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Acute Oncology Service

 

In the Oncology Department at St George’s we understand that if you are a patient with cancer the Covid-19 pandemic is a very difficult and worrying time. All of our patients, their relatives, and their carers can be reassured that at St George’s we are doing all we can to make sure patients get the treatment, information and support they need whilst reducing the risk of exposure to infection.

What is coronavirus?

The coronavirus is a viral infection that causes symptoms similar to seasonal ‘flu, and in most people the symptoms will be mild. COVID-19 is the illness caused by a novel type of coronavirus affecting your lungs, airways and breathing. Although for most people it will be a mild illness, for some the virus can have serious complications.

People with cancer are among those at higher risk of complications. This is because cancer and its treatment can weaken the immune system.

How can cancer and treatment weaken immunity?

The immune system protects the body against illness and infection caused by viruses such as coronavirus. Some people with cancer have a weakened immune system which reduces their ability to fight these infections.

One of the reasons for this can be that treatments, like chemotherapy, can stop the bone marrow from making enough white blood cells. White blood cells are part of your immune system.

Some cancer treatments, particularly chemotherapy and immunotherapy, make patients much more likely to have serious effects from the COVID-19 infection because of the body’s reduced ability to fight infections. This may lead to the need for intensive care in hospital.

Which cancer patients are at highest risk during the COVID 19 pandemic ?

If you are in one of the following groups, we believe you to at increased risk from COVID 19. These groups of people include patients who are currently receiving or have received in the last 3 months:

  • chemotherapy
  • radical radiotherapy for cancer
  • immunotherapy or other continuing antibody treatments for cancer
  • having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • Patients with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment can review advice on the haematology website :
  • https://www.stgeorges.nhs.uk/service/diagnostic-services/haematology/

If you are unsure what treatment you are having and whether you are in one of these groups speak to the team caring for you. Your Cancer Specialist Nurse at St Georges can help you identify if you are at high risk or not.

You should remain at home as much as possible and adopt shielding (see section below on shielding).

What do I do if I have symptoms or a high temperature?

When you are receiving cancer treatment (particularly those listed above i.e. currently receiving treatment or have been in the last 3 months), you are at risk of getting infections. The symptoms from any infection and the symptoms from COVID 19 may be very similar. If you have a fever you MUST contact emergency cancer care line urgently. In these circumstances you must NOT self isolate at home, as you may have another life threatening infection that requires urgent treatment,  you will be advised to come to hospital for urgent review.

The symptoms of coronavirus include:

  • a high temperature of above 37.8C and, or
  • a new continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)

Contact the emergency cancer advice line below, if you have these symptoms and you are having cancer treatment or have cancer that affects your immune system. You should do this as soon as possible if you have symptoms and/or you feel unwell.  Or call 999 immediately if you are seriously ill.

If you have symptoms but you are not having cancer treatment, you can look at the NHS 111 online coronavirus service or call NHS 111.    

https://111.nhs.uk/covid-19/

Will I continue my cancer treatment?

We will continue to provide cancer treatment, but in order to protect you as best we can, we will carefully consider what steps can be taken to minimise your risk and keep you safe. Looking at the risks versus possible benefits is part of normal decision making in cancer medicine and we continue to adopt this approach in the current environment taking into consideration the added risks the coronavirus pandemic poses whilst following national guidance and best practice.

All of our recommendations are made on an individual basis and will meet your individual requirements, without compromising your cancer care:

The decision to continue your treatment will be carefully considered by the team looking after you and discussed with you by a member of your team who know you and your treatment best. In some circumstances the risks carried from COVID 19 may outweigh the benefit of your cancer treatment, and in these circumstances it may be best to discontinue treatment.

For some patients, it may be that your treatment can be safely postponed (by weeks or months) without significantly compromising your cancer care. In some patients we may modify or change the type of treatment that we give in order to minimise risk to you.

For some patients, it may be that a telephone consultation would be adequate prior to receiving treatment, and we may be able deliver your medication in the post.

You will be at the centre of all our treatment decisions and your oncology doctor or another member of the team looking after you will keep you informed and discuss with you which is the safest and recommended course of action during this pandemic.

How might my cancer appointments change?

We would ask that you do not bring relatives, or friends to appointments with you. If you need a carer, then of course they can come.

We will endeavour to minimise your face to face contact at the hospital, however, for some patients your doctor will still need to see you in person, your team will direct you as to whether you are suitable for telephone consultations or whether you need to come to your appointment in person. A telephone consultation just means that we will phone you at home rather than asking you to come into hospital, and discuss all of the same issues that we would normally discuss (such as side effects from treatment, how you are coping generally etc).

Should I attend for scans and tests?

If your doctor has booked a test or scan, we would strongly encourage you to attend for the scan or test, as these often provide important information to keep you safe and are crucial for guiding your care and they are very important. You may receive a letter or telephone message asking you not to attend for your scan from the radiology department. You should follow this advice.

If you are not sure if you should attend, please contact your specialist nurse.

The Trevor Howell day unit and the Ambulatory Oncology Care Unit (AOCU) have temporarily relocated.

Another approach to protecting our patients, and to continue treatment, has been to move the Trevor Howell Day Unit, where you would normally receive your treatment, and the Ambulatory Oncology Care Unit, where you would be assessed for cancer related/treatment related symptoms, to a separate building called the Maxillofacial and Day Surgery building, which is on the perimeter road next to the Rose Centre:

You can access the map here:

https://www.stgeorges.nhs.uk/wp-content/uploads/2013/05/MaxFax-Map-1.png

The new chemotherapy day unit telephone numbers are now: 0208 725 0434 and 0208 725 0418

The previous telephone numbers for the AOCU have all been diverted to the new site, and the emergency patient number continues to be: 07831 147653

To reduce the risks of exposure we will avoid unnecessary trips to the hospital and advice regarding management of symptoms will be given within this context, only bringing patients in for assessment/treatment when it is in your best interests.

What is shielding?

‘Shielding’ means that you stay home and avoid face-to-face contact for at least 12 weeks. You can continue to have visits from anyone who helps you with essential support.  For example, healthcare staff or carers.

All visitors should wash their hands with soap and water for at least 20 seconds when they arrive at your home and often during the visit. Shielding means you should:

  • avoid anyone who has possible coronavirus symptoms
  • stay at home
  • avoid family gatherings, even in private spaces
  • ask family or friends to arrange shopping for you and leave it at your door

You may receive a letter about shielding if you belong to a vulnerable group. If you think you belong to one of these groups and you have not had a letter, talk to your GP or cancer specialist. The 12 week time period may change if the guidance changes.

I live with other people, what should we do?

Anyone who lives with you should reduce their contact outside their home where possible. But they do not have to practice the same shielding measures. They should practice social distancing (see below).

Look at the Public Health England guidance for detailed information on how to do shielding.

  • Spend as little time as possible with other people that you live with in shared spaces, such as the kitchen or living room. Keep these areas well ventilated.
  • Try to keep 2 meters (3 steps) away from people you live with. Sleep in a different bed where possible.
  • Use separate towels to other people in your house.
  • Use a separate bathroom if possible. If you need to share a toilet and bathroom, this should be cleaned after you use them.
  • Everyone should wash their hands regularly, avoid touching their face and clean frequently touched surfaces.

Depending on your situation, it could be very difficult to stay separate from others at home. Do what you can. It is important that you feel you can support each other through this.

The decision to protect yourself from coronavirus with shielding measures is your personal choice and circumstances. For example, there are some people who because of their cancer may have a limited time to live. And so they may decide not to fully follow the shielding measures.

For more information about shielding, visit the GOV.UK website

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

I have cancer but I’m not in one of the vulnerable groups, what should I do? (social distancing)

If you are not in one of the above vulnerable groups, you should follow guidance for social distancing. The aim is to reduce your risk of catching and spreading the coronavirus.

Social distancing means reducing your social contact with other people. The guidance includes:

  • steps you can take to reduce your social interaction
  • importance of looking after your mental wellbeing and keeping in touch with others
  • advice for visitors and informal carers

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Coping with worry and anxiety, and maintaining a healthy mind

It can be very difficult if you are advised to stay at home and reduce face-to-face contact. Getting support from others when you have to deal with cancer is important. Talk to those close to you when you can and stay in touch in whatever way you can, whether by phone, online or letter. It helps to share what is making you anxious. And knowing you are not alone can help you cope better.

If you are feeling scared or anxious about coronavirus, it might be sensible to limit the time you spend looking at social media or news on TV. Only use reliable sources of information.

Tips

  • Have a routine
  • Eat a healthy diet, drink plenty of fluids and avoid getting into unhealthy habits such as smoking or drinking alcohol.
  • Keep active – the NHS website has tips for keeping fit at home
  • Try to do things you enjoy such as reading, jigsaws, cooking, drawing.
  • Keep in contact with family and friends – use an app so you can see them, you could eat a meal together while chatting.
  • Get fresh air – open your windows, if you have a garden go in it, or sit on your step keeping at least a 2 metre distance from anyone.

Cancer research UK have a freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.

https://www.cancerresearchuk.org/about-us/contact-us/talk-to-our-nurses

There are also different charities and organisations that offer online support or telephone support.

https://www.mind.org.uk/information-support/coronavirus/coronavirus-and-your-wellbeing

https://www.nhs.uk/oneyou/every-mind-matters/coronavirus-covid-19-staying-at-home-tips/