Unique risks of COVID-19 for people with breast cancer

Most people infected with the COVID-19 virus will have mild to moderate respiratory symptoms and recover without requiring special treatment or hospitalization. Some will have no symptoms at all.

According to the CDC, currently having cancer increases your risk of having serious complications if you do become infected with COVID-19. At this time, it’s not known if having a history of cancer increases your risk of serious complications.

This higher risk for serious complications from COVID-19 for people currently diagnosed with cancer likely is because having cancer puts a strain on the body and also because certain treatments can cause people to become immunocompromised (have a weakened immune system) or have lung problems.

The following breast cancer treatments can weaken the immune system:

• all standard chemotherapy drugs, such as Taxol (chemical name: paclitaxel), Taxotere (chemical name: docetaxel), Cytoxan (chemical name: cyclophosphamide), and carboplatin
• certain targeted therapies, such as Ibrance (chemical name: palbociclib), Kisqali (chemical name: ribociclib), Verzenio (chemical name: abemaciclib), and Piqray (chemical name: alpelisib)

Typically, the immune system recovers within a couple of months after you stop receiving chemotherapy or targeted therapy. But your immune system’s recovery time can vary and depends on several factors. If you received those treatments in the past, it’s not clear if you are at higher risk for serious complications from COVID-19. If you’re receiving ongoing treatment with these medicines for metastatic breast cancer, it’s likely that your immune system is weakened.

Some chemotherapy medicines and targeted therapies can also cause lung problems, which could put people at higher risk for serious COVID-19 complications. Rare but severe lung inflammation has been linked to Ibrance, Kisqali, Verzenio, and the immunotherapy drug Tecentriq (chemical name: atezolizumab).

People with metastatic breast cancer in the lungs also can have lung problems that may get worse if they develop COVID-19.

Some people with breast cancer may have other risk factors for developing serious complications from COVID-19. For example, you are at greater risk if you:

• are age 65 or older; though the risk for serious complications increases with age, so people in their 50s are at higher risk than people in their 40s and people in their 60s and 70s are at higher risk than people in their 50s; the greatest risk for serious complications is among people age 85 and older
• have chronic obstructive pulmonary disease (COPD)
• have a serious heart condition
• have type 2 diabetes, chronic kidney disease, or sickle cell disease
• are obese
• smoke

Research on COVID-19 and cancer is very limited, so it’s not clear how COVID-19 may affect people diagnosed with cancer. It’s also not clear how different types of cancer may affect COVID-19 outcomes.

To provide more information, researchers at Vanderbilt University have launched a project called the COVID-19 and Cancer Consortium (CCC19) to track outcomes of adults diagnosed with cancer around the world who have been infected with COVID-19. More than 100 cancer centers and other organizations are participating.

The first report from this project was published in the Lancet on May 28, 2020, and included information on 928 people diagnosed with cancer in Spain, Canada, and the United States who also were diagnosed with COVID-19. Breast cancer was the most common cancer in the group, affecting about 20% of the people. Half the people were older than 66, and 30% were older than 75.

About 13% of the people in the study died, which is about twice the death rate for all people with COVID-19. A higher risk of dying for people with both cancer and COVID-19 was linked to the same risk factors for people without cancer who get COVID-19, including:

• being older
• having a serious underlying health condition, such as diabetes, kidney disease, or heart problems
• being a man

Still, the researchers also found risk factors that were unique to the people diagnosed with cancer, including:

• having active (measurable) or growing cancer
• a poor ECOG performance status score, which measures a person with cancer’s ability to function, care for themselves, and engage in physical activity

Cancer type and cancer treatments did not appear to affect the risk of dying from COVID-19. If you are very concerned about how your specific breast cancer treatments may affect your ability to recover from COVID-19, it makes sense to talk to your doctor and decide on a treatment path that gives both of you peace of mind.

Other small studies that looked specifically at people with breast cancer at hospitals in France and New York City showed similar encouraging findings: most people with breast cancer recovered from COVID-19 if they were infected, and underlying medical conditions seemed to increase the risk of COVID-19 complications more than breast cancer treatments did.

Again, it will take time to perform enough research for scientists to completely understand how a cancer diagnosis affects COVID-19 outcomes.

From www.breastcancer.org