Cancer Care During the COVID- 19 Pandemic

 

Dr Brook's Letter to the Editor  published  in the New York Times has an important message to all cancer survivors:

The prolonged COVID -19 pandemic has led to an increase in the number of patients who present with late-stage, previously undiagnosed cancers, and recurrence of a previously diagnosed malignancy.

This is probably due to the reluctance of people to seek medical care because of fear of contracting COVID -19 at medical facilities; the closing or reduction in clinical services; the requirement to obtain COVID -19 testing before some medical procedures; and the use of telemedicine without physical examination instead of an actual office visit.

It is important that people not defer their medical care during the pandemic. It is especially important that those who previously received a cancer diagnosis continue their treatment and follow-up. Those who experience new or unusual signs and symptoms that may indicate aggravation of their condition or a new ailment should seek medical care without delay.

Postponing care or ignoring symptoms may lead to complications and deterioration, making future care more difficult and leading to increased morbidity and mortality.

Increased risk of serious illnesses including advanced stage cancer due to COVID -19 pandemic

 

The prolonged COVID-19 world wide pandemic led to an increase in medical problems due to other etiologies. Medical providers are facing growing number of patients with previously undiagnosed late stage cancers, and recurrence of a previously diagnosed malignancies.  This led to an increase in the number of radical surgeries including laryngectomies and increase in the death rate among patients with many types of cancer.   

This is likely due to several factors that include the reluctance of individuals to seek medical care because of fear of contracting COVID-19 at medical facilities; the closure or reduction of clinical services, the suspension of cancer screening, the deferral of routine diagnostic work, the requirement to obtain COVID-19 testing prior to some medical procedures, and the utilization of telemedine without physical examination instead of an actual office visit.

It is therefore important that individuals do not defer their medical, dental, and mental care during the COVID-19 pandemic. It is especially important that those who were previously diagnosed with an ailment including cancer continue their treatment and follow up. Those who experience new or unusual signs and symptoms that may indicate an aggravation of their condition or a new ailment should seek medical care without delay. Postponing care or ignoring symptoms may lead to complications and deterioration making future care more difficult and may lead to increase morbity and mortality.

  

Three studies from Italy and Scotland reported seven laryngectomees who  developed COVID -19 infection. Two acquired the infection while in the hospital after undergoing laryngectomy. The infection was serious in three of them and they required intubation and intensive care admission. All the patients survived.

The authors concluded that individuals who have undergone laryngectomy for head and neck squamous cell carcinoma are high risk for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways.

The "Laryngectomee Guide for COVID-19 Pandemic" is available in English, Spanish, Portuguese, Italian, Turkish, Bosnian, and Japanese.

The "Laryngectomee Guide for COVID-19 pandemic” is available in English, Spanish, Portuguese, Italian, Turkish, Bosnian,  Malaysian, and Japanese.

The corona (COVID-19) pandemic presents many medical, social and psychological challenges for laryngectomees and their medical providers. The Laryngectomee Guide for COVID -19 provides information for laryngectomee and neck breathers how to cope with the COVID -19 pandemic. It contains information how to prevent the infection and deal with depression, social isolation, fibrosis, lymphedema, mucous problems, and voice prosthesis leak. It provides suggestions how to deal with esophageal dilation, hospitalization, and keep fit and eat well.

The Guide in English is available as eBook (free) at  https://bit.ly/2AY41RO , and paperback at: https://amzn.to/3i5XncR   through Amazon.com and https://bit.ly/3glrlJf through Lulu publishing. 

The Guide in Spanish is available as eBook (free) at https://bit.ly/3bFgPeb and paperback at https://bit.ly/32djqIW 

 

The Guide in Portuguese is available as as eBook (free) at  https://bit.ly/3eFcYPN  and paperback at https://bit.ly/3pklpVJ 

The Guide is available from Associação Portuguesa de Terapeutas da Fala (APTF)(Portuguese Speech Therapists Association)

The Guide in Italian is available as eBook (free) at https://bit.ly/2RfdrgE and paperback at 

 https://bit.ly/2DSWq92

The Guide in Romanian is available as eBook (free) at https://bit.ly/3nfGSgO and paperback at https://bit.ly/3a7kWAS   

The Guide in Bosnian is available as eBook (free) at https://bit.ly/2TzfKfG and paperback at https://bit.ly/3p2Mf4e and  https://publish.sweek.com/books/244071/ 

The Guide in Turkish is available as eBook (free) at https://bit.ly/2RHYIeg and paperback at 

 https://bit.ly/3cmgu0k 

The Guide in Malaysian is included in The Laryngectomee Guide Malaysian Edition.  It is available as Paperback http://bit.ly/3n4fK3m , eBook http://bit.ly/2X29Rcu  

The Guide in Japanese is available as eBook (free) https://bit.ly/3j94Don  , and paperback at: https://bit.ly/3jd85yf

    

The eBook is also available from the Japanese Laryngectomee Association.

Guide in English

Guide in Spanish

Guide in Portuguese

Guide in Italian 

Guide in Turkish 

Guide in Romanian

Guide in Bosnian

Guide in Japanese

The Head and Neck Alliance offers links for Laryngectomee Guide and Laryngectomee Guide for COVID-19 pandemic.

Click this link to obtain The Laryngectomee Guide in 20 languages/dialects: English, French, Russian, Italian, Chinese (traditional and simplified), Korean, Indonesian,Turkish, Arabic, Bulgarian, Romanian, Portuguese, Persian (Farsi), Tagalog, Bosnian, and Spanish (Central American, Andine, Spain, and South American version) and Laryngectomee Guide for COVID-19 Pandemic.

All eBooks are Free.

How to avoid and cope with quarantine fatigue

Months into the COVID-19 pandemic, the effects of the disease and public safety precautions have been devastating — mental health and addiction issues have risen, jobs have been lost and, tragically, tens of thousands have lost their lives. Some have simply become weary of the monotony and loneliness of staying at home. These lonely and isolation can be more severe in laryngectomees and head and neck cancer survivors who have communication difficulties.

All of this has led to what experts are calling “COVID-19 quarantine fatigue,” a modern-day version of what is known as “caution fatigue.” This is a phenomenon when one’s body and mind tire of the persistent sense of danger and the constant stress it is causing, leading to becoming complacent or unable to make good decisions.

With quarantine fatigue, one might grow weary of — or actively ignore — the precautions that can slow the spread of COVID-19. The sense of urgency in managing the global health emergency may fade,  leading to impatient or tiredness of complying with the health and safety guidelines.

One may begin to feel hopeless, as if no amount of measures can keep one safe from exposure. This can result in decreasing the home sanitizing and forgetting to wear a face covering when going out. Some may expand the number of people they spend time with in person or forego all precautionary measures.

There is an understandable eagerness to ‘go back to normal.’ Since the virus is invisible,  it may seem that it does not really exist, even though there is evidence it is still spreading. There is a genuine desire to and interact and connect with others and deny or ignore the health risks associated with the virus.

It is important to resist quarantine fatigue and remember that we are all in this together and it takes cooperation from everyone in the community to decrease the spread of COVID-19. Yielding to isolation fatigue can cause an increase in COVID-19 cases as well as repeated lockdowns and further shuttering of businesses and schools. A rise in infection rates, can overwhelm the health care system, and increased deaths in those who are vulnerable.

Resisting quarantine fatigue is especially important in older adults, people who have severe underlying medical conditions and immunocompromised individuals who are at higher risk for developing serious complications from COVID-19 illness.

Enclosed are recommendations how to avoid quarantine fatigue and continue being diligent in the collective efforts to keep our community healthy and reduce the number of COVID-19 infections:

• Staying informed with trusted and reliable resources, such as the Centers for Disease Control and Prevention (CDC) website.
• Avoiding constant exposure to news, though it may be beneficial to check local news at occasional intervals to learn pertinent details about COVID-19 in your community.
• Taking care of oneself — eating a nutritionally balanced diet, exercising, getting appropriate amounts of sleep, practicing self-care, and taking care of one’s medical needs.
• Staying connected with loved ones, friend and support groups.
• Maintaining precautions to avoid catching or spreading the disease.

Hydroxychloroquine and Coronavirus Disease 2019: A Systematic Review

Hydroxychloroquine (HCQ) emerged early in the course of the coronavirus disease 2019 (COVID-19) pandemic as a possible drug with potential therapeutic and prophylactic benefits. It was quickly adopted in China, Europe, and the USA. A systematically review of the existing clinical evidence of HCQ use for the prevention and treatment of COVID-19 was performed by  Rakedzon and colleagues from Rambam health Center, Haifa, Israel

The researcher all clinical studies describing HCQ administration to treat or prevent COVID-19 in PubMed before June 20, 2020. This included randomized controlled trials (RCTs), non-randomized comparative cohorts, and case series studies that had all undergone peer review.

A total of 623 studies were screened; 17 studies evaluating HCQ treatment were included. A total of 13 were observational studies, and 4 were RCTs. In terms of effect on mortality rates, observational studies provided conflicting results. As a whole, RCTs, including one large British RCT that has not yet been published, showed no significant effect of HCQ on mortality rates, clinical cure, and virologic response. The use of HCQ as a post-exposure prophylactic agent was found to be ineffective in one RCT. The authors concluded that there is no evidence supporting HCQ for prophylaxis or treatment of COVID-19. Many observational trials were methodologically flawed. Scientific efforts have been disappointingly fragmented, and well-conducted trials have only recently been completed, more than 7 months and 600,000 deaths into the pandemic.

List of Open Clinical Trials for Patients with COVID-19 in the USA VA and Department of Defense facilities.

There is an urgent need to find effective treatment or a vaccine for COVID-19. Worldwide there are over 1,800 trials addressing COVID-19-related health care. There are 10 trials developed by the US Department of Veterans Affairs (VA), US Department of Defense, and the National Institute of Allergy and Infectious Diseases have provided important data on effective treatment options. The clinical trials listed below are all open as of May 31, 2020.

Adaptive COVID-19 Treatment Trial (ACTT)

This study is an adaptive, randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of novel therapeutic agents in hospitalized adults diagnosed with COVID-19. The study will compare different investigational therapeutic agents to a control arm. ID: NCT04280705

Study to Evaluate the Safety and Antiviral Activity of Remdesivir (GS-5734) in Participants with Severe Coronavirus Disease (COVID-19)

The primary objective of this study is to evaluate the efficacy of 2 remdesivir (RDV) regimens with respect to clinical status assessed by a 7-point ordinal scale on Day 11 (NCT04292730) or Day 14 (NCT04292899).

Expanded Access Remdesivir (RDV; GS-5734)

The treatment of communicable Novel Coronavirus of 2019 with Remdesivir (RDV; GS-5734) also known as severe acute respiratory syndrome coronavirus 2.

A Study to Evaluate the Safety and Efficacy of Tocilizumab in Patients With Severe COVID-19 Pneumonia (COVACTA)

This study will evaluate the efficacy, safety, pharmacodynamics, and pharmacokinetics of tocilizumab  compared with a matching placebo in combination with standard of care in hospitalized patients with severe COVID-19 pneumonia.

Administration of Intravenous Vitamin C in Novel Coronavirus Infection (COVID-19) and Decreased Oxygenation (AVoCaDO)

The study evaluates if Vit C is safe and tolerable in COVID-19 subjects given early or late in the disease course and may reduce the risk of respiratory failure requiring mechanical ventilation and development of ARDS along with reductions in supplemental oxygen demand and inflammatory markers.

Treatment Of CORONAVIRUS DISEASE 2019 (COVID-19) With Anti-Sars-CoV-2 Convalescent Plasma (ASCoV2CP)

This is an expanded access open-label, single-arm, multi-site protocol to provide convalescent plasma as a treatment for patients diagnosed with severe, or life-threatening COVID-19.

A Study to Evaluate the Safety and Efficacy of MSTT1041A (Astegolimab) or UTTR1147A in Patients With Severe COVID-19 Pneumonia (COVASTIL)

This is a Phase II, randomized, double-blind, placebo-controlled, multicenter study to assess the efficacy and safety of MSTT1041A (astegolimab) or UTTR1147A in combination with standard of care (SOC) compared with matching placebo in combination with SOC in patients hospitalized with severe coronavirus disease 2019 pneumonia.

Adaptive COVID-19 Treatment Trial 2 (ACTT-II)

ACTT-II will evaluate the combination of baricitinib and remdesivir compared to remdesivir alone. Subjects will be assessed daily while hospitalized. If the subjects are discharged from the hospital, they will have 3 home visits.  

Click to get more information 

Dr. Brook's interview about becoming a laryngectomee, and coping with COVID-19

Dr. Itzhak Brook is a physician and laryngectomee.

In the interview made for the International Association of Laryngectomees 69th Annual Meeting - Voice Institute 60th meeting on June 13, 2020, he describes how he dealt with throat cancer, and became a laryngectomee. He also discusses how laryngectomees can protect themselves from COVID-19 virus and deal with the challenges of caring for their airways during this period.

Dr. Itzhak Brook is a physician and laryngectomee.

In the interview made for the International Association of Laryngectomees 69th Annual Meeting - Voice Institute 60th meeting on June 13, 2020, he describes how he dealt with throat cancer, and became a laryngectomee. He also discusses how laryngectomees can protect themselves from COVID-19 virus and deal with the challenges of caring for their airways during this period.

Treatments for COVID-19 What helps, what doesn't, and what's in the pipeline for COVID-19

Most who become ill with COVID-19 will be able to recover at home. No specific treatments for COVID-19 exist right now. But some of the same things you do to feel better if you have the flu — getting enough rest, staying well hydrated, and taking medications to relieve fever and aches and pains — also help with COVID-19.

Scientists are working hard to develop effective treatments. Therapies that are under investigation include drugs that have been used to treat malaria and autoimmune diseases; antiviral drugs that were developed for other viruses, and antibodies from people who have recovered from COVID-19.

Enclosed is an update about the current treatments and potential ones for COVID-19 prepared by Harvard Medical School.

Signs and symptoms of COVID-19 infection

COVID-19 affects different people in different ways. Infected people have had a wide range of symptoms reported – from mild symptoms to severe illness.

Symptoms may appear 2-14 days after exposure to the virus. The CDC recommends that people with these symptoms may have COVID-19:

•          Fever or chills
•        Cough
•       Shortness of breath or difficulty breathing
•        Fatigue
•        Muscle or body aches
•        Headache
•        New loss of taste or smell
•       Sore throat
•        Congestion or runny nose
•        Nausea or vomiting
•       Diarrhea

Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately

•     Trouble breathing
•        Persistent pain or pressure in the chest
•        New confusion
•        Inability to wake or stay awake
•        Bluish lips or face

Call your medical provider for any other symptoms that are severe or concerning to you.

It is helpful to have a plan in place in case one becomes sick. Identifying a caregiver and staying in touch with family, friends, neighbors, and healthcare professionals during the pandemic through email or phone, especially if some lives alone is important. If one is aware of an exposure or are experiencing symptoms such as a sore throat, dry cough, fever, and/or shortness of breath, seek medical help as soon as possible. Trying to contact one’s care team over the phone before coming into a medical center can facilitate their care.

COVID-19 May Be a Blood Vessel Disease. Learn more about this

Many of the infection’s bizarre symptoms have one thing in common. This article is by Dana G Smith.  

Months into the pandemic, there is now a growing body of evidence to support the theory that the novel corona virus can infect blood vessels, which could explain not only the high prevalence of blood clots, strokes, and heart attacks, but also provide an answer for the diverse set of head-to-toe symptoms that have emerged.

In a paper published in April in the scientific journal The Lancet, Mehra and a team of scientists discovered that the SARS-CoV-2 virus can infect the endothelial cells that line the inside of blood vessels. Endothelial cells protect the cardiovascular system, and they release proteins that influence everything from blood clotting to the immune response. In the paper, the scientists showed damage to endothelial cells in the lungs, heart, kidneys, liver, and intestines in people with COVID-19.

Click to read the whole article. 

COVID-19 virus and blood cells

DIAGNOSTIC TESTS FOR CORONA VIRUS INFECTION

The pandemic of coronavirus disease 2019 (COVID-19) continues to affect much of the world. Knowledge of diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still evolving, and a clear understanding of the nature of the tests and interpretation of their findings is important. An article by Sethuraman et al. describes how to interpret 2 types of diagnostic tests commonly in use for SARS-CoV-2 infections—reverse transcriptase–polymerase chain reaction (RT-PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over time.describes how to interpret 2 types of diagnostic tests commonly in use for SARS-CoV-2 infections—reverse transcriptase–polymerase chain reaction (RT-PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over time. 

Click to see the original article

Publication of the "Laryngectomee Guide for COVID-19 Pandemic"

The "Laryngectomee Guide for COVID-19 pandemic” is available.

It provides information about preventing infection, dealing with voice prosthesis leak, social isolation, psychological issues, and hospitalization.

It is available as eBook (free) https://bit.ly/2AY41RO , and paperback at: https://bit.ly/3glrlJf 

The Head and Neck Alliance offers links for Laryngectomees Guide and Laryngectomee Guide for COVID-19 pandemic.

Click this link to obtain The Laryngectomee Guide in 19 languages/dialects: English, French, Russian, Italian, Chinese (traditional and simplified), Korean, Turkish, Arabic, Bulgarian, Romanian, Portuguese, Persian (Farsi), Tagalog, Bosnian, and Spanish (Central American, Andine, Spain, and South American version) and Laryngectomee Guide for COVID-19 Pandemic.

All eBooks are Free.

Dr. Brook's video: Copping with the COVID -19 as a laryngectomee

Click to watch the 16 minutes video about how laryngectomees can protect themselves from getting infected with COVID-19, feal with voice prosthesis leakage, and cope with medical , social and psychological issuses during the pandemic. 

in Spanish: Laringectomía y Total y el nuevo virus corona: Sugerencias para la protección.

Laringectomía y Total y el nuevo virus corona: Sugerencias para la protección.

30 de marzo de 2020. Dr. Itzhak Brook.

Sugerencias sobre cómo los pacientes con cáncer de cabeza y cuello (incluidos los que respiran el cuello) pueden protegerse de la nueva infección por coronavirus (COVID -19).

Los pacientes con cáncer de cabeza y cuello (CCC) y los respiradores de cuello (incluidos las laringectomías) pueden tener un mayor riesgo de sufrir una infección grave por COVID-19. El riesgo de enfermedad grave es especialmente alto en aquellos que actualmente reciben o han recibido recientemente quimioterapia o terapia inmunosupresora.

Es prudente que los pacientes con CCC y los respiradores de cuello sigan las instrucciones del gobierno y las autoridades de salud locales y eviten la exposición al virus siguiendo las indicaciones de aislamiento estrictamente.

Los respiradores de cuello son susceptibles a las infecciones del tracto respiratorio inferior porque el virus puede ingresar a su tracto respiratorio directamente a través del estoma del cuello. Los virus respiratorios también pueden acceder al cuerpo a través de la boca, la nariz y la conjuntiva. Por lo tanto, es imperativo que tales individuos ejerzan un cuidado especial para evitar infectarse.

COVID-19 puede causar una infección grave en personas con vías respiratorias comprometidas. Las vías respiratorias de los laringectomas pueden verse comprometidas porque su tráquea y bronquios a menudo están secos e irritados crónicamente, y su capacidad pulmonar puede verse reducida debido al colapso parcial de sus lóbulos inferiores (atelectasia).

Las medidas que pueden reducir el riesgo de infección incluyen:

Limpieza frecuente de manos:

• Lavarse las manos con frecuencia con jabón y agua caliente durante al menos 20 segundos, especialmente después de estar en un lugar público, o después de limpiarse el estoma del cuello, sonarse la nariz, toser o estornudar.

• Si no hay agua y jabón disponibles, use un desinfectante para manos que contenga al menos 60% de alcohol.

• Evitar tocarse los ojos, la nariz, la boca y el estoma con las manos sin lavar.

Evitar el contacto cercano:

• Evitar el contacto cercano con personas enfermas.

• Poner distancia entre uno mismo y otras personas. Esto es especialmente importante para las personas que corren un mayor riesgo de enfermarse gravemente.

Tomar medidas para proteger a los demás:

• Quedarse en casa cuando está enfermo, excepto para recibir atención médica.

• Cubrirse cuando tosa y estornude

• Cubrirse la boca, la nariz o el estoma con un pañuelo al toser o estornudar o al usar el interior del codo.

• Tirar pañuelos usados a la basura.

• Lavarse las manos inmediatamente (ver arriba)

• Usar una mascarilla cuando está enfermo

Limpieza y desinfección:

• Limpieza y desinfección de superficies frecuentemente tocadas.

• Evite tocar superficies que no estén limpias.

• Lávese las manos inmediatamente después de tocar una superficie que no estaba limpia.

Los laringectomizados pueden protegerse tomando estos pasos adicionales:

• Usar un intercambiador de calor y humedad (HME) 24/7 si pueden. Un HME proporciona humidificación del aire inhalado y cierto nivel de filtración (mecánica) dependiendo del tamaño de la partícula en relación con el tamaño de poro del material HME y la tapa sólida evita el contacto directo entre el dedo y el estoma (es decir, Provox XtraMoist y Provox XtraFlow de Atos Medical).

Las HME con alta eficiencia de filtración funcionarían mejor para reducir el riesgo de inhalar el virus (es decir, Provox Micron de Atos Medical). Provox Micron es un HME que tiene un filtro electrostático integrado que proporciona una eficiencia de filtración de> 99% para bacterias y virus y su cubierta evita el contacto directo de los dedos con el estoma. El filtro electrostático proporciona filtración independientemente de la dirección del flujo de aire, por lo que usarlo también protege a otras personas de infectarse cuando el laringectoma está infectado. (ver foto 1)

• Usar un HME de manos libres, que no requiere tocarse al hablar, en quienes usan el habla traqueoesofágica con una prótesis de voz. Aquellos que usan un HME regular deben lavarse las manos antes de tocar su HME.

• Usar una mascarilla (preferiblemente N95) sobre el estoma (ver fotos 2-4). Se puede modificar una máscara facial con cuatro cuerdas para que se ajuste sobre el estoma. Una de las cadenas se puede extender con una cadena adicional; y el par inferior de cuerdas se puede atar detrás de la espalda.

• Usar mascarilla sobre la nariz y la boca, y anteojos protectores. Esto puede evitar que el virus ingrese al cuerpo a través de estos sitios.

Si se usa correctamente, una máscara facial puede ayudar a bloquear las gotas de partículas grandes, salpicaduras, aerosoles o salpicaduras que pueden contener gérmenes (virus y bacterias). Las mascarillas también pueden ayudar a reducir la exposición de las secreciones respiratorias del usuario a otras personas.

Los pacientes con CCC (incluidos los laringectomas) deben consultar a sus médicos acerca de los pasos adicionales a seguir.

Para protegerse. Las personas deben comunicarse con sus médicos ante cualquier signo de infección respiratoria.

Finalmente, aunque todas estas medidas pueden ser útiles para proteger a los pacientes con CCC y los respiradores de cuello Infección por COVID-19, no son necesariamente infalibles y ciertamente no se garantiza que eviten la adquisición una infección.

Itzhak Brook MD

Departamento de Enfermedades Infecciosas

Profesor de Pediatría y Medicina.

Facultad de medicina de la Universidad de Georgetown

Washington DC

Estados Unidos

Suggestions in Spanish: Laringectomía y Total y el nuevo virus corona: Sugerencias para la protección.

Foto 1 

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