Ocean Hematology & Oncology

Submitted by Sarah J. Easaw, MD, FACP

1. The risk of death in cancer patients affected by COVID 2. The impact of COVID 19 on the timely diagnosis and treatment of

cancer #

Most people infected with COVID 19 only experience mild symptoms that resolve without any treatment. But some are severely affected, needing hospitalization and oxygen support. A significant percentage of people die from COVID 19 infection, in spite of hospitalization and ICU care. The risk of developing severe infection is mainly based on certain risk factors.

Risk factors for developing severe COVID infection include older age, diabetes, lung disease, heavy smoking, alcoholism, uncontrolled high blood pressure, heart disease, kidney failure, cancer and conditions that cause low immunity.

Several studies were done to assess the risk of severity in COVID 19 patients with cancer. Some studies did not show a significant difference in the rate of death in cancer patients with COVID, but most studies observed that the risk was high.

1. Older age 2. Those undergoing active treatment with chemotherapy and immunotherapy 3. Smokers 4. Lung cancer and cancer of blood and blood-forming organs (hematologic malignancies) 5. Within 6 months of receiving high-dose chemotherapy and stem cell transplant 6. Prolonged period of low immunity (persistent low white count) 7. Other co-existing conditions such as diabetes, heart disease, kidney disease

Excessive caution should be taken in patients with the above risk factors to limit their exposure to COVID 19 infection. These include strict physical distancing, avoiding any gatherings or crowds, always wearing a mask when with others, and frequent handwashing. In addition, any unusual symptoms should be reported to the doctors and should warrant COVID testing, so that early intervention can be done. Impact of COVID 19 in the diagnosis and treatment of cancer:

Ever since the pandemic started, many people tend to stay away from the hospitals and doctors’ offices. Most have postponed routine check-ups and diagnostic tests like mammograms and colonoscopies. In addition, the ability of centers to offer screening tests at typical levels was impacted by the severity of the pandemic. Because of that, there could be a delay in diagnosing and treating cancer. This is a significant challenge for healthcare providers. The fear of catching the infection must be weighed against the potential of dying from cancer, if not diagnosed early.

Most centers have now resumed routine screening for cancer. A COVID test is done prior to any hospital admissions and procedures. All healthcare facilities practice strict guidelines in screening for symptoms of COVID and implementing mask-wearing for employees and patients. These measures reduce the risk of contracting the infection. Harm in delaying cancer treatment:

Many cancer patients have delayed their treatment due to fear of catching COVID. This is a legitimate concern because the risk of severe infection is higher if you have cancer. But the delay in treatment can lead to progression of cancer and an increased risk of dying from it.

Most hospitals and chemotherapy infusion centers are offering COVID testing to screen for asymptomatic carriers of COVID prior to chemotherapy and surgical procedures. Strict enforcement of mask-wearing and social distancing also help to reduce the risk of contracting the disease. The impact of delaying treatment can be harmful, especially in rapidly growing cancers. The risks and benefits of treatment must be weighed against the risks of contracting the infection.

Did you know that lung cancer is the leading cause of cancer deaths in both men and women in the U.S.? Approximately What you can do: 1. If you are actively undergoing cancer treatment, take extra caution 200,000 new cases are diagnosed each year and 27 percent to avoid exposure to COVID: stay away from anyone other than of all cancer deaths are from lung cancer. your immediate household, wear masks, and use strict handwashing What causes lung cancer? Smoking. Smoking is the number one risk factor for lung cancer. Even though non-smokers can also get lung cancer, the risk is much higher in those who smoke. The more you smoke, the higher your risk. The likelihood of getting lung cancer decreases after you quit smoking. Tobacco smoke damages cells in the lungs, causing the cells to grow abnormally. Regular exposure to smoke from someone else’s cigarettes, cigars or pipes (called second-hand smoking) can increase a person’s risk of lung cancer, even if they are non-smokers. Exposure to asbestos. Certain jobs such as shipbuilding, asbestos mining, insulation or automotive brake repair may cause exposure to asbestos. Asbestos fibers can irritate the lungs guidelines, but don’t delay the cancer treatment. Make sure that the facility where you are getting treatment is also taking these precautions. 2. Those who were diagnosed with cancer, but are not in need of active treatment, should also follow safe practices, but your risk of getting severe infection is not increased due to cancer diagnosis alone. 3. Report any unusual symptoms to your healthcare provider and seek immediate help. COVID symptoms can be very variable and not everyone presents with fever and chills. Diarrhea, abdominal and cause cancer. When combined with smoking, the risk of developing lung cancer is much pain, sore throat, cough, lack of taste and smell, skin rash, redness higher. in the eye, shortness of breath: all these complaints can be the first

Radon. Radon is an invisible, odorless gas released by soil and some rocks. Exposure to presenting symptom of COVID. higher levels of radon can cause cancer, especially lung cancer. 4. If your facility offers COVID screening prior to procedures, take it! You What are the types of lung cancer? could be asymptomatic and still be a carrier. Help prevent transmission of this deadly virus by being screened. There are two different types of lung cancer: small cell and non-small cell. This difference is based on the type of cancer cells. Most lung cancers are non-small cell. Among the non-small Last, but not least, try to stay positive in these tough times. Many people are suffering from anxiety, depression and loneliness due to the effect of the pandemic. Stay in touch cell lung cancers, there are several subtypes: adenocarcinoma, squamous cell and large cell. with your loved ones, your friends and family, virtually to support one another.

Symptoms and signs include coughing, hemoptysis (coughing up blood), shortness of If you have any questions about any cancer-related questions, breath, chest pain, fatigue and weight loss. please contact Dr. Sarah J. Easaw at 732-961-0010Most often, the symptoms do not manifest until the cancer is advanced. Sometimes lung cancer can be detected as a shadow in the lung on an X-ray done for other reasons. or visit www.oceanhemonc.com.

Once your doctor suspects that you have lung cancer, you will be sent for CT scans and in some cases, a PET scan. A PET scan can detect cancer more accurately than other tests. The diagnosis is confirmed by taking a biopsy of the suspicious lesions seen on the X-ray or CT scans. The scans also help to see if the cancer has spread to any other organs, a process called metastasis.

Staging is different for small cell and non-small cell lung cancers. Small cell lung cancer has only two stages: limited stage (confined within the lungs) or extensive (spread outside the lungs).

Non-small cell lung cancer has four stages: stages I to IV. Stage I is a small tumor that is confined to the lung, that has not spread to the lymph glands. Larger tumors and those that are spread to the lymph glands come under stages II and III. When the cancer has spread to other organs, it is stage IV.

Treatment is based on the stage and the type of lung cancer. Small cell lung cancer is mainly treated with chemotherapy. In limited stage small cell lung cancer, radiation can be combined with chemotherapy.

Early stage non-small cell lung cancer is best treated by surgical resection. An experienced surgeon removes the tumor, surrounding normal lung tissue and the lymph glands around it. Even after removing the tumor, cancer cells can remain and cause recurrent cancer, either in the lung itself or in other organs. Chemotherapy, radiation or both are used after surgery to reduce the chance of recurrent cancer.

Advanced stage lung cancer is treated with chemotherapy. The types of chemotherapy drugs used are based on the type of lung cancer, age of the patient, other medical illnesses, etc. There is ongoing research to improve the outcome in patients with lung cancer.

Targeted agents: Medicines that target certain proteins or receptors on the cancer cells are being developed for the treatment of various cancers. These targeted agents attack the cancer cells specifically, sparing other cells. Targeted agents cause less severe side effects than chemotherapy.

A few different targeted agents are found to be beneficial in lung cancer. Tarceva (erlotinib) is a drug that works in certain types of lung cancers carrying a mutation in a receptor called EGFR. A new drug called crizotinib was approved recently for the treatment of lung cancer that carries a gene called ALK fusion oncogene.

No two tumors are alike! Even among lung cancers, there are different distinguishing features. Your oncologist chooses the type of treatment based on a number of factors, including the cell type, stage, different biological markers on the cancer cells, and your other medical problems.

Over the last few decades, immunotherapy agents have been studied in the treatment of many cancers, including lung cancer. Several immunotherapy drugs are now approved for use. Our immune system fights cancer cells normally, and thus reduces the chance of Medical Professionals transforming normal cells into cancer cells. But this does not work always, as people with normal immune systems also develop cancer. The principle of immune therapy is based on

What You Need To Know boosting the immune system so that it can efficiently destroy cancer cells.

The use of immune checkpoint inhibitors has been a major breakthrough in cancer research. Did you know that lung cancer is the leading cause of cancer

These drugs help to take the “brakes” off the immune system, so that they can recognize and kill cancer cells more effectively. deaths in both men and women in the U.S.? Approximately 200,000 new cases are diagnosed each year and 27 percent of all cancer deaths are from lung cancer.

OPDIVO, KEYTRUDA, and TECENTRIQ are some of the immune checkpoint inhibitors that are used in lung cancer. Even though these drugs don’t have the typical side effects of What causes lung cancer? Smoking. Smoking is the number one risk factor for lung cancer. Even though non-smokers chemotherapy, they still can cause reactions such as inflammatory disorders.can also get lung cancer, the risk is much higher in those who smoke. The more you smoke, the higher your risk. The likelihood of getting lung cancer decreases after you quit smoking. Tobacco smoke damages cells in the lungs, causing the cells to grow abnormally. Regular exposure to To learn more about lung cancer and the treatment of smoke from someone else’s cigarettes, cigars or pipes (called second-hand smoking) can increase a person’s risk of lung cancer, even if they are non-smokers. other cancers, contact Dr. Sarah Easaw at 732-961-0010 orExposure to asbestos. Certain jobs such as shipbuilding, asbestos mining, insulation or automotive brake repair may cause exposure to asbestos. Asbestos fibers can irritate the lungs visit www.oceanhemonc.com.and cause cancer. When combined with smoking, the risk of developing lung cancer is much higher.

Radon. Radon is an invisible, odorless gas released by soil and some rocks. Exposure to higher levels of radon can cause cancer, especially lung cancer.

There are two different types of lung cancer: small cell and non-small cell. This difference is based on the type of cancer cells. Most lung cancers are non-small cell. Among the non-small cell lung cancers, there are several subtypes: adenocarcinoma, squamous cell and large cell.

Symptoms and signs include coughing, hemoptysis (coughing up blood), shortness of breath, chest pain, fatigue and weight loss. Most often, the symptoms do not manifest until the cancer is advanced. Sometimes lung cancer can be detected as a shadow in the lung on an X-ray done for other reasons.

Once your doctor suspects that you have lung cancer, you will be sent for CT scans and in some cases, a PET scan. A PET scan can detect cancer more accurately than other tests. The diagnosis is confirmed by taking a biopsy of the suspicious lesions seen on the X-ray or CT scans. The scans also help to see if the cancer has spread to any other organs, a process called metastasis.

Staging is different for small cell and non-small cell lung cancers. Small cell lung cancer has only two stages: limited stage (confined within the lungs) or extensive (spread outside the lungs).

Non-small cell lung cancer has four stages: stages I to IV. Stage I is a small tumor that is confined to the lung, that has not spread to the lymph glands. Larger tumors and those that are spread to the lymph glands come under stages II and III. When the cancer has spread to other organs, it is stage IV.

Treatment is based on the stage and the type of lung cancer. Small cell lung cancer is mainly treated with chemotherapy. In limited stage small cell lung cancer, radiation can be combined with chemotherapy.

Early stage non-small cell lung cancer is best treated by surgical resection. An experienced surgeon removes the tumor, surrounding normal lung tissue and the lymph glands around it. Even after removing the tumor, cancer cells can remain and cause recurrent cancer, either in the lung itself or in other organs. Chemotherapy, radiation or both are used after surgery to reduce the chance of recurrent cancer.

Advanced stage lung cancer is treated with chemotherapy. The types of chemotherapy drugs used are based on the type of lung cancer, age of the patient, other medical illnesses, etc. There is ongoing research to improve the outcome in patients with lung cancer.

Targeted agents: Medicines that target certain proteins or receptors on the cancer cells are being developed for the treatment of various cancers. These targeted agents attack the cancer cells specifically, sparing other cells. Targeted agents cause less severe side effects than chemotherapy.

A few different targeted agents are found to be beneficial in lung cancer. Tarceva (erlotinib) is a drug that works in certain types of lung cancers carrying a mutation in a receptor called EGFR. A new drug called crizotinib was approved recently for the treatment of lung cancer that carries a gene called ALK fusion oncogene.

No two tumors are alike! Even among lung cancers, there are different distinguishing features. Your oncologist chooses the type of treatment based on a number of factors, including the cell type, stage, different biological markers on the cancer cells, and your other medical problems. The County Woman Magazine www.TheCountyWoman.com November/December 2018

Over the last few decades, immunotherapy agents have been studied in the treatment of many cancers, including lung cancer. Several immunotherapy drugs are now approved for use. Our immune system fights cancer cells normally, and thus reduces the chance of transforming normal cells into cancer cells. But this does not work always, as people with normal immune systems also develop cancer. The principle of immune therapy is based on boosting the immune system so that it can efficiently destroy cancer cells. Testimonials The use of immune checkpoint inhibitors has been a major breakthrough in cancer research. These drugs help to take the “brakes” off the immune system, so that they can recognize and kill “Dear Dr. Easaw, cancer cells more effectively. I am writing to thank you for your kindness in caring for my Mom. My family has comfort in OPDIVO, KEYTRUDA, and TECENTRIQ are some of the immune checkpoint inhibitors that are used in lung cancer. Even though these drugs don’t have the typical side effects of knowing that she was taken care of by a compassionate group of folks who made her multiple trips chemotherapy, they still can cause reactions such as inflammatory disorders. to the office and hospital tolerable. I have also appreciated your kindness and patience in taking my To learn more about lung cancer and the treatment of many calls to discuss my Mom’s schedule, results etc.” other cancers, contact Dr. Sarah Easaw at 732-961-0010 or visit www.oceanhemonc.com. “I am so glad that I finally found a great doctor to help me navigate through my newly diagnosed cancer.” Dear Dr. Easaw & Staff, “Thank you all so much for the wonderful care that you gave Mom. You all added that personal touch, that most people, including my family couldn’t and wouldn’t give. For that we will always be thankful.”

Sarah J. Easaw MD, FACP Board Certified Hematology & Oncology specialist Serving Monmouth and Ocean Counties for more than 15 years

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