:53they may have heard that you kind
14:53 --> 14:56of feel a little bit like crap,
14:56 --> 14:58and when you're on chemo,
14:58 --> 15:01you might feel like crap too. NOTE Confidence: 0.87298423
15:03 --> 15:05So how should cancer patients
15:05 --> 15:08think about how they're going
15:08 --> 15:10to feel after the vaccine?
15:10 --> 15:13And are there any precautions or
15:13 --> 15:15concerns that you might advise
15:15 --> 15:18in terms of overcoming those
15:18 --> 15:22sequelae?
15:22 --> 15:25That's a great question and the way to really think about this is
15:25 --> 15:28that if you develop side effects or if you
15:28 --> 15:31develop symptoms after getting the vaccine,
15:31 --> 15:33that's a sign that your immune system
15:33 --> 15:36is kicking in and doing its job.
15:36 --> 15:38We don't know yet whether people who
15:38 --> 15:41get more side effects actually get
15:41 --> 15:43more protection from the vaccine.
15:43 --> 15:47That doesn't seem to be the case, but I
15:47 --> 15:49certainly would not be overly concerned.
15:49 --> 15:52And patients who are getting side effects,
15:52 --> 15:55say achiness or a low grade fever,
15:55 --> 15:57people have a lot of actual
15:57 --> 15:59soreness at the injection site,
15:59 --> 16:02more even than with other vaccines
16:02 --> 16:04like the flu vaccine, for example,
16:04 --> 16:06but we would just recommend
16:06 --> 16:07taking some Tylenol,
16:07 --> 16:09taking it easy,
16:09 --> 16:12trusting your body and really
16:12 --> 16:14appreciating the fact that the side
16:14 --> 16:17effects you may feel may be a sign
16:17 --> 16:20that in the next six weeks or so you
16:20 --> 16:23will have protection against this virus and
16:24 --> 16:26so if you have taken the
16:26 --> 16:28vaccine and you're due for
16:28 --> 16:30your next dose of chemotherapy,
16:30 --> 16:32but you're feeling like crap,
16:32 --> 16:34what should you do?
16:34 --> 16:37Should you talk to your doctor about
16:37 --> 16:40maybe pushing your next dose of chemo out?
16:40 --> 16:44Should you go and take the chemo anyways?
16:44 --> 16:46How should patients kind of
16:46 --> 16:47navigate that landscape?
16:47 --> 16:49Yeah, I think
16:49 --> 16:51that is a question that I can't
16:51 --> 16:54answer for the general population
16:54 --> 16:56because people's treatment and the
16:56 --> 16:59timing of their treatment vary so much,
16:59 --> 17:02and in the urgency of getting
17:02 --> 17:04a treatment on time,
17:04 --> 17:05varies with different
17:05 --> 17:08treatments in different regimens as well.
17:08 --> 17:10So I would say the most important
17:10 --> 17:13thing is to talk to their treating
17:13 --> 17:15oncologist or hematologist.
17:15 --> 17:18Well I want to transition a
17:18 --> 17:20little bit to talking about
17:20 --> 17:22actual covid and cancer patients.
17:22 --> 17:25Many cancer patients have questions
17:25 --> 17:28that pertain to what it's like or what
17:28 --> 17:31they should do when exposed to covid.
17:31 --> 17:34So let's take it from the
17:34 --> 17:37most benign to the most severe cases.
17:37 --> 17:39So right now, we know that we're
17:39 --> 17:42in the middle of the pandemic,
17:42 --> 17:44and every day we watch the
17:44 --> 17:47news and we see more and more
17:47 --> 17:49people getting affected by covid.
17:49 --> 17:52We know that there are
17:52 --> 17:54variants in the population
17:54 --> 17:56that have more infectivity
17:56 --> 17:58than the standard strain,
17:58 --> 18:02so just in terms of general precautions,
18:02 --> 18:04what precautions should cancer
18:04 --> 18:07patients take in order to mitigate
18:07 --> 18:09their risk of developing covid?
18:10 --> 18:11Yes, maintaining social
18:11 --> 18:14isolation is the
18:14 --> 18:17most important thing right now.
18:17 --> 18:20It's not putting yourself in
18:20 --> 18:23a place where you are at risk
18:23 --> 18:25for contracting the virus.
18:25 --> 18:28So really, minimizing exposures
18:28 --> 18:30to groups of people,
18:30 --> 18:32especially in the indoor setting.
18:35 --> 18:38Certainly not getting together
18:38 --> 18:41with people who were exposed to the virus
18:41 --> 18:45and whenever you do need to be in close
18:45 --> 18:48proximity to somebody, wearing a mask
18:48 --> 18:51other than your immediate family members.
18:51 --> 18:54I think as the covid prevalence
18:54 --> 18:57has really spread through the community,
18:57 --> 19:00the chance of having an asymptomatic
19:00 --> 19:02infection has gone way up,
19:02 --> 19:06so there will be circumstances and we've
19:06 --> 19:09certainly seen this in our patients where
19:09 --> 19:11a family member does have covid and
19:11 --> 19:15the rest of the family needs to protect
19:15 --> 19:18themselves against contracting the
19:18 --> 19:20virus and in that situation,
19:20 --> 19:23obviously, if that person can go stay
19:23 --> 19:26somewhere else where they won't expose
19:26 --> 19:28their family member or especially their
19:28 --> 19:31family member with cancer, that's ideal.
19:31 --> 19:33If that's not feasible,
19:33 --> 19:35we really recommend that the infected
19:35 --> 19:39person be isolated in a room wearing masks,
19:39 --> 19:41and that contact be minimized.
19:41 --> 19:44Hand sanitizer be used as regularly as
19:44 --> 19:47possible and that people really,
19:47 --> 19:50really work to do whatever
19:50 --> 19:53they can not to get the virus,
19:53 --> 19:56so picking up on that when you
19:56 --> 19:58talk about cancer patients,
19:58 --> 20:00social isolating do you
20:00 --> 20:02say they shouldn't
20:02 --> 20:04go to the grocery store,
20:04 --> 20:05they shouldn't
20:05 --> 20:08socialize or is it really just
20:08 --> 20:10maintaining that 6 foot distancing?
20:10 --> 20:12Or do cancer patients really
20:12 --> 20:14need to take more precautions
20:14 --> 20:16than the general population?
20:17 --> 20:18That's a great question,
20:18 --> 20:21and I think there's been a lot of
20:21 --> 20:23controversy with what precautions the
20:23 --> 20:26general population should take as well.
20:26 --> 20:28I would really stress that social
20:28 --> 20:30isolation not putting yourself in
20:30 --> 20:33a position where you're exposed to
20:33 --> 20:36many people who could be carrying the
20:36 --> 20:38virus remains absolutely essential.
20:38 --> 20:39Mask wearing is better,
20:39 --> 20:42but it's by no means a guarantee,
20:42 --> 20:45so this is not the
20:45 --> 20:47time to go to rock concerts.
20:47 --> 20:50But we all have to eat occasionally.
20:50 --> 20:53We have to go to the supermarket
20:53 --> 20:56and if you do that,
20:56 --> 20:58I just suggest wearing a mask
20:58 --> 21:00and using hand sanitizer,
21:00 --> 21:02and certainly taking advantage of
21:02 --> 21:04things like on line grocery delivery
21:04 --> 21:07programs whenever possible.
21:07 --> 21:10Bringing us to the next situation which
21:10 --> 21:14you mentioned in terms of families and
21:14 --> 21:16before the break you had also mentioned
21:16 --> 21:20that we're seeing an increase in covid
21:20 --> 21:22cases spread between family members.
21:22 --> 21:25So even when you're in your household,
21:25 --> 21:27say you have cancer,
21:27 --> 21:29you're in active treatment,
21:29 --> 21:32you have a partner who might be working.
21:32 --> 21:35You have kids who might
21:35 --> 21:39be going to school part time or
21:39 --> 21:41going out outside should
21:41 --> 21:44you be wearing a mask inside
21:44 --> 21:47your house even amongst your
21:47 --> 21:49immediate family members or not?
21:49 --> 21:52Or is that something that you should
21:52 --> 21:56do only if somebody contracts covid?
21:56 --> 21:59So it's very hard for people to
21:59 --> 22:02wear masks in their own house,
22:02 --> 22:05but I would say that if they are in
22:05 --> 22:07close proximity to a family member who
22:07 --> 22:10is at risk, grandchildren
22:10 --> 22:13who are probably not following the
22:13 --> 22:16rules the same way older people might.
22:16 --> 22:19If you have a family member
22:19 --> 22:21who's an essential worker,
22:21 --> 22:23and going to work where they
22:23 --> 22:25could potentially contract it,
22:25 --> 22:27maintaining distance and wearing masks
22:27 --> 22:28certainly is ideal,
22:28 --> 22:31not easy to implement in one's own house,
22:31 --> 22:34but certainly as much as they can.
22:34 --> 22:36We would recommend
22:36 --> 22:38that. And if somebody tests positive
22:38 --> 22:41then you really want to isolate
22:41 --> 22:43that person who tested positive.
22:54 --> 22:56What about mealtimes with
22:56 --> 22:58people who might have covid?
22:58 --> 23:01Many people have talked about
23:01 --> 23:03the fact that when we're eating,
23:03 --> 23:05we're clearly not wearing a mask.
23:05 --> 23:08There tends to be a lot of droplets.
23:08 --> 23:10If you're in a household where somebody does
23:10 --> 23:13have covid and you're a cancer patient,
23:13 --> 23:15what should you do at mealtimes?
23:15 --> 23:17Should you separate those or
23:17 --> 23:18how should that work?
23:18 --> 23:20Yeah, if you have a
23:20 --> 23:21family member with Covid,
23:21 --> 23:24they need to be alone in a
23:24 --> 23:26room getting their meals.
23:26 --> 23:28This is not the time for us to
23:28 --> 23:30come together in celebration so
23:32 --> 23:35we do not recommend group meals especially
23:35 --> 23:37when somebody has
23:37 --> 23:39been identified as having covid,
23:39 --> 23:41I'm going to digress a little,
23:41 --> 23:43but one thing that
23:43 --> 23:46has been so hard for people
23:46 --> 23:48in this year of the pandemic,
23:48 --> 23:51and especially for patients with cancer
23:51 --> 23:53who are often facing questions of
23:53 --> 23:56mortality and can be really worried
23:56 --> 23:58about living to the most in the
23:58 --> 24:00time that they have left.
24:04 --> 24:07This virus has really posed a challenge.
24:07 --> 24:08A lot of my patients
24:08 --> 24:10articulating that
24:10 --> 24:12Covid has taken what they feel
24:12 --> 24:14is a critical year from them,
24:14 --> 24:17and being able to be with their loved ones
24:17 --> 24:20and be with their family and experience
24:20 --> 24:21life and experience the world
24:21 --> 24:24and the only way
24:24 --> 24:26to really see that limitation,
24:26 --> 24:28or that last
24:28 --> 24:30time coming to an end, is
24:30 --> 24:33if we can all get vaccinated,
24:33 --> 24:35and really get control of this
24:35 --> 24:36virus on a national level.
24:36 --> 24:38So if you're debating whether
24:38 --> 24:40or not to get the vaccine,
24:40 --> 24:42the vaccine
24:42 --> 24:45is what will allow you to begin
24:45 --> 24:46to get your life back.
24:47 --> 24:48So important.
24:48 --> 24:49I know that many patients
24:49 --> 24:51might be thinking you know,
24:51 --> 24:54especially when we go back to the
24:54 --> 24:55situation of having family members
24:55 --> 24:58with covid and having to isolate
24:58 --> 25:01And you might be, as you say,
25:01 --> 25:02contemplating your own mortality
25:02 --> 25:05and how much time you have left,
25:05 --> 25:07maybe thinking you know what,
25:07 --> 25:09I don't want to not have
25:09 --> 25:11dinner with my family.
25:11 --> 25:14My family is really important to me and
25:14 --> 25:17I don't know how many days I have left.
25:17 --> 25:21These are such tough
25:21 --> 25:23choices for people to make.
25:23 --> 25:27This has been such a tough year
25:27 --> 25:31really for everyone. But this
25:31 --> 25:34brings us to the last topic,
25:34 --> 25:37which is what about when cancer patients
25:37 --> 25:40actually start to get symptoms that
25:40 --> 25:43might make them concerned about covid?
25:43 --> 25:46So the first question is
25:46 --> 25:48sometimes the symptoms of Covid,
25:48 --> 25:51as you say, can be completely asymptomatic,
25:51 --> 25:54but sometimes they can have low grade fever.
25:54 --> 25:55They might have a cough,
25:55 --> 25:57they might have some chest pain,
25:57 --> 25:59they might have some shortness of
25:59 --> 26:02breath or changes in how they perceive,
26:02 --> 26:04taste and smell, but you can get a
26:04 --> 26:07lot of those symptoms with chemo too.
26:07 --> 26:09So how are patients to
26:09 --> 26:10differentiate the two,
26:10 --> 26:13and when should they call their doctor?
26:13 --> 26:14Yeah, so they should call
26:14 --> 26:17their doctor as soon as they have
26:17 --> 26:18any of those symptoms.
26:18 --> 26:20And you're absolutely right.
26:20 --> 26:23It can be very hard to figure out
26:23 --> 26:25whether patients are just experiencing
26:25 --> 26:27the side effects of treatment,
26:27 --> 26:28or whether they actually
26:28 --> 26:30might have a covid infection,
26:30 --> 26:32and because it was so important
26:32 --> 26:35for us to be able to protect our
26:35 --> 26:37population of patients with cancer
26:37 --> 26:40from those who might actually be
26:40 --> 26:42carrying the virus or contagious.
26:42 --> 26:44We had to develop a whole new
26:44 --> 26:46area actually just
26:46 --> 26:49to screen our cancer patients
26:49 --> 26:52for Covid so that they wouldn't expose other
26:52 --> 26:54patients when they might have symptoms,
26:54 --> 26:56and so we are able
26:57 --> 26:59if you call your doctor because
26:59 --> 27:01you're having symptoms,
27:01 --> 27:04we are able to get a rapid test and
27:04 --> 27:06screen our patients for symptoms to
27:06 --> 27:09figure out whether it's just side
27:09 --> 27:12effects from treatment or whether they
27:12 --> 27:13actually carry the virus.
27:13 --> 27:16And so in our last minute or two,
27:16 --> 27:20what if a cancer patient actually gets covid?
27:20 --> 27:21What happens then?
27:21 --> 27:23Can you kind of lay out the
27:23 --> 27:25landscape of what happens?
27:25 --> 27:27I mean, are they immediately hospitalized?
27:27 --> 27:30Do they have to self isolate?
27:30 --> 27:33What does that mean in terms of treatment?
27:33 --> 27:36I mean that must be just a double whammy.
27:38 --> 27:41When one of our patients gets
27:41 --> 27:44covid we have to evaluate them clinically,
27:44 --> 27:46and if they are very clinically
27:46 --> 27:48stable like many people are,
27:48 --> 27:50we will send them home
27:50 --> 27:52with instructions to self isolate
27:52 --> 27:54and we probably will hold their
27:54 --> 27:56chemotherapy treatment at least during
27:56 --> 27:59the phase of the acute infection,
27:59 --> 28:02we have a program where our nurses
28:02 --> 28:06will call to check up on our
28:06 --> 28:09patients who have covid daily and
28:09 --> 28:11make sure that they're doing OK.
28:11 --> 28:14And assuming their symptoms don't get worse,
28:14 --> 28:16they will finish out their 10 days
28:16 --> 28:19to two weeks and then can come back
28:19 --> 28:21and resume treatment. For patients
28:21 --> 28:23who develop more severe symptoms,
28:23 --> 28:25they could in the end
28:25 --> 28:27need to be hospitalized,
28:27 --> 28:28especially if they're
28:28 --> 28:29having breathing problems.
28:29 --> 28:32And if any of those more serious
28:32 --> 28:33symptoms are developing, we would
28:33 --> 28:36make sure that you
28:36 --> 28:38talk to your doctor and
28:38 --> 28:41if needed, bring you into the hospital.
28:41 --> 28:43Doctor Kerin Adelson is the chief
28:43 --> 28:45quality officer and Deputy Chief
28:45 --> 28:46medical Officer at Smilow
28:46 --> 28:48and an associate
28:48 --> 28:51professor at the Yale School of Medicine.
28:51 --> 28:52If you have questions,
28:52 --> 28:54the address is canceranswers@yale.edu
28:54 --> 28:56and past editions of the program
28:56 --> 28:58are available in audio and written
28:58 --> 29:00form at yalecancercenter.org.
29:00 --> 29:02We hope you'll join us next week to
29:02 --> 29:05learn more about the fight against
29:05 --> 29:07cancer here on Connecticut Public Radio.

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January 24, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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