Coronavirus (COVID-19) – health advice for liver cancer patients

Posted on: 22nd May 2020

The coronavirus is a large family of viruses that includes the common cold and flu. COVID-19 is the disease caused by a recently discovered coronavirus.

If you or a loved one has liver cancer, you are likely to be very worried about the impact of COVID-19.

Here you’ll find all information and links to help you if you live with liver cancer.

Hospitals are continuing to actively manage patients with liver cancer, and plan to do so within an in-patient and out-patient infrastructure which prioritizes patient safety and minimizes risks of exposure to the virus.  We recognise that these are unusual and unsettling times and we have been assured by clinicians that they are not too busy to take your calls. If you have been diagnosed with liver cancer please do therefore contact your local team.  Telephone consultations are safe and very easy to arrange.

Some people with liver cancer are more at risk of becoming seriously ill if they contract COVID- 19.

You are more at risk if you

  • are undergoing active chemotherapy
  • having immunotherapy or other continuing antibody treatments
  • have secondary cancers
  • are having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

 

Other factors are also understood to be linked with a poorer prognosis with COVID-19 and may also have been considered in the risk assessment of continuing your treatment.

 

  • Age over 60
  • Pre-existing cardiovascular disease
  • Pre-existing respiratory disease

Your hospital team are best placed to advise on what impact stopping your treatment may have on your overall health.

Your hospital team may assess whether the risks of starting or continuing cancer treatment during the COVID-19 pandemic will outweigh the benefits. They will be in touch with you if there will be any changes to your treatment or how you receive it, including any decision to temporarily stop or delay treatment.

However, generally the number of Covid patients is now reducing, and hospitals are now actively planning services. Whilst the majority of outpatient consultations may still be virtual or telephone, hospitals are seeing people face to face when necessary, employing strict hygiene and social distancing criteria to keep people safe. Interventional treatments for cancer patients, such as TACE and MWA are still being performed and hospitals have defined specific pathways to minimize the risk of exposure to COVID-19. Liver cancer patients can also be assessed for transplant.

Any decision made to alter or stop your cancer treatment during the COVID-19 outbreak will have been carefully considered by your hospital team – assessing whether the risks of continuing your treatment may outweigh the benefits.

Do not stop taking your treatment unless you have been advised to by your hospital team.

Some cancer treatments may cause a weak immune system. This is because they can stop the bone marrow from making enough white blood cells, and white blood cells are part of your immune.

If your treatment has weakened your immune system, you will have received a letter from the Government, or your GP or hospital, notifying you that you are considered ‘clinically extremely vulnerable’.

During the peak of the pandemic, you will have been instructed to ‘shield’, but currently the government is advising that you no longer need to shield because the rates of transmission of COVID-19 in the community have fallen significantly.

However, if there is an outbreak of COVID-19 within your area, you should follow any guidance set out locally or any specific law which applies to the area you live in. If you do have any concerns as to how your cancer or your cancer treatment may affect your immune system, your hospital team will be able to provide you with information tailored to you and your treatment.

If your cancer treatment has been paused or changed because of the COVID-19 outbreak, it is anticipated that you will be able to restart your current treatment once the COVID-19 outbreak has passed. Your hospital team will be able to provide you with advice around this, and any plans for restarting treatment.

 

Your hospital team will be able to advise on how contracting COVID-19 may impact your current treatment schedule.  If you are worried that you have contracted COVID-19 please contact your healthcare team by telephone to notify them as soon as possible.

COVID-19 is a new virus and a lot is still unknown about it. However, it is understood that certain groups of people have increased vulnerability to COVID-19, including cancer patients dependent on their cancer and the type of treatment they are receiving.

Hospital teams will consider their cancer patients on an individual basis to assess whether what is known about COVID-19 poses an increased risk to them, and if any changes to their current cancer treatment should be made to help manage or minimise this risk. Such changes may include involve switching a patient’s current treatment to one that can be administered at home, altering the treatment schedule to minimise hospital visits, delaying treatment, etc.

If your healthcare team makes the decision to alter your treatment at all, they will be able to explain the reason for this decision, and the risks and benefits of this decision to you and your family or carers.

If you have increased vulnerability to COVID-19 because of your cancer or treatment, you will have previously been instructed to ‘shield’, but the government has now ‘paused’ this because the rates of transmission of COVID-19 in the community have fallen significantly.

This means:
• You do not need to follow previous shielding advice
• You can go to work as long as the workplace is COVID-secure, but should carry on working from home wherever possible
• Clinically extremely vulnerable children should attend education settings in line with the wider guidance on reopening of schools and guidance for full opening: special schools and other specialist settings
• You can go outside as much as you like but you should still try to keep your overall social interactions low
• You can visit businesses, such as supermarkets, pubs and shops, while keeping 2 metres away from others wherever possible or 1 metre, plus other precautions
• You should continue to wash your hands carefully and more frequently than usual and that you maintain thorough cleaning of frequently touched areas in your home and/or workspace
• You will no longer receive free food parcels, medicine deliveries and basic care from the National Shielding Service

You will still be able to get:
• Local volunteer support by contacting your local authority
• Prescriptions, essential items and food you buy delivered by NHS Volunteer Responders
• Priority slots for supermarket deliveries (if you previously registered for free food parcels)

However, if there is an outbreak of COVID-19 within your area, you should follow any guidance set out locally or any specific law which applies to the area you live in.

On their websites, Macmillan and Cancer Research UK both provide information on how different treatments and different tumour types may be affected by the pandemic:

Macmillan: https://www.macmillan.org.uk/coronavirus/cancer-treatment-and-coronavirus
Cancer Research UK: https://about-cancer.cancerresearchuk.org/aboutcancer/cancer-in-general/coronavirus/cancer-treatment

The NHS is continuing to ensure essential cancer treatment and diagnostic tests will continue to run during the pandemic. However, in some circumstances there will be some changes in the way these services and treatments are delivered. Your hospital team will call you to discuss these changes, or if they need to rearrange any scans or diagnostic tests.

For general appointments, some hospitals and GP practices are using alternative methods to deliver medical advice and decisions surrounding cancer care, such as telephone or video consultations. These methods of communication are to help cancer patients avoid unnecessary travel to hospitals for appointments and consultations that are not needed to take place in person.

If you do need to travel to the hospital for your appointment, you will be asked to attend without family members or carers, if you can, to reduce the risk of contracting or spreading COVID-19. To minimise the time you spend in a waiting area, you might be asked
to avoid arriving early or waiting outside until you receive a text to say you can enter the hospital for your appointment.

Every individual case is different, and your hospital team will be able to provide you with further information on how your treatment and care plan will be organised. Your safety is paramount during this time, so your hospital team will always ensure to update you with any changes concerning your cancer care. If you are waiting for a test, scan or treatment, but have not heard anything from your hospital team, you should contact them as soon as possible to discuss.

Your hospital team will be able to discuss if it is necessary for you to travel to hospital to receive treatment and will be able to present alternative options to administer treatment if needed. These discussions will likely be with a doctor and will be conducted via a consultation via telephone or video conference. Some treatment services may be able to be administered at home. Your hospital team will discuss if this is necessary based on your individual treatment plan and circumstance.

Remember - hospitals are increasingly safe places to visit – the number of Covid patients is reducing.  If your hospital cannot do an appointment virtually – by telephone or video – they will do everything they can to ensure patients are as safe as possible and feel safe when they have to attend.  Social distancing, strict hygiene and sanitising and using PPE are there to protect patients – from other patients and staff. Increasingly, if you are admitted for a procedure or a treatment, it is very likely you will need to be tested and be shown to be COVID free before the hospital can proceed – with the reassurance that all the patients around you have also been tested and are also COVID free.

If you have any concerns or questions about attending a hospital appointment, please speak to your hospital team.

People who are diagnosed with cirrhosis, have hepatitis B or C, have non-alcohol related liver disease or haemochromatosis, should receive regular ultrasound scans and blood tests every six months to monitor for primary liver cancer (HCC). This is called surveillance. Having these tests regularly can pick up hepatocellular cancers earlier, when they are smaller and surgery may be possible.

During COVID-19, surveillance had been postponed until it is safer for patients to attend hospital. Most hospital teams are now planning to re start surveillance from June 2020 and will be planning to ‘catch up’ with the missed scans over the coming months.

 

Active new patient recruitment for most trials has been suspended.  For all active treatments whether standard or as part of a trial – the responsible teams will be making decisions on a case by case basis, dependant on benefits versus risks for individual patients.

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