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SARC-CoV-2 i.e. 'Severe Acute Respiratory Syndrome - COVID-19; is known to affect our lungs by causing fibrosis in the cells of lung and pneumonia that produces characteristic symptoms like respiratory distress. It leaves patients in a condition where they can not breathe spontaneously. The issue becomes critical further if patient has a pre-existing lung disease of any nature. Some of the common lung diseases that are present in Indian population are Asthma, Chronic Obstructive Pulmonary Disorder (COPD), Lung Cancer, etc. The elevated levels of pollution in India, especially in the population residing in metro cities, causes deterioration of lung capacity and overall lung performance; if not any specific lung disease.

These factors have the potential to contribute to poor outcomes if cancer patient gets infected with Coronavirus. Unfortunately, most of us do not know the real capacity of our lungs in present time therefore we can only determine some factors that can help assume it. This can be elaborated with an example of smokers. Those who smoke should anticipate that their lung capacity is likely to be compromised. Similarly, many patients in India has childhood or otherwise Asthma because of which they fall in high-risk category for Coronavirus infections.

Problems are even more severe for Lung cancer patients. Some of them may have pre-existing pneumonia or pleural effusion (water deposition inlining of lungs) because of cancer. The chances of developing Coronavirus infection to those patients who have undergone lung cancer surgery or who are taking chemotherapy is much higher. We at Mumbai Oncocare Centre have realized that we can not remain rigid about how we were treating lung cancer patients so far. We are following differential/de-escalation protocols for lung cancer chemotherapy or medications; with or without radiation therapy depending on the biology of lung cancer. The sole intention is to minimize the risk of SARC-CoV-2 infection in such patients.

We prioritize & maintain those treatments which has significant survival benefits, as they are, without altering, as much as possible. For metastatic lung cancer patients, we do not stop treatment without a good reason. Some amount of dose adjustments are often exercised as the doses validated in western literature do not apply to Indian patients as they are, and it demand a small modification even otherwise in Indian patients. There are quite a few oral, targeted therapies approved and available for lung cancer treatment which makes our and patient's life easy to a great extent. Patients can comfortably consume them sitting at home. While offering any treatment, we ensure adequate preventive measures for patients, anticipating the increased risk of Coronavirus as well as other infections.

Patients are advised to follow the following instructions as an additional safety measure during Corona times:

- Wearing clean cloth mask as much as possible, especially when they are out for treatment

- Washing their hands frequently with soap or applying sanitizer

- Disinfecting commonly touched surfaces at home

- Avoiding going out, except for cancer treatment

- Strictly maintaining social distancing

- Immediately reporting fever, cough, cold-like symptoms to doctors if arise

Many metastatic lung cancer patients have disease spread to their brain (brain metastasis). Brain is a common site of spread of cancer in lung cancer patients. There are some reports on COVID-19 infection which document the neuroinvasive potential of Coronavirus. To simplify, neuroinvasion is the ability of invading the central nervous system (CNS). In patients with brain metastasis, this characteristic property of COVID-19 can have a devastating effect. Infection of Coronavirus can cause neurological symptoms like headache, nausea and vomiting which are commonly observed in patients who are administered chemotherapy or other cancer medications for their cancer. Therefore it is important that cancer patients should report these additional symptoms to their treating oncologists as soon as they are experienced.

Patients should be extra cautious and vigilant about such changes in their body while on cancer treatment. If reported on time, these can be dealt with comfortably. By following the instructions and recommendations of the treating oncologists, lung cancer patients can complete their treatment without any hassle while they can also prevent themselves from infection of COVID-19.

Dr. Pradip Kendre

Consultant Medical Oncologist

Mumbai Oncocare Centre

8779676707 / 9687311750