Managing Elderly Cancer Patients During COVID-19
Since the COVID-19 pandemic began, physicians and researchers have been working to determine how the virus impacts cancer patients and their care. Moffitt Cancer Center has partnered with more than 120 other health care institutions across the U.S. to form the COVID-19 and Cancer Consortium. The group’s mission is to collect data about patients with cancer who have been diagnosed with COVID-19.
The consortium has determined elderly patients have certain risk factors beyond age that could increase their risk of dying from COVID-19. Recent data shows the risk of death from the virus was at least two to three times greater for older patients whose cancers are progressing or are not responding well to treatment. That risk increases even more if the patient was intubated due to COVID-19.
Dr. Christine Sam, medical oncologist in Moffitt's Senior Adult Oncology Program
“The elderly patient population definitely has a higher risk of developing severe infections with COVID-19,” said Dr. Christine Sam, a medical oncologist in Moffitt’s Senior Adult Oncology Program. “If you have an elderly patient with cancer who fits three major risk factors—advanced age, progressing cancer and poor performance status—then their risk of having a serious outcome if they become infected with COVID-19 is very high.”
Sam says the Senior Adult Oncology Program has been working on strategies to reduce exposure to COVID-19 and limit treatment related immunosuppression to ensure the safety of its patient population.
In addition to encouraging social distancing, mask wearing, appropriate vaccinations and proper hand hygiene, the clinic is taking advantage of telemedicine.
“Telehealth is one of the best ways to reduce the risk of health care exposure to COVID-19,” said Sam. “That can be a double-edged sword because some of our patients are not comfortable with using technology. Going forward, we need to find ways to help these patients feel more comfortable with telehealth visits or find a more geriatric-friendly way of conducting telehealth visits.”
For high risk patients with many comorbidities, Sam says the clinic considers administering less intense doses of chemotherapy or changing to alternative treatments that are less likely to affect the immune system. This is not always possible, so each patient is given a COVID-19 test before beginning immunosuppressive treatment and their physical fitness is assessed by a geriatric evaluation.
“It's important to assess patients in terms of their functional status and treat based on that rather than just age,” said Sam. “Functional age, which includes fitness and overall health, is more important than chronological age when assessing for risk of toxicity with treatment.”
Sam says while new COVID-19 protocols will continue to evolve, it is important to inform patients of the risk of COVID-19 and how it impacts their treatment.
