By Passakorn Wanchaijiraboon, MD.
Assistant Director, Cancer Excellence Center, Prapokklao Hospital, Chantaburi

“Cancer” is a malignant disease near us because at any stages of lives or any gender, if cells in our body are growing abnormally or mutating from their original forms, any given individuals could easily become “cancer patient.”   Because this disease is often diagnosed late between intermediate and terminal stage, the treatment is often ineffective and the disease is progressing and becomes more aggressive, ultimately leading to death of a patient.

“Coronavirus disease 2019 or COVID-19 (co-vid-nineteen” is a new emerging infectious disease caused by an infection with a novel corona virus (SARS-CoV-2).  The pandemic has been identified since last year and become so severe that World Health Organization (WHO) has declared COVID-19 as global “pandemic.”

WHO has recently updated new global COVID-19 cases of 3,517,345 with 243,401 deaths* (information as of 5 May 2020).

The danger of COVID-19 is its destruction of respiratory system, particularly an end organ like “lungs.”  Patients who get treatment too late have a chance of death.  In addition, the elderly as aged 70 years and older, small children under 5 years and those with underlying or pre-existing diseases are considered high risk groups if infected with COVID-19.  Symptoms could be more serious and life-threatening than common people.

The next question is how cancer patients whose disease are severe will handle the situation of COVID-19 pandemic to protect themselves from this disease and lessen their underlying cancer at the same time.

This article can help answer this question more profoundly by Passakorn Wanchaijiraboon, MD., Assistant Director, Cancer Excellence Center, Prapokklao Hospital, Chantaburi.

Q:   What is the fear of COVID-19 and cancer?

A:   COVID-19 is a new emerging infectious disease so study data are limited and data are constantly updating.  The dread of this disease
lies with the fact that all ages and all gender could be infected with this disease, more or less, depending on risk factors they are facing.

       Symptoms of COVID-10 start from mild to severe and ultimately death.  However, if elders have this disease, the symptoms are often severe, more prone to intensive care (ICU) than other ages, including high mortality rate than other ages.

       Taken this into account, we believe COVID-19 has effects on the immune system.  Healthy people, if infected with COVID-19, can control the disease better and, therefore, the symptoms are less severe.  However, the mortality rate of this disease is not as much as that of cancer, which will be later discussed.

    The fear of cancer includes:

  • “Cancer takes up lots of spaces.” For example, a patient with lung cancer has tumor near trachea.  When a tumor gets bigger, the trachea and bronchi can become blocked, causing lungs to get infected easier.
  • Cancer treatments, e.g. chemotherapy or radiotherapy can “weaken patients’ immune system.”
  • The severity of cancer becomes aggressive because tumors or certain substances produced by cancer can gradually worsen patients’ symptoms.
  • Most cancer patients are elders whose “immune system is already weak due to older  age.”  Therefore, the dread of cancer is cancer patients with weakened immune system has more chance of getting other diseases easily, especially while chemotherapy or radiotherapy is being given, the immune system is even more weakening, leading to higher risk of getting infection.

Q:   Why do cancer patients are at higher risk of getting COVID-19 infection?

A:   Actually, current evidence or data is unclear if cancer patients are at higher risk of getting COVID-19 infection.  However, principally, cancer patients are considered vulnerable group of COVID-19.  The reasons for this include:

       Normally, cancer is classified into 2 main types, i.e. “solid tumor” and “hematologic tumor” such as white blood cells, lymph node.  Cancer associated with blood cells or lymph node involve with the body’s immune system, thus weakening the immune.  

       Solid tumors depend on how spread this tumor is in the organs of the body as the problems most solid tumors are blocking, narrowing or clogging or breaking apart, for example. if the cancer tumor is located near a windpipe and becomes so enlarged that the windpipe becomes blocked, causing lungs to get general infection even more.  This infection may not be related to COVID-19.

       In addition, once having cancer, patients are also more prone to suffer from other diseases, such as loss of appetite due to change in taste or diet limitations, leading to weight loss and consequently malnutrition, ultimately decreased immune system, respectively.

       In conclusion, cancer has many risks.  Therefore, overall, cancer patients are considered “risk group.”  Once having cancer and getting COVID-19 infection, the risk of death is higher when compared to healthy people with COVID-19 infection.  As mentioned before, these data have not yet been established and further study is required.  We have to constantly update if this proves to be true.

Q:   What causes the decrease in immune system of cancer patients?

A:   In addition to the severity of the cancer itself, anti-cancer treatment is also a major factor of the immune system in cancer patients.  There are 3 main anti-cancer therapies as follows:

  • Surgery
  • Chemotherapy or chemo (classified into 3 methods, including chemotherapy, targeted therapy and immunotherapy)
  • Radiotherapy or radiation

Q:   Which type of cancer patients, if infected with COVID-19, could have the most severe symptoms?

A:   In principles, COVID-19 is a respiratory system infection, from nose to lungs.  Therefore, those with underlying lung diseases, whether emphysema or asthma, are risk groups.

       Thus, if you have lung cancer, whether it is originated from cancer or spread from somewhere, you are also at higher risk of getting COVID-19 than other types of cancer.  If the virus is infected in the lungs and the space in the lungs with already small will become even smaller, and thus the symptoms are more severe than those without lung diseases.

Q:   What cancer patients should do in the situation of COVID-19 pandemic?

A:   Cancer tumors do not stop growing.  Thus, we cannot stop treating.

       I would like to group cancer patients into 4 groups as follows:

       Group 1 Recently diagnosed patients, not starting any anti-cancer treatment

       Group 2 Patients who have just started some anti-cancer treatment

For groups 1 and 2, the doctors want these cancer patients return for treatment, counselling.  I would like to tell that more than 80% COVID-19 cases can be cured without treatment.  However, cancer cannot resolve by itself.  It needs treatments.

       Group 3 Cancer patients who have completed all treatment procedures.  They are now in the follow-up stage.  Mostly, these patients have a visit every 3 months in the first year and then every 4 months in the second year, and every 6 months to 1 year in the 3rd-4th-5th year.  For group 3 patients, even if treatment procedures are completed, they must return for follow-up as scheduled because there is a chance that cancer could come back at any time and may not originate from the same site.  If there is any abnormality, e.g. chronic illness, seek immediate treatment.

If asked “if you are definitely having cancer and if you may be at risk of getting COVID-19 infection,” I feel “cancer is more powerful because it never stops growing.  Therefore, we better get cancer treated first and I recommend that loss to follow-up with the treatment team must not occur.

During this time, some hospitals have many new contact channels, for example, Cancer Excellence Center, Prapokklao Hospital, Chantaburi, has opened up a new contact channel “Medical consult via line for cancer patients.”  It helps you to contact the cancer clinics before visiting the hospital.  It is the social-distancing treatment between patients and healthcare providers to prevent and control the spread of COVID-19.

If you are a patient in any region or near any hospitals, please enquire for contact channel to avoid loss to follow-up.

Q:   If visiting the hospital cannot be avoided, what cancer patients should do to be safe from the COVID-19?

A:   Rule 1 For cancer patients who have to visit a hospital, they also must follow the same measures being campaigned nowadays to avoid being exposed to COVID-19, as follows:

  • Eat hot food and use your own cutleries;
  • Practice social distancing;
  • Wear masks when having illness or every time you leave the house.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; after blowing your nose, coughing, or sneezing;
  • Avoid touching your eyes, noses and mouth;
  • Avoid coming in contact with others e.g. handshaking, embracing;
  • Avoid closed contacting with patients;
  • Avoid being in risky places, crowded places, such as public transportation, temple fair, or any other places where getting infection is possible.

These are measures to avoid being exposed to COVID-19 or else we can spread it to others when we visit the hospital.  This is what you can prepare before coming to the hospital.

Rule 2 When arriving at the hospital, strictly follow the hospital’s policies, starting at the screening point.  Patients must have their temperature measured, wash hands and they must not cover up their medical history.  If you have fever, coughing, you must immediately tell a hospital staff because you will be separated for testing at another facility.  This is useful in a way that if you have COVID-19, other people will not get it and you can get treatment fast.

Rule 3 Come to an exam room at the scheduled time.  You should not come and wait for a long time.  Then, have blood draw, get exam and go home immediately.

However, being in the hospital, you should practice social distancing, meaning leave 1 or 2 chairs between each other and wear mask all the times.  If touching something in the hospital, wash your hands with soap or alcohol gel.

Rule 4 Once getting home, wash your hands with soap thoroughly.  Take off your mask, take a shower and change into new clothes.  Then, observe if you have any of the following symptoms:

-   High fever

-   Coughing frequently

-   Sore throat

-   Shortness of breath

-   Dyspnea

-   Muscle ache

-   Weakness

-   Abnormal taste or smelling sensation

If you experience any of these symptoms, go to the hospital immediately for COVID-19 testing. 

Q:   What should cancer patients’ relatives do during COVID-19 pandemic situation?

A:    When cancer patients visit the hospital, their relatives often accompany them since patients with cancer are always weak due to the underlying disease or a number of treatment procedures.  Therefore, accompanying relatives must also take care of themselves similar to the same measures for cancer patients, starting from preventing themselves from becoming infected with the COVID-19 and avoiding risky groups or places.  If the patients’ relatives come from risky places, they may have to be contained for 14 days.  They do not see or visit cancer patients just yet because they may bring the disease to cancer patients.

       Then, accompanying relatives must strictly follow the hospital’s rules e.g. wear mask all the times, wash hands frequently and correctly.  For staying overnight at the hospital, before accompanying relatives stay overnight at the hospital, but during the COVID-19 pandemic, all hospitals have their own policy.  Therefore, if the hospital has arranged this overnight staff, the relatives may not be needed during this time. 

A:   If cancer patients become infected with COVID-19, which disease should first be treated?

Q:   There is only one answer.  Treat COVID-19 first.  Even if cancer patients may have severe symptoms than normal people, if treated immediately, cure is possible.  Once the virus is gone, then resume cancer treatment as planned because cancer tumors do not stop growing.  If not treated, death is potential.

Therefore, cancer requires treatment and so does COVID-19.

It is apparent that even if COVID-19 is an emerging disease and easily spread but it can be prevented, and if infected, it can be cured while cancer is not contagious disease but if not getting the right treatment and the treatment is not continuous, it may progress, become worsened or complications may be developed and ultimately lead to death more than COVID-19.

Therefore, if you are a cancer patient or a closed relative of cancer patient, during the COVID-19 pandemic, you must strictly take care of your hygiene, follow the instructions of the treatment team, and regularly come for monitoring.  Most important, keep getting treatment and never lose contact with the treatment team.




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