Coronovirus (Covid-19) and Palliative Chemotherapy

I have known a few people who are dealing with cancer for several years – they have been on treatment off and on for years. Amazingly, we have managed to keep disease under control. Some on cytotoxic chemotherapy, some on hormone blockade, some on immunotherapy, some on wait-and-watch and so on so forth.

The Coronovirus (Covid-19) has changed everything. We are worried about people who are immunosuppressed with steroids or chemotherapy. People who have had several lines of treatment and can still get some form of cytotoxic therapy are now being counselled about stopping chemotherapy. The benefit of 4th or 5th line of treatment is small, but the risk of immunosuppression is very high.

The risk of death higher.

Very difficult conversations. Most outpatient consultations now are either with the patient alone or with one relative/friend or via a teleconferencing platform. Really difficult conversations as hard as they are… and now with more restrictions – it is even harder. The heartache is felt by the patient, their families, friends, treating doctors and the nurses. The reception staff who have known these people for years are also struggling with the circumstances.

Terrible times. Most of us with overcome this. I feel sad for people who will not.

Toilet Paper and Cancer

The Coronovirus (Covid-19) pandemic is bringing out the best and worst in us as a society.

One of the problems is that some of us are buying huge quantities of items from supermarkets and hoarding them (or still selling them on the black markets for huge mark-up prices).

I recently had a patient who was diagnosed with breast cancer – which had spread to her brain. This was managed with steroids and radiotherapy to the brain lesions.

She was then started on tablets which block the hormones driving the breast cancer. The plan was to start her on a CDK4/6 modulating tablet along with the hormone blocker. I had planned to start her on Abemaciclib – which is the few medications which cross into the blood-brain barrier. The biggest problem being that these tablets can cause severe diarrhoea for the first few weeks.

The dilemma then being that this poor patient did not have enough supply of toilet paper – as they could not source it from any of the supermarkets.

We contacted the local supermarket and the manager was so helpful. He kept aside one box of toilet rolls for the patient. Also helped rebuild my faith in society.

She was then started on Letrozole and Abemaciclib. She is doing well as of now.

This was the first time the lack of toilet paper actually affected my decision making for patient care!!

Think about people around you. Care.