Is it safe to delay radiation due to COVID-19?
This article from Katie Deming, MD, radiation oncologist, may help breast cancer patients who are trying to decide if they should delay their radiation treatment because of the COVID-19 pandemic. Dr. Deming talked with radiation oncologists across the US to determine best practices regarding COVID-19.
Here are six frequently asked questions to help you decide if you should delay radiation:
Will a delay in my treatment increase my risk of recurrence?
It depends on the features of your breast cancer and the stage. The typical time between surgery and radiation is six weeks. For small (<2cm) tumors with no lymph node involvement, studies show that a delay in radiation therapy of up to 20 weeks after surgery results in no increased risk of recurrence.
If your tumor is larger than 2cm, triple-negative, Her2Neu positive, or lymph node-positive, your doctor may recommend proceeding with radiation sooner. The timeliness of radiation may be more critical in tumors with these features. It is essential to discuss the pros and cons with your physician.
If you are having radiation directly after chemotherapy, the typical time between chemotherapy and radiation generally is four to six weeks. Discuss this with your clinical team to determine the best timeframe for you.
Are there alternative therapies available while I wait for radiation?
If your tumor is estrogen positive, the answer is “yes.” Your medical oncologist may start you on anti-estrogen therapy during the delay.
If your tumor is Her2Neu positive, you normally (in most cases) will be prescribed anti-Her2Neu therapy for one year while you wait for radiation.
For triple-negative tumors, normal protocol (in most cases) is chemotherapy before radiation. If you have a delay between chemotherapy and radiation therapy, the options for additional therapy are minimal. It is important to discuss options with your care team.
Is my immune system compromised during radiation?
Radiation does not lower your blood counts and is not considered immunosuppressive (immunosuppression is an impaired ability of the immune system to fight infection or other diseases), although it is important to note that radiation does cause stress on the body, which can impact your immune system. During radiation, your body expends more energy on DNA repair, and this may affect immune function.
The best way to bolster your immune system during radiation is to eat well, sleep at least eight hours a night and exercise.
If you had chemotherapy before radiation, you would have immunosuppression from chemotherapy. Blood counts typically recover by four weeks after chemotherapy. It is essential to ask your medical oncologist how long he or she expects immune compromise after chemotherapy.
What will happen if I get COVID-19? Can I get critically ill or die?
The Centers for Disease Control and Prevention (CDC) has established these statistics by age (updated March 22, 2020), but they are changing rapidly. (If you are not receiving chemotherapy, it is appropriate to consider your likelihood based on your age category).
20 – 44 years old: <1% mortality
45 – 54 years old: <1% mortality
55 – 64 years old: 1-3% mortality
65 – 84 years old: 3-11% mortality
85 years and older: 10-27% mortality
Note: if you are immunocompromised from chemotherapy, your risk is higher than the age categories listed below.
Shouldn’t I have my treatment now while the infection rate is low?
The low infection rate is likely due to a lack of testing and a long incubation period of the virus (seven to 21 days). Infection rates are rising. As testing becomes more available, medical experts will gain a better understanding of the true incidence of infection. Talk with your doctor to determine if a delay in radiation is considered safe, or if waiting is the best decision.
Is it socially irresponsible to come in for radiation treatment during the COVID-19 pandemic?
As an oncologist, I firmly believe it is NOT irresponsible to come in for your cancer treatment. If you and your doctor have decided you should receive treatment, follow your doctor’s orders. Your cancer treatment is essential to your health and well-being.
For the most up-to-date information on COVID-19, please go to these websites:
- Centers for Disease Control and Prevention: cdc.gov/coronavirus
- World Health Organization: who.int
Katie Deming, MD, is a board certified radiation oncologist in Portland, Oregon, who specializes in breast and gynecologic malignancies. She is a clinical researcher with The Center for Health Research, and creator of the first cancer-specific national patient advisory council within Kaiser Permanente.