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COVID-19 and Breast Cancer Care: Follow-Up Questions
Brian Wojciechowski, M.D.
August 24, 2020

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On July 30, 2020, Breastcancer.org hosted a virtual town hall to hear from medical experts and patients about the effect of COVID-19 on breast cancer care. During the town hall, the medical experts answered many questions, but didn’t have time to answer all of them. In this podcast, Breastcancer.org medical adviser Dr. Brian Wojciechowski answers the rest of the questions.

If you’d like more information, visit our special report on COVID-19 and breast cancer care.

Dr. Wojciechowski practices medical oncology in Delaware County, Pennsylvania at Riddle, Taylor, and Crozer hospitals. He trained at Temple University School of Medicine and Lankenau Medical Center. Dr. Wojciechowski is a sought-after speaker on the topics of medical ethics and the biology of cancer.

Listen to the podcast to hear Dr. Wojciechowski explain:

  • what we know about how stress and anxiety can affect the immune system
  • how people diagnosed with metastatic breast cancer can protect themselves in public spaces
  • whether or not it is safe to get a chemotherapy port flushes
  • questions to asks surgeons and other doctors to ensure the proper safety protocols are in place

Running time: 21:14

Thank you for listening to the Breastcancer.org podcast. Please subscribe on iTunes, Stitcher, Spotify, TuneIn, Google Play, or wherever you listen to podcasts. To share your thoughts about this or any episode, leave feedback on the podcast episode landing page on our website.

Show Full Transcript

Jamie DePolo: Hello. As always, thanks for listening. On July 30, 2020, Breastcancer.org hosted a virtual town hall to hear from medical experts and patients about the effect of COVID-19 on breast cancer care. During the town hall, the medical experts answered many questions, but they didn’t have time to answer all of them. In this podcast, Breastcancer.org medical adviser Dr. Brian Wojciechowski is going to answer the rest of the questions for us. 

If you’d like even more information, you can visit our special report on COVID-19 and breast cancer care at Breastcancer.org/COVID19. And COVID19 is all one word, no spaces, no hyphen. 

Dr. Wojciechowski practices medical oncology in Delaware County, Pennsylvania at Riddle, Taylor, and Crozer hospitals. He trained at Temple University School of Medicine and Lankenau Medical Center. Dr. Wojciechowski is a sought-after speaker on the topics of medical ethics and the biology of cancer. 

Dr. Wojciechowski, welcome to the podcast. Thank you so much for answering the rest of these questions for us. 

Brian Wojciechowski, M.D.: Thank you, Jamie. It’s an honor and a privilege. 

Jamie DePolo: So, the first one is: Is there evidence that people with metastatic breast cancer who are taking Ibrance and letrozole have higher COVID-19 infection rates than other women diagnosed with breast cancer? 

Brian Wojciechowski, M.D.: Well, that hasn’t really been teased out in the data, in the epidemiologic numbers. In other words, it’s hard to know that for sure. What we do know is that anyone with cancer is at higher risk for complications from COVID. And you know, I would advise a woman who’s on Ibrance or who’s not on Ibrance dealing with breast cancer the same thing. I would tell them the same thing, that just by virtue of the fact that you have cancer, you’re at high risk for probably catching the disease and definitely for complications from the disease up to and including death, unfortunately. 

Jamie DePolo: Okay. So, we don’t really know about the infection rates though, people are working so hard on studying treatments and cures, I think some of these, I don’t want to call it secondary research, but sort of off-shoot research, like who’s getting infected the most, hasn’t really been looked at yet or we don’t have the data yet. 

Brian Wojciechowski, M.D.: Right. The data just isn’t that granular. We just don’t have that specific info. 

Jamie DePolo: Okay. All right. Thank you. 

So, here is actually another question about metastatic breast cancer and Ibrance: Should people with metastatic breast cancer taking Ibrance return to work in public places? And there’s a second part to that question: Are there specific breast cancer treatments, whether for early- or advanced-stage disease, that might make people more likely to be infected with COVID-19? So, kind of a two-parter there. 

Brian Wojciechowski, M.D.: Yeah. So, that’s a tricky question because Ibrance can lower the white blood cells, as I think many of our listeners know. But it’s a low white blood cell count. So your white blood cells are primarily involved in fighting infection. And even though we know that the white blood cells are low, it doesn’t usually translate into a particularly high risk for infections. 

When I have patients on Ibrance, I don’t see them getting infected more often than other patients with, say, pneumonia, or urinary tract infections, or skin infections, that sort of thing. So, again, I don’t think we really know if the low white count that women get on Ibrance is associated with a higher risk of getting infected with COVID. 

Now, the question of should people go back to work in public while they’re taking Ibrance, well again, if you’re taking Ibrance it means that you have metastatic breast cancer. So, by virtue of that, you’re at high risk of complications from the virus if you get the virus. And it’s also complicated because people have different reasons for going back to work, and people have different needs in terms of is that critical income, are we worried about putting food on the table, do you or do you not have an option to stay home, are you going to work because you love your job but your survival doesn’t depend on it? 

So, I would say if at all possible that anyone with cancer, but most importantly anyone with metastatic breast cancer taking Ibrance, should try to avoid any unnecessary public exposure right now. But what that means is that you’re making a judgement of how important it is for you to go back to work, and no doctor, no study, the CDC and the World Health Organization, can’t make that judgement for you. But all other things being equal I would say that it is still time to avoid unnecessary exposure in public if you can help it. 

If you have to go back to work, you have to protect your mucus membranes. So, that means at the very least cover the nose and the mouth, frequent hand washing, try not to touch the nose and the mouth, eye coverings if possible. I think we’re a little more sure about nose and mouth transmission than we are about eye transmission, but if I was someone with metastatic breast cancer, I’d want to take all the precautions that I could within reason. 

Jamie DePolo: Okay. So, can I ask you this: Do glasses, like regular eyeglasses, do they offer some sort of protection? And if somebody didn’t necessarily need to wear glasses, could they buy — I don’t want to say fake — but glasses that don’t have any prescription in them, but just clear glass, is that helpful? 

Brian Wojciechowski, M.D.: Yeah. Well, a full face shield is the best because it would cover the eyes from many angles. And I’m not speaking from a scientific perspective here because I think we don’t really know, but I think that glasses are probably better than no glasses, but a full face shield would obviously give you more protection. 

Jamie DePolo: Okay. The next question: Have you seen any evidence in the people you care for of the stress of worrying about COVID-19 affecting cancer progression or weakening the immune system? 

Brian Wojciechowski, M.D.: There’s really been no hard evidence that worry and anxiety can cause progression of cancer. Cancer progresses most of the time because the tumors pick up mutations and find ways to get around your treatment. That’s the biology of cancer. And I’ve never seen any hard studies to suggest that depression, or worry, or anxiety can cause someone’s cancer to get worse. So, I wouldn’t lose too much sleep over that particular concern. 

Jamie DePolo: What about weakening the immune system? Have you heard anything about that, like stress and anxiety affecting the immune system at all? 

Brian Wojciechowski, M.D.: I’ve heard a lot about that actually, about whether or not it can affect the immune system. And that’s a very tricky thing to measure, because stress and anxiety is very subjective. People experience anxiety differently. Anxiety isn’t something that’s easily measured, like, for example, the size of a tumor. 

It’s a very subjective thing, and it’s also not a constant thing, so we’re not constantly worried, and everyone has different symptoms when they get anxiety. Some people get physical symptoms, some people get mental symptoms, so it’s a very difficult thing to measure. Whenever someone makes the claim that anxiety and stress, and depression can decrease your immune system, I’m always skeptical of that because again, very hard to measure and really no good, solid scientific evidence. 

Jamie DePolo: Okay. Okay. Thank you. Next question: How safe is it to get my chemotherapy port flushed right now? 

Brian Wojciechowski, M.D.: So, that usually happens in a doctor’s office, and it depends on the procedures at your doctor’s office. I will tell you that doctors’ offices — at least I can speak for my practice — my office is a very safe place. And the reason I can say that is because we don’t allow any visitors or guests into the office with patients unless someone has a disability where they need to have someone else with them, and even patients who are allowed into the office are screened pretty thoroughly for any symptoms or exposure. So, for example, you can’t come if you have a fever, or if you’ve had a cough, or if you’ve been exposed to someone with COVID, or if you work at a nursing home. 

So, in some sense your doctor's office might be one of the safest places for you to be, but I can’t really answer that question for everyone because I don’t know what their hygiene and screening practices are. 

I would say in general, yes, it is safe to get your port flushed, but again, do the precautions, do the face mask, do the frequent hand washing, and I think the risk is pretty low. 

Jamie DePolo: Okay. Okay. Have any of your patients with metastatic disease been diagnosed with COVID-19, and if so, how did their recovery go? 

Brian Wojciechowski, M.D.: Yeah. We had one or two of our patients in the practice with metastatic disease get COVID, and I’m happy to say they did not die from it. Recovery can be prolonged, and I think it was in one case where the person was hospitalized and they actually had to go to a long-term acute care facility for breathing support, and they had to stay on the high-flow oxygen that you probably hear a lot about, for a good 30 or 40 days before they recovered. 

I think that the same risk factors apply for people with metastatic disease as would apply for anyone. So, if you have medical problems like heart problems, diabetes, lung disease, if you’re older, you’re going to be higher risk than if you don’t have those conditions. But most people who get COVID will survive. Even for cancer patients, the chance of surviving COVID if you get it is greater than 90%. 

Jamie DePolo: That’s a good statistic to know. 

Brian Wojciechowski, M.D.: Yeah. People should hold onto that number if they’re concerned. 

Jamie DePolo: How isolated does someone on chemotherapy need to be right now? Is it okay for a spouse to make grocery or errand trips on public transportation, or is it better to have everything delivered? 

Brian Wojciechowski, M.D.: Well, the food delivery services are so good these days and so easy to use. We’ve been using them a lot. I think I would encourage my patients to use that as much as possible, and if that’s not possible and you have to get food, well, you have to eat. 

Remember that transmission of COVID really happens from mucus membrane to mucus membrane. I don’t think there’s any strong evidence that it can spread to you by touching a metal surface or a shopping bag or anything like that. It’s really when material from someone else’s mucus membrane comes in contact with your own. So, someone coughs in your face or exchange of bodily fluids. I keep coming back to just wear the mask and wash your hands. 

I have a lot of colleagues who are lung doctors and infectious disease doctors on the frontline of this pandemic, have been seeing multiple COVID patients every day for the past 4 months. who have not gotten sick. So, the point that I’m trying to make is that wearing the mask works, and washing your hands works, and just following the guidelines will keep you safe. 

Jamie DePolo: Okay. So, it sounds like, just to clarify a little bit, if somebody did have to go out or have a spouse or partner go out to get food and other necessary items, the person that goes out wears the mask, comes home, washes hands, takes off the mask right away. And then if people are really concerned, they could even wipe down whatever they’ve purchased if they felt super strongly about that. 

Brian Wojciechowski, M.D.: Yes. Absolutely. Absolutely. While I did say before that there’s no evidence that you have a high chance of catching the virus from touching a surface, we do know that the virus can live on certain surfaces for a period of time. So, the virus lives longer on hard surfaces, on metal surfaces, and lives shorter on soft surfaces, like paper or plastic. 

Jamie DePolo: Okay. 

Brian Wojciechowski, M.D.: Okay. So, if that’s a real concern, that’s something else to bear in mind. 

Jamie DePolo: Okay. What question should a person ask of her surgeons to ensure that proper safety protocols are in place at the facility? 

Brian Wojciechowski, M.D.: I think the most important question is, what is the screening procedure for people coming in and out of the hospital for elective surgeries, and what’s the screening procedure for staff members who will be assisting in the surgery? Every hospital should have protocols in place to keep people who are infected or people who might have symptoms, a concern for COVID, or might have been exposed to COVID, out of the hospital and out of the operating room. So, if you had one question to ask the surgeon it would be, what are your screening procedures? 

Jamie DePolo: Okay. I would assume — I’m going to extrapolate, I don’t know the person who asked the question — but you could ask that question of any facility, whether you were going in for a follow-up visit, you’re going in for chemo, you’re going in for surgery. If you’re concerned, you could ask that of any doctor’s office or any other facility that you would be going into. 

Brian Wojciechowski, M.D.: You certainly can, and at my hospital they’re actually testing everyone for COVID who is getting a procedure. 

Jamie DePolo: Oh, really? Okay. 

Brian Wojciechowski, M.D.: Yeah. Symptoms or not, they’re requiring testing ahead of the procedure. So, that’s another good question for patients to ask their surgeons. 

Jamie DePolo: Okay. Because I will say, I’ve had to have two doctors’ appointments since the pandemic has started, and in both cases I was screened, my temperature was checked, I texted or called to check in and then waited in my car, and nobody else was in the check-in area of the facility when I went in. So, I personally felt very safe. Now, I’m also not diagnosed with cancer, so I don’t have that added burden, but it seemed like there were a lot of good protocols in place. 

Brian Wojciechowski, M.D.: It sounds like they’re doing right, Jamie. 

Jamie DePolo: Yeah. And you know what, I apologize, I feel like we’ve already answered this last question which is: Can depression and anxiety weaken the immune system? That seems to be a really big concern. I have a feeling that people are feeling anxious, scared, depressed because of the whole pandemic, not being able to go out, not being able to see other family members, especially if maybe some family members are in care facilities, that’s obviously concerning. And it sounds like everybody’s just really concerned that that's going to weaken their immune system. 

Brian Wojciechowski, M.D.: Yeah. I mean, people who suffer from depression and anxiety understand that it does take a physical toll on your body, especially anxiety. Anxiety can cause all kinds of scary physical symptoms even to the point where you think you’re going to pass out or die. It can be that big. And then even depression can cause you to feel tired, can cause muscle aches and joint pains. So, it’s not unreasonable for people to think, “Well, if I’m feeling this way physically, what is it doing to my immune system?” 

The two things that I would say about that is, number one, again, there’s no real good scientific evidence that it affects your immune system, depression and anxiety. Number two is, just don’t try to beat yourself up, because people who really do suffer from these conditions, you know that it’s something you can’t help all the time. Depression, anxiety, panic attacks, a lot of times it just comes on and you can’t control it. It’s not like you can flick a switch or anything like that. So, I would encourage people to talk to your therapist, do your meditation, do your cognitive exercises, and just do your best with it, but don’t get into the cascade of, “Well, I have anxiety and I’m worried about the immune system so that’s going to make my anxiety worse and…” 

Jamie DePolo: Exactly. It’s kind of a whole chase-your-tail-around, and it just keeps spiraling. 

Brian Wojciechowski, M.D.: Yeah. Yeah. It just keeps going up, and up, and up, and you get on the vicious, vicious circle. So, yeah, easier said than done, but try not to lose too much sleep over that, and just bear in mind that there really is not any strong scientific data to suggest that that affects your immune system. 

Jamie DePolo: All right. Well, thank you so much, Dr. Wojciechowski. We really appreciate your insights and taking the time to answer these questions. 

Brian Wojciechowski, M.D.: Thank you, Jamie.

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