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COVID-19, what are the risks for patients with lung cancer?
The LUNGS are under attack of the new coronavirus Sars-CoV-2. And there is a growing concern for those who, because of a tumor, is already compromised. As you protect, then, the patients most vulnerable without prejudice to their care pathway? If it is true that all cancer patients are vulnerable, it is also true that anyone who is affected by a tumor in the lungs runs a higher risk if you get sick of COVID-19. “In these patients the lung tissue – the target of the virus - it is often already compromised”, says Massimo Di Maio, the National Secretary of the AIOM (Italian Association of Medical Oncology) and Director of Oncology of the Hospital Mauriziano of Turin: “There are patients who have less lung because they have been operated, and patients in whom the function of the organ is decreased because of smoking or suffering from chronic bronchitis. Many also have a circulatory system already compromised”.
lung Cancers, more attention In the everyday life for these people to follow the rules for the prevention of infection is indicated by the world health Organization it is even more important than for others. But what to do if you have to go into the hospital for a visit or a planned therapy? “You evaluate a case-by-case answers Of Maio - but to protect the patients, it is important to limit the opportunity for exposure to the Coronavirus. The hospital visits, therefore, should be reserved for cases of actual need, i.e. when the benefits that the patient may benefit from treatment are greater than the risk of going in the hospital.”

“As medical oncologists, we are facing a big dilemma practical in this time of emergency: the desire to provide treatments to patients collides with the need to protect them from infection with Sars-Cov-2, and with the lack of resources in many hospitals. However, we are not in disarray: the AIOM, together with CIPOMO (Italian College of Primary Medical Oncologists, Hospital) and COMMUNITY (the College of the Medical Oncologists at University) has issued general recommendations to develop a case-by-case, by appeal to the good sense and good clinical practice, to ensure the care services they need without adding risk to risk.” In general, when practical, for patients with lung cancer in chronic treatment (many months) with chemotherapy or immunotherapy, it is reasonable to consider postponing the check-up visits, and therapy sessions in the hospital. “Are patients in the maintenance, for which a delay of a few weeks the treatments did not affect the prognosis.

patients who are taking oral medication with molecular target drugs, such as inhibitors of the ALK or EGFR, however, should not stop the treatment, otherwise the tumor starts to grow again. “In these cases we tend, when possible, to reduce access hospital providing a supply of medication that covers a longer period, or even we can think of to send the medication home. If the doctor has observed that in a given patient the drug is well tolerated and does not expect you to have too much toxicity, then it is also possible to postpone the visits of control”. We also recommend that you postpone the appointments of follow-up for patients without active disease, and who have completed the treatments, or try alternatives such as contact by telephone or e-mail.
Immunotherapy, no panic in A question that doctors and researchers are (already for some time) trying to find an answer is if the drugs immunoterapici (the purpose of which is to strengthen the immune system against the tumour) and may contribute to give rise to an exaggerated response, and then to complications in case of infections. “The truth – says Di Maio - is that we do not know yet. The relationship between immunotherapy and effects on the risk of infections is not well known. Will probably be useful to studies that are immediately political parties, in Italy and in the world, to describe the progress of the disease COVID-19 in cancer patients. From these studies, we will draw useful information on the evolution of the disease depending on the type of tumor and type of treatment. In Italy in recent months, the study was conducted ENVY-2, which aimed to describe the use and effectiveness of the vaccine and anti-flu in over a thousand patients undergoing immunotherapy. This study, without intending to, will also be a useful mine of information on any cases that have contract COVID-19”.
always Communicate In these days the communication with the patient is become, if possible, is even more fundamental. “The Agenda at hand, we will contact you by telephone patients who had a visit or a therapy session in the program, and depending on the case we decide to confirm or postpone the appointment,” says Di Maio. “Important is to explain to the patient the reasons that led to the decision: we can't just erase all of the concerns, but we can reassure you on the fact that no one will be left behind.”

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