Lung Cancer and COVID-19 Update

The COVID-19 pandemic continues to be challenging for the world, especially for those already facing lung disease. The pandemic has presented many challenges for lung cancer patients. The symptoms of an acute or chronic COVID infection can be similar to issues people face with lung cancer and it can be difficult to figure out how to best protect yourself from infection while maintaining your lung disease treatment schedule and activities of daily living. In this blog, you will hear an update on key points regarding lung cancer and COVID-19. It is important to note that this blog was written in August 2021, and new data is emerging every day. Always consult your healthcare provider before making any changes to your care.

COVID-19 Protection

At this point, most people are familiar with the basic COVID-19 prevention methods such as hand washing, masking, social distancing and of course, vaccination. However, as the nation experiences surges in infection and states reopen, you may be more likely to find yourself in a situation where someone you live with has contracted COVID-19 or been exposed to the disease. Dr. Amy Cummings, a thoracic medical oncologist at UCLA Health, provides advice for keeping yourself safe in this situation. She says, “I have had several patients who have remained COVID free despite living with a COVID-19 patient. They’ve done so by isolating themselves as much as possible. That means quarantining the infected person to one room and minimizing contact in shared spaces by leaving meals in front of their door and having them use their own bathroom if possible.”

Dr. Cummings also recommends lung cancer patients get fully vaccinated against COVID-19 and to speak with their doctor about receiving a booster shot, especially patients currently on treatment or symptom management. Timing of the vaccination is important. Ideally, a patient receiving chemotherapy or immunotherapy should receive their vaccination 2-3 week prior to starting treatment. This gives the body time to make COVID antibodies and reduces their risk of worse side effects from cancer treatment. Right now, there aren’t timing consideration for people on targeted therapies such as tyrosine kinase inhibitors because the mechanism of treatment is very different.

Timing of vaccination should also be considered when a patient is scheduling a CT scan. The vaccine can cause lymph node swelling in some patients and it can be challenging to know if this swelling is related to the cancer or the vaccine. Dr. Cummings suggests waiting two weeks after vaccination to have a scan if possible. However, the bigger picture is that it is important for lung cancer patients to be vaccinated against COVID-19 AND receive timely care, so do your best but don’t let scheduling keep you from receiving the treatment you need.

COVID-19 and Lung Cancer Treatment

So much is still unknown about the lasting impacts of the COVID-19 infection. In lung cancer patients who have contracted COVID-19, it is especially difficult to tell the difference between the symptoms of a lingering COVID infection versus the underlying lung cancer. In lung cancer patients with lasting COVID-19 infections, Dr. Cummings is seeing continued breathlessness, shortness of breath, cough and feeling limited in normal activities. When Dr. Cummings sees a patient who is symptomatic and has had the COVID-19 infection, she is highly vigilant about monitoring their cancer treatment side effects. She notes, “We are most concerned about side effects from immunotherapy in patients who have lingering COVID infections. Immunotherapy harnesses the power of the immune system which is already overreacting in the case of long COVID. This can cause side effects of the treatment to be more intense.” She goes on to say, “To date, we haven’t seen any major issues and we have many tools that can help us treat side effects from immunotherapy. But we always watch the patient very closely.”

In terms of chemotherapy, long COVID patients who receive chemo may feel better, because chemotherapy can help reduce inflammation in the body caused by COVID-19. The last major treatment consideration is for patients facing thoracic surgery. Thoracic surgeons have seen worse outcomes in patients who are operated on too soon after a COVID infection, so sometimes these patients are given chemotherapy or radiation until they can have surgery.

Managing Lingering COVID-19 Symptoms

If you have been infected with COVID-19, you may have lingering symptoms, some of which you may not have experienced during your infection. According to the Centers for Disease Control and Prevention (CDC), post-COVID conditions can be considered as a “lack of return to a usual state of health following acute COVID-19 illness or the development of new or recurrent symptoms that occur after the symptoms of acute illness have resolved.”

“One reason why it has been hard to support patients after COVID is that some people don’t realize they are “long haulers” or that their symptoms are related to COVID. Sometimes they get new symptoms or symptoms are worse than what they experienced when they were actively sick,” says Lisa Penziner a nurse and nursing home administrator who runs a virtual support group for people with long COVID.

Lisa started her support group in June 2020, before the medical community really knew much about long COVID. She was hearing of patients experiencing lingering breathing problems, neuropathy, brain fog and mental health problems. Patients were going from doctor to doctor trying to find answers and not realizing it was related to COVID. Through Lisa’s professional experience as well as her role as a Better Breather’s Club Facilitator, she was able to connect long COVID patients with resources she uses to help patients with COPD and pulmonary fibrosis. “In our group we do a lot of breathing exercises including fun activities like playing the harmonica and cardio drumming. These activities help to expand the patient’s lungs, build endurance and reduce fatigue,” says Lisa. Her support group also provides invaluable emotional support and a way for patients to connect. Lisa notes, “This is a positive group. We look forward, not back. We help each other set short term goals and celebrate each other.”

The American Lung Association recognizes the invaluable role peer-to-peer support plays for patients facing lung disease. In August 2021, the Lung Association launched the Living with Long COVID community, a free online support community on the Inspire platform. This new community joins the Lung Association’s ten other free online support communities on Inspire, including the Lung Cancer Survivors Community. “The Living with Long COVID community complements other support offerings like local support groups and our virtual Better Breather’s Clubs. The Living with Long COVID community is always there and gives patients a way to connect anonymously any time of day with a large number of other people who are in their shoes,” says Deb Brown, Chief Mission Officer at the American Lung Association.

Putting it all Together

The COVID-19 pandemic has really shown the importance of care from a multidisciplinary team for patients with lung cancer. Dr. Cummings notes that she relies even more heavily on her pulmonologist colleagues during this time to guide care for patients struggling with breathing issues. And as we learn more about long COVID, physicians from all fields should continue to come together to assist patients with their recovery. Lisa’s work with her support group is a beautiful example of how to use the tools and expertise you have to fill a much-needed void in a time of crisis. The Lung Association is committed to not only ending COVID-19 but supporting those facing all lung diseases, including lung cancer and long COVID. And we encourage all Americans to do their part to keep our vulnerable populations safe.