What is coronavirus, or COVID-19? Coronaviruses are a large family of viruses that are common in people and many different species of animals. SARS-CoV-2 is a novel (new) coronavirus that causes a respiratory disease named coronavirus disease 2019, which is abbreviated COVID-19. As SARS-CoV-2 spreads, the virus can change, which results in new variants. Some variants may spread more easily than others or be more resistant to vaccines or treatments.If I have cancer now or had it in the past, am I at higher risk of severe COVID-19? If you have cancer, you have a higher risk of severe COVID-19. Other factors that increase the risk for severe COVID-19 include having a weakened immune system (being immunocompromised), older age, and other medical conditions. People with blood cancers may be at higher risk of prolonged infection and death from COVID-19 than people with solid tumors. That is because patients with blood cancers often have abnormal or depleted levels of immune cells that produce antibodies against viruses. NCI is conducting a large study of people with cancer who have COVID-19 to learn more about the risk factors for COVID-19 and to help doctors better manage treatment for people with cancer and COVID-19. If you had cancer in the past, you also may be at higher risk of severe COVID-19, and you may want to discuss your concerns about COVID-19 with your doctors.If I have cancer now or had it in the past, should I get a COVID-19 vaccine? Yes. The Centers for Disease Control and Prevention (CDC) recommends that everyone age 6 months and older stay up to date with COVID-19 vaccination, including all primary series doses and boosters. That includes most people with underlying medical conditions, including cancer. CDC recommends most people get the Moderna, Novavax, or Pfizer-BioNTech vaccine for their primary series. You may get Johnson & Johnson’s Janssen vaccine in some situations. Both the Moderna and Pfizer-BioNTech vaccines are authorized to be used for booster doses. People ages 5 years and older should get an updated (bivalent) booster that targets the Omicron variant, the form of the virus that is most common in the United States. If, like most people (including most people who had cancer in the past), you have a healthy immune system, CDC recommends that you follow this vaccine schedule:
People with certain cancers and those who are receiving treatment that suppresses the immune system may have a weaker response to COVID-19 vaccines than people whose immune systems are not compromised.
Credit: Centers for Disease Control and Prevention
If you recently received cancer treatment that suppresses the immune system—such as chemotherapy, a stem cell or bone marrow transplant, or cell therapy—your doctor may suggest that you wait until your immune system has recovered before you get vaccinated. Or your doctor may suggest that you wait a few weeks after vaccination to get immunosuppressive treatment.
COVID-19 Vaccines and People with Cancer
CDC also recommends that people who received one or more doses of COVID-19 vaccine before or during a stem cell transplant or CAR T-cell therapy be revaccinated with an mRNA vaccine for any dose(s) received before and during treatment. Revaccination should start at least 3 months after transplant or CAR T-cell therapy.
Revaccination may also be considered for people who received one or more doses of COVID-19 vaccine while being treated with drugs that destroy B cells, such as rituximab (Rituxan). Revaccination should start about 6 months after completing B cell-depleting therapy.
Talk with your doctors if you think you may need to be revaccinated.
To help protect people with cancer from COVID-19, it is important that their family members, loved ones, and caregivers get vaccinated and boosted. All of the COVID-19 vaccines are highly effective at preventing severe disease and death from all variants that have emerged so far.
If I’m at high risk for severe COVID-19, what are other ways that I can protect myself? Aside from vaccination, the most effective way to prevent COVID-19 is to avoid being exposed to the virus that causes it. To protect yourself and prevent the spread of COVID-19, take precautions:
Get vaccinated against COVID-19 and stay up to date on boosters.
Wear a well-fitting mask that covers your nose and mouth.
Stay 6 feet away from people who don’t live with you.
Avoid crowds and poorly ventilated indoor spaces.
Some doctors advise that you make sure anyone you do have contact with has been vaccinated and/or tested negative for COVID-19.
Wash your hands often with soap and water. Use hand sanitizer if soap and water aren’t available.
Cover coughs and sneezes.
Clean and disinfect frequently touched surfaces daily.
Monitor your health and be alert for symptoms of COVID-19.
Your family members, loved ones, and caregivers can help protect you and other people at high risk of serious COVID-19 by following these precautions, too.
Certain people who are at high risk of severe illness from SARS-CoV-2 infection may be eligible to receive Evusheld to prevent the development of COVID-19 even before they have become infected with the virus. This product, a combination of the monoclonal antibodies tixagevimab and cilgavimab, has been authorized by the Food and Drug Administration for emergency use and is not a substitute for COVID-19 vaccination. People age 12 years and older weighing at least 40 kg (or 88 lb) are eligible to receive Evusheld only if they:
are not currently infected with SARS-CoV-2 and have not recently been exposed to someone who is infected
are moderately to severely immunocompromised and may not mount a protective immune response to COVID-19 vaccines
are unable to be fully vaccinated due to a history of severe adverse reaction to a COVID-19 vaccine or its components
What should I do if I have symptoms of an infection? What treatment should I get if I have COVID-19? If you think you have been exposed to COVID-19 or have symptoms of an infection, you should get a COVID-19 test. If the test shows that you have COVID-19, isolate yourself from others and call your health care provider. Treatments are available for people who test positive and are more likely to get very sick from COVID-19, including people with cancer. These treatments, which include both antiviral medications and monoclonal antibody treatments, must be given within a few days after symptoms begin, even if your symptoms are still mild. If you are being treated for cancer and need treatment for COVID-19, your health care providers should consider potential drug interactions with your cancer therapies or overlapping side effects. In some cases, your cancer treatment may need to be paused or modified while you receive treatment for COVID-19.Visit CDC’s website for more information about treatments your health care provider might recommend if you are sick.This is a stressful time. How do I cope? Coping with cancer in the face of the coronavirus can bring up a wide range of feelings you’re not used to dealing with. Learn more about feelings you may have and ways to cope with them.What if I have additional questions? NCI’s Cancer Information Service (CIS) can help answer questions that you or a loved one may have about COVID-19 or your cancer care. To reach the CIS:
Call 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 9:00 p.m. ET in English or Spanish. After business hours, recorded information is available.
Online LiveHelp® chat offers online assistance in English and Spanish Monday through Friday from 9:00 a.m. to 9:00 p.m. ET.
The following article features coverage from the American Society of Clinical Oncology 2020 meeting.
Significantly higher levels of pain were reported by women with a history of ovarian cancer who were classified as having a late chronotype compared with an early or mid-chronotype (P <.05). These baseline findings from an ongoing randomized trial evaluating lifestyle interventions were presented during the ASCO20 Virtual Scientific Program.
Few studies have evaluated the effect of chronotype, a manifestation of underlying circadian rhythm, on quality of life and other lifestyle outcomes in women with ovarian cancer.
This analysis assessed the association between chronotype and self-reported pain, sleep duration and quality, diet quality, physical activity, and the levels of systemic metabolic biomarkers at baseline in 438 patients with previously treated stage II, III, or IV ovarian, fallopian tube, or primary peritoneal cancer enrolled in the large, randomized, phase 3 Lifestyle Intervention for ovarian cancer Enhanced Survival (LIVES) study (ClinicalTrials.gov Identifier: NCT00719303). All patients had completed ovarian cancer treatment at least 6.5 months prior to enrollment.
Chronotype was defined in this study according to patient-reported bedtime as assessed using the Pittsburg Sleep Quality Index, with early, mid-, and late chronotypes corresponding to self-reported bedtimes of prior to 9 pm, between 9 pm and 12 am, and after 12 am, respectively. Patient-reported outcomes regarding health-related quality of life (HRQoL), including pain, were evaluated using the Rand-36 questionnaire, other validated measures were used to assess diet and physical activity, and levels of circulating biomarkers were evaluated at routine clinic visits.
Of the 438 patients included in the analysis, chronotype was classified as early, mid, and late for 33, 351, and 54 patients, respectively. While chronotype was not found to be associated with age, smoking history, and ethnicity, individuals with early chronotype had the lowest mean body mass index (22.9 kg/m2), followed by those in the mid-chronotype (27.6 kg/m2), and late chronotype (29.6 kg/m2) categories.
Other key study findings included significantly lower mean levels of sleep duration in those with late chronotype (7.4 hours) compared with mid- (10.3 hours) and early 8.6 hours) chronotypes (P <.05), although reported sleep efficacy was significantly higher in those with late chronotype compared with early and mid-chronotype (P <.05). Nevertheless, global sleep scores for those in all 3 categories of chronotypes were suggestive of disrupted sleep.
Regarding measures of HRQoL, only pain was significantly associated with chronotype, with higher levels of pain reported by individuals with a late chronotype compared with the other 2 groups (P <.05). Furthermore, significant associations between higher reported pain level and higher levels of C-reactive protein (P <.001) and fasting blood insulin (P =.015) were found that were independent of chronotype.
In her concluding comments, Tracy E. Crane, PhD, RDN, of the College of Nursing at the University of Arizona Cancer Center in Tucson, who was the lead author and study presenter, stated that plans were in place to perform longitudinal analyses of these measures according to LIVES study treatment arm assignment, and to include assessments of the circadian rhythms of study participants using actigraphy.
COVID-19 is presenting challenges for doctors treating ovarian cancer patients. And the ways in which they are adapting is changing in real time as the pandemic unfolds. First and foremost, a lot of patients with symptoms are staying at home, as they are being instructed to by the shelter-in-place directives. “But that means a lot people are at home with symptoms that aren’t being addressed,” says Dr. Lori Weinberg, gynecologic oncologist with Minnesota Oncology in the Minneapolis area
Covid-19 continues to pose challenges for doctors caring for ovarian cancer patients.
Due to shelter in place directives, women experiencing symptoms at home may not be getting lab work, or visiting with their doctor. Surgery is being delayed as a result of the pandemic. Starting treatment with chemotherapy rather than surgery is often the best option. COVID-19 is presenting challenges for doctors treating ovarian cancer patients. And the ways in which they are adapting is changing in real time as the pandemic unfolds.
First and foremost, a lot of patients with symptoms are staying at home, as they are being instructed to by the shelter in place directives. “But that means a lot people are at home with symptoms that aren’t being addressed,” says Dr. Lori Weinberg, gynecologic oncologist with Minnesota Oncology in the Minneapolis area. “I think there are many scenarios where women with symptoms are not getting the ideal workup—meaning CAT scans, biopsies, even a visit with their doctor— to help manage their symptoms. In addition, we’re also struggling with the surgical side of things.”
At start of the pandemic, the American College of Surgeons called on physicians to halt nonessential procedures. Most people assume that means facelifts or perhaps knee replacements that could be temporarily delayed without too much harm to the patient. But elective surgery is, by definition, any surgery that is scheduled. That includes cancer surgery, organ transplants, and other lifesaving procedures, many of which are now on hold. Though the guidelines specify that treatment shouldn’t be delayed if it would harm a patient, many surgeries remain in limbo.
“We are not able to take patients to the operating room right away, even when we feel like it’s necessary, because of hospital restrictions that are based on the number of COVID cases in our communities,” Weinberg says. Those restrictions aren’t always due to a lack of capacity to treat patients but more about trying to preserve ventilators, PPE—the protective equipment like masks and gowns that are in short supply—and ICU beds for patients with the virus. Of course doctors are also concerned about bringing patients who may already be immunocompromised into hospitals where they may be exposed to the virus, Weinberg says.
“For ovarian cancer we do have the benefit of the fact that we can treat our patients with upfront chemotherapy” rather than doing the surgery first. “We know from several studies that the outcomes are just as good if we consider doing neoadjuvant chemotherapy” —where doctors start with chemotherapy and then follow that up with surgery after about three or four cycles of treatment—”in certain scenarios. This gives us the opportunity to wait out these surges in COVID patients and still care for our patients the best way we can.”
Learn more about SurvivorNet’s rigorous medical review process.
Only a minority of women with ovarian or breast cancer undergo recommended genetic testing, a new study suggests.
Researchers examined data for about 77,000 women diagnosed with breast cancer and 6,000 diagnosed with ovarian cancer in 2013 and 2014. Only about 24% of breast cancer patients and 31% of ovarian cancer patients had genetic test results, the research team reports in the Journal of Clinical Oncology, online April 9.
“We initiated this study – the largest population-based study of multigene testing in breast and ovarian cancer patients – because we wanted to see what cancer genetic testing and results looked like in the real world,” Dr. Allison Kurian of Stanford University in California said in a news release.
“Our major finding was substantial under-testing of ovarian cancer patients: fewer than one third were tested, while guidelines advise that nearly all should be tested. For breast cancer, guidelines have not recommended testing all patients and thus a rate of 24.1% is less concerning,” Dr. Kurian told Reuters Health by email.
“It is crucial that doctors seeing ovarian cancer patients discuss genetic testing with them and facilitate their obtaining it, and that ovarian cancer patients and their relatives advocate for appropriate genetic counseling and testing in their care,” she added.
When genetic tests were performed, 7.8% of women with breast cancer and 14.5% of those with ovarian cancer had pathogenic variants, information that “could be used to drive care decisions and influence family members’ health care and screening choices,” Dr. Kurian said in the release.
The study also found “concerning” disparities in genetic testing by race/ethnicity and insurance status.
For example, nearly 34% of non-Hispanic white women had genetic testing, compared with only about 22% of black women and 25% of Hispanic women. About 20% of Medicare patients were tested compared with about 34% of those with other forms of health insurance.
The prevalence of genetic was around 20% in areas where 20% or more of residents were poor compared with about 38% in regions with less poverty.
“More research is needed to understand all the factors contributing to this gap in care quality and how best to fix it,” Dr. Kurian told Reuters Health.
The study did not have commercial funding. Dr. Kurian has received research funding from Myriad Genetics and has other relationships with Ambry Genetics, Color Genomics, GeneDx/BioReference, Invitae and Genentech.
What is coronavirus, or COVID-19? Coronaviruses are a large family of viruses that are common in people and many different species of animals. SARS-CoV-2 is a novel (new) coronavirus that causes a respiratory disease named coronavirus disease 2019, which is abbreviated COVID-19. As SARS-CoV-2 spreads, the virus can change, which results in new variants. Some variants may spread more easily than others or be more resistant to vaccines or treatments.
The following article features coverage from the American Society of Clinical Oncology 2020 meeting.
Only a minority of women with ovarian or breast cancer undergo recommended genetic testing, a new study suggests.