Dr. Nadeem Shoket
The tumultuous arrival of COVID-19 has hardly afforded any time for experts to put forward formal recommendations regarding the management of different types of cancers of the human body during this pandemic. Same holds true for leukemias, which are types of a more commonly used term called blood cancer. Four common leukemias we oncologists frequently encounter in our clinical practice include: Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Chronic Myeloid Leukemia (CML) and Chronic Lymphoblastic Leukemia (CLL). These are some of the most troublesome ailments a human body can be afflicted with. Put COVID-19 in the mix, and you have a potential catastrophe at hand.
Most of these leukemias have a prolonged treatment course which requires multiple hospital visits and day care admissions, sometimes over a period of months. The issue of dealing with leukemias in the midst of the COVID-19 pandemic needs to be dealt with utmost seriousness and care, because here we have patients at the lowest level of their immunity venturing into an environment as hostile as any, for treatment, of course.
So, a close liaison between patient and treating oncologist becomes one of the most important factors for management of the disease during the COVID-19 pandemic. Open communication utilizing every modern technological resource at hand to minimize COVID-19 exposure risk is crucial as it can significantly reduce the number of hospital visits for the patient. Making the patient or their attendant understand the goal of the treatment process, the hows and the why, the ins and theouts of what needs to be monitored between each hospital visit so that they can look out for when to contact the treating oncologist in assessing whether any intervention is needed between treatments, especially assessing the option to bring the patient in or not for checkups. In majority of these cases, evading neutropenia (low neutrophil counts) stands as the central goal through the course of leukemia treatment. Closely monitoring blood counts and altering drugs accordingly in a timely fashion can help reduce hospital visits tremendously, especially in patients with ALL where the treatment has a tediously long maintenance phase. Telephonic corroboration of the blood counts and other lab investigations, or e-visits (which most hospitals are adopting these days) with the oncologist over the internet for minor ailments can add tremendous value in mitigating COVID-19 transmission and keeping these ALL patients safe while not compromising on patient care as far as cancer treatment is concerned. For leukemias with comparatively less immunosuppression such as CML as well, similar strategy, such as telephonic or e-consults with the oncologist can be implemented to minimize COVID-19 transmission risk. Altering treatment plans to avoid neutropenia after corroborating complete blood counts, again, becomes an option here, which can be discussed with the oncologist.
This strategy of altering drugs to avoid neutropenia is not an option always available to the oncologist. This holds true for induction of treatment for ALL where recommendations have to be followed strictly with hardly any room for improvisation. For intensification, again though, drug regimens can be implemented in a way to minimize neutropenia.
Also, for CLL, the room for improvisation for the oncologist is restricted because the staging of CLL can sometimes force the oncologist to start treatment as soon as the disease is diagnosed even if it exposes the patient to a higher risk for secondary infections. This is the decision the oncologist can make, weighing the risk vs benefit profile of each individual patient and the staging of the disease.
AML requires intensive treatment and most of the treatment might need to be done on an in-patient basis. This should be managed by keeping AML patients undergoing treatment in isolation wards with a dedicated nursing staff to reduce the probability of COVID-19 infection to as much as institutionally possible.
(The Author is Medical Oncologist in American oncology Institute-Jammu)
Dr. Nadeem Shoket