Your doctors will aim to continue with your treatment wherever possible. But they might need to change your treatment or prioritise certain treatments over others.
Talk to your health care team about the effect of the coronavirus outbreak on your treatment plan. They know about your individual situation and will try to work with you to find the best plan for you.
It might mean that how you have treatment is different, such as taking tablets instead of having a drip or you might have your treatment in a different centre. It is understandable that you might worry about this, understanding more about these possible changes can help you to cope with them.
The coronavirus causes an illness called COVID-19 which can affect your lungs and airways. For most people, the virus won’t cause serious problems. But for some people with cancer, the virus can have serious complications. This is because cancer and treatment can weaken your immune system.
We have information on this page about coronavirus and different treatment types including:
- chemotherapy, immunotherapy and other cancer drugs
- stem cell transplants
What's being done to help cancer treatments continue?
Cancer specialists are working together to coordinate cancer services. They have set up specialist ‘cancer hubs’ across the country.
Theses hubs coordinate cancer services in the different hospitals in that area. The hubs will support both NHS hospitals and private hospitals to work together to help hospitals deliver as much cancer treatment as possible. This might mean you go to a different hospital for part of your treatment – for example, your surgery. But your current cancer specialist will remain in charge of your overall care and you should contact them or your specialist nurse if you have any questions about your care.
The National Institute for Health and Care Excellence (NICE) has issued guidelines for cancer specialists. These aim to keep people with cancer as safe as possible and make the best use of NHS resources and protect staff. The guidelines are also there to help doctors make treatment decisions and prioritise some treatments over others, should they need to.
How do doctors decide about changes to my treatment plan?
Treatment risks and benefits
When you start cancer treatment, your doctors weigh up the risks and benefits of treatment and discuss these with you. But the risks of your current treatment plan might have changed because of the coronavirus.
Treatment risks include:
- how your cancer treatments affect your immune system - you’re more at risk of becoming seriously ill from COVID 19 if your immune system is weak after treatment
- exposure to the virus during hospital visits – your team might look at how you have your treatment to reduce your hospital visits
Treatment benefit usually refers to the aim of your treatment.
Your treatment might aim to:
- cure your cancer
- lower the chance of your cancer coming back
- help you live longer with your cancer
- control symptoms so you are more comfortable
Your doctors will carefully weigh up the treatment benefit with the risks of treatment. They will discuss this with you.
Your doctors will also consider how urgent your treatment is.
Although doctors usually treat cancer urgently, some treatments are more urgent than others. In some emergency situations, delaying treatment could be life threatening or result in long term damage. But in other situations, delaying treatment might not make a big difference to the outcome.
Your doctors also have to consider the impact of the coronavirus outbreak on all health services. For example, it’s likely that there will be staff and bed shortages. This means they might need to delay or rearrange treatments. Because of this they might need to prioritise some treatments over others.
You usually visit the hospital regularly if you're having cancer treatment. These visits might be for treatment, tests or appointments with your healthcare team.
Visiting the hospital increases your risk of being exposed to and getting the coronavirus. So your healthcare team might make changes to reduce your hospital visits and to lower the amount of time you spend in the hospital.
These changes might include:
- asking you to come to your appointments on your own to lower the risk of spreading the infection
- texting you when they’re ready to see you so you don’t have to wait around inside the hospital
- offering you appointments over the telephone
- delivering medicines to your home, or finding other places for you to pick up medicines
Before you have treatment
Your hospital will have specific guidelines in place to protect you and others from getting or spreading the coronavirus during treatment. How you need to prepare for treatment may vary depending on where you live in the UK.
Your hospital might:
- arrange a coronavirus test several days before a planned hospital admission or on admission, if it’s an emergency
- ask you and everyone you live with to isolate for 14 days before a planned hospital admission (including day surgery)
Getting the most out of your telephone appointment
You're likely to have some telephone appointments with your specialist doctor, rather than seeing them in the hospital.
When you speak to the doctor, it can be difficult to remember everything you want to say. And it can be difficult to remember everything they say, especially on the phone. These tips will help you get the most out of your telephone appointment.
- Find a quiet part of the house to take the call – your doctor will hopefully give you an idea of what time of day they will call you.
- You can ask someone to listen in for support - you can put your phone on loudspeaker to do this. They could also ask questions and help you remember what the doctor says.
- Write down a list of questions before the call, and think about what you want to find out from the doctor.
- Tell your doctor if you are worried about anything in particular.
- Ask them to explain anything you don’t understand.
- Ask the doctor who you can call if you have any further questions after your phone appointment.
Will my cancer treatment continue?
Your doctors will aim to continue with your treatment wherever possible. But they might need to change your treatment or prioritise certain treatments over others.
Will my chemotherapy, immunotherapy and other cancer drug treatments continue?
Your healthcare team might review your chemotherapy and cancer drug treatment plan.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. Other cancer drugs include targeted cancer drugs and immunotherapy.
Your healthcare team will weigh up the risks and benefits of your treatment. The risks of your current treatment plan might have changed because of the coronavirus. This is because cancer drug treatments can increase the risk of complications from COVID-19.
They will contact you if there are any changes to your care or treatment.
Why do cancer drug treatments increase the risk of complications from COVID-19?
Chemotherapy can stop your bone marrow from making enough white blood cells. White blood cells are part of your immune system.
Some targeted cancer drugs and immunotherapy drugs also affect how well your immune system works.
The immune system protects the body against illness and infection caused by viruses like coronavirus. Having a weak immune system can mean you are less able to fight these infections.
Some cancer drugs affect the immune system more than others. Your doctor will look at your individual treatment plan, and assess the risks to you. They can tell you whether your treatment increases your risk of complications from COVID-19.
Changes to your treatment plan
Your doctors might make changes to your cancer drug treatment to reduce your hospital visits. This will lower your risk of being exposed to and catching the coronavirus.
They might look at alternative ways you can have your treatment. For example, you can have some chemotherapy drugs as a tablet or injection under the skin. You might be able to have this at home instead of coming to the hospital.
For some targeted cancer drugs or immunotherapies, you might be able to have a longer break between treatment cycles.
What do I do if I am on treatment and develop symptoms of COVID-19?
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)
- a loss of, or change in, your normal sense of taste or smell
Contact your cancer advice line, chemotherapy helpline or Acute Oncology Service 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 these symptoms and, or you feel unwell. You can also get other types of infection so it's important you contact your advice line if you have any new or unusual symptoms.
Some targeted cancer drugs can cause a fever. This might be confusing as this is also a symptom of COVID-19. You should still contact your healthcare team if you have a fever.
Some cancer drugs can also cause a loss of, or change in, sense of taste or smell. So it might be hard to know whether the change is caused by your treatment or the virus. Contact your healthcare team if you have these symptoms.
Your healthcare team will assess you over the phone and might ask you to stay at home. But you should speak to your advice line or healthcare team in the first instance.
Will my radiotherapy treatment continue?
Your doctor will talk to you if there are any changes to your radiotherapy treatment plan.
They will weigh up the benefit and urgency of your treatment against your risk of being exposed to the coronavirus at your hospital visits. Your team might need to prioritise some radiotherapy treatments over others. This is because of pressures on the radiotherapy department such as staff shortages.
There are guidelines to help doctors make these difficult decisions. Your healthcare team will consider factors such as:
- your type and stage of cancer, and other factors such as how fast your cancer is growing
- what other treatment you've had so far, and what alternative treatment options there are
- what the aim of your treatment is
To lower the risk of spreading the coronavirus, your team will ask you to come to your appointments on your own. They will also try to reduce the amount of time you spend in the radiotherapy department. For example, they might text you when they’re ready to start the treatment so you don’t have to wait around inside the hospital.
Your healthcare team will assess you before your treatment to see if you might have COVID-19 or have been exposed to COVID-19.
Can I continue radiotherapy if I have COVID-19?
You might be able to continue with your radiotherapy treatment even if you have confirmed or suspected COVID-19. This will depend on your situation. The radiotherapy team will follow strict guidance on infection control to protect themselves and other radiotherapy patients
Will my surgery go ahead?
You will be aware that the coronavirus outbreak is having a huge impact on healthcare services. You might feel worried about how this will affect your surgery.
Your doctors will plan to carry out surgery as planned whenever possible. But there are pressures such as shortages in staff, ward beds and intensive care beds. So they might need to make changes to your planned surgery.
They will also carefully consider risks to you if you catch COVID-19 during your hospital stay. For example having a big operation increases your risk of getting an infection, including coronavirus. With some operations this risk is greater than the benefit of having surgery. This might mean that your surgery is delayed or that they suggest another type of treatment.
They will contact you to talk about your surgery.
Due to the pressures on the health service your team might need to prioritise some operations over others. There are guidelines to help surgeons make these difficult decisions. They are using a system to prioritise patients. This splits patients into 3 priority levels. Your team will consider how risky it would be in your situation to delay surgery and then decide which priority level your surgery is:
- Level 1 means surgery is an emergency to save your life or prevent long term damage – level 1a means you need surgery within 24 hours, and level 1b means you need surgery within 72 hours
- Level 2 means surgery is necessary to stop your cancer from progressing to a stage where it's no longer possible to operate or cure you - in this situation you usually need an operation within 4 weeks
- Level 3 means surgery can be delayed for 10 to 12 weeks and this shouldn't affect your overall outlook (prognosis)
Where will I have my surgery?
Cancer specialists and hospitals are working together to coordinate cancer treatments and minimise disruptions to cancer treatment. You might have your surgery at your local treatment centre as planned. But some people will go to a different hospital for their surgery. This might be because:
- your current treatment centre isn’t able to do your cancer surgery – this might be because of shortages in beds, staff or other resources
- in your area, certain hospitals have been identified to treat people with COVID, and other hospitals treat people without COVID – this is to minimise risk of spreading the infection
If you have surgery at a different centre, your current cancer specialist will remain in charge of your overall care. You should contact them or your specialist nurse if you have any questions about your care.
After a stem cell transplant, you’re more at risk of becoming seriously ill from COVID-19.
You have a stem cell transplant after very high doses of chemotherapy. The chemotherapy stops your bone marrow from making enough white blood cells. White blood cells are part of your immune system which protects the body against illness and infection caused by viruses like coronavirus.
If you're due to have a stem cell transplant
The doctors will look at your individual situation to decide whether your transplant should go ahead as planned. They will carefully weigh up the risks of delaying your transplant against the risks of becoming seriously ill from COVID 19. They will also consider all of your treatment options.
Your doctors might decide to delay your transplant until the coronavirus outbreak has settled down. They will talk to you about this decision and explain all your options. They will try to answer any questions you have.
If you are going to have a stem cell transplant, your doctors will ask you to follow the shielding advice for extremely vulnerable people. This is to lower the risk of you getting the coronavirus before your transplant.
They will test you for COVID-19 before your transplant. If a test shows you have COVID 19 they will need to delay your transplant. Your doctors will talk to you about how long this delay will be.
If you've had a stem cell transplant
During your time in the hospital for a stem cell transplant, the healthcare team will look after you in protective isolation. They will follow strict guidance on infection control to try and protect you from infection.
After a stem cell transplant, you should follow the government shielding advice for extremely vulnerable people if you:
- had a transplant using your own stem cells (an autologous stem cell transplant) in the last year
- had a transplant using donor stem cells (an allogeneic transplant) in the last 2 years
- are on drugs that suppress your immune system (immunosuppressants) after a transplant
- have graft versus host disease (GVHD) or an ongoing weak immune system after a transplant
Contact your health care team if you are uncertain or you’re concerned that you might be in the extremely vulnerable group.
(On this page, we base our information for stem cell transplant patients on the NICE guidelines for COVID-19 and stem cell transplants).
How you might feel
It is understandable that you might feel very worried if your cancer treatment changes or is delayed. Cancer treatment usually feels urgent, and it can be very unsettling to face changes to your treatment plan.
Try to talk to your healthcare team about your situation. It might help to write down any questions or worries that you have.
Your specialist team will consider a lot of factors about your individual situation when they make these difficult decisions. They will also be consulting other specialists and following guidance written by clinical experts.
You can also phone the Cancer Research UK nurses if you would like to talk to someone at this worrying time. You can call them on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
What to ask your doctor
You will probably have some questions about your cancer treatment and COVID-19. Here are some suggestions for questions you might want to ask your doctor:
- What are the risks to me if I catch COVID-19?
- How does my cancer treatment affect my risk of becoming seriously ill from COVID-19?
- Are there any changes you can make to my treatment to lower the risk of getting COVID-19 or becoming seriously ill if I do get it?
- What should I do if I, or someone I live with, gets COVID-19?
- Will my treatment continue if I have confirmed or suspected COVID-19?
- My treatment has been delayed - how long will this be for, and when can I expect to have the treatment?
- Will a delay to my treatment affect how well my treatment will work (the prognosis)?
- My treatment is now at a different hospital - will you still treat me or will I see another doctor?
- Can you explain the reasons for making changes to my treatment plan?