We have put together some answers to frequently asked questions from our community. Take a look below. Remember, if in doubt, speak to your medical team – they are in the best position to help you.
Treating and managing your cancer is as important as treating and managing COVID-19. Your medical team will speak to you about this, and how to manage potential risks, but most people will be advised to continue on with their treatment. The safest place to have treatment is still at your local cancer centre or hospital.
We will be talking in more detail over the next few days, as more information becomes available, about possible changes in the way your cancer care is delivered (e.g. consultations over the phone). This page will be updated as the situation evolves.
You can watch our webinar, 'COVID-19 and breast cancer', at the bottom of the page.
Breast Cancer Foundation NZ is still here to support you during this time. You can see the support services we have available here, or call our nurses on 0800 226 8773 if you have any questions or concerns.
Your immunity and COVID-19
- Am I at higher risk from COVID-19 because I've had breast cancer?
- Will my immunity be affected by treatment?
- How long will my immune system be suppressed after I finish chemotherapy?
- I’ve had lymph nodes removed as part of my surgery for breast cancer treatment. Will this affect my immunity?
Everyone carries the same risk of getting Covid-19, but it will impact everyone differently. People who currently have breast cancer, including those who’ve recently been diagnosed or who have advanced breast cancer, may have lowered immunity because of the cancer itself. Some breast cancer treatments can also lower your immunity.
It also seems that people who have had cancer in the past may be at higher risk of complications from the virus. Most people who develop cancer – in New Zealand and around the world – are older, and are likely to have other medical conditions too. These factors may raise your risk of getting sick.
Certain cancer treatments can affect your immune system, making you more vulnerable to infection. Those having chemotherapy or targeted treatment (like Herceptin) at the moment, or who have who have recently completed treatment, are likely to be immune-compromised in some way.
While on chemotherapy there is, of course, the very real risk of developing severe bacterial infections and your team of doctors and nurses will have spent time explaining this risk to you – describing the signs and symptoms of infection and how to report concerns immediately to hospital staff. This situation doesn’t change with COVID-19 and you should continue to have regular blood tests to check your white blood cell count if you have been asked to. It’s important to keep taking any medicine you’re been prescribed, as this will help support your body’s ability to fight infection. Please continue to keep your appointments with your treatment team, and contact them directly if you have symptoms and follow their advice.
Radiotherapy is less likely to affect your immune response, but you may find that your medical consultant will look at new ways of scheduling treatments to limit your exposure to others.
Taking hormone therapies, like tamoxifen, won’t increase your risk of getting sick, as there is no evidence that hormone therapies affect the immune system.
If you’ve finished treatment recently, your immunity should recover within the next few months. If you finished cancer treatment months or years ago, your immunity should have recovered by now.
There is no definitive way to test how good your overall immunity is, but how fast you recover from colds, etc might give you a clue about this. This will be different for everyone, as everyone’s immune system and treatment is different. If you’re still unsure, the best person to ask is your breast nurse or oncologist.
While lymph nodes are part of the immune system, having lymph nodes removed doesn’t affect your body’s ability to fight infections like COVID-19.
Changes to your treatment
- Will my breast cancer surgery be delayed?
- Will I still be able to have chemotherapy
- Will my radiation therapy still go ahead?
- Is it still safe to visit the hospital or cancer clinic?
There may be some changes in the timing of your surgery. Your medical team will coordinate timing and this may change from region to region. If your surgery is deferred, that decision has been made on evidence that it won’t affect your treatment result, and it’s most likely because the risk of being in the hospital at this time, or the risk of complications requiring additional care that may not be available, is too high. For those who have a high risk of complications or COVID-19, other treatments such as endocrine therapy or chemotherapy may be used first.
Reconstruction surgery will not be available in the immediate future, and your medical team will discuss your options and agree the treatment plan that’s best for you.
If you have been prescribed chemotherapy this is an important part of your overall treatment and this will continue to be offered as long as it can be given safely. Your medical team will be looking at the benefit of starting or continuing with cancer treatments vs the risk of you getting COVID-19 or other side effects from chemotherapy (especially if it’s likely you will be severely immuno-compromised) and might require ICU care.
Your team will be considering the following when it comes to treatment:
- Possible switch to a lower-risk chemo (less damaging to your immune system) and additional drugs to support your immune system
- Possible switch to oral chemo so that you don’t need to have as many appointments in the hospital
- Possible changes in timing of your chemotherapy appointments
- Where your individual benefit of having chemo is small, your doctor might discuss with you whether it’s safer for you not to have it
If there are any changes to your treatment plan, your team will talk to you about this.
It’s likely your treatment will go ahead, but there may be some changes in the way it’s carried out. Radiation therapy involves visiting the hospital every day for several weeks – your doctor may discuss ways that you can reduce the number of visits you make.
Your doctor may also discuss the following treatment changes with you:
- Receiving 15 treatments instead of 20 or 25. This does not mean your radiation is less effective – 15 treatments is the standard that New Zealand hospitals have been moving to, and it is considered best practice. People with advanced breast may receive a single, higher dose for bone metastases.
- For some very low-risk patients, it may be recommended that these patients don’t have radiation therapy. Patients in this group include those with low-grade DCIS or elderly patients with low-grade tumours, where the benefit of radiation therapy is low and the risks of getting COVID-19 may outweigh these benefits. There are already clinical trials underway in NZ looking at low-risk patients foregoing radiation therapy, so we know this can be managed very well with additional follow-up for those patients.
- Your appointment time may also be moved in order to limit the amount of time spent in the waiting room, and there may be a few weeks’ delay in the start of your treatment.
If there are any changes to your treatment plan, your radiation oncologist will discuss these with you.
Hospitals and cancer clinics are still safe places to have your treatment, but it’s very important that you phone ahead before you visit. Do not go to the cancer clinic without an appointment.
There may be changes at hospitals and clinics to manage the risk of COVID-19 and to keep patients safe. You can expect to see the following changes, although this may vary region by region and will change as the situation evolves:
- Appointments may not be with your usual doctor, as teams are rearranged to allow best cover for all cancers if staff are sick or quarantined.
- You may only be allowed to take one support person to appointments, and in some regions, you won’t be able to take any.
- You will be screened for COVID-19 symptoms and exposure (such as being asked questions or having your temperature taken) before you go into a clinic.
- Your clinic could be moved to another location within the hospital, to allow for social distancing.
- What should I do if I become unwell or think I have been exposed to COVID-19?
- Can I visit my GP if I find a lump or an unusual change in my breasts?
- Should I wear a face mask to the hospital to protect myself?
- Can I take ibuprofen if I have a fever?
- Should I have the flu vaccine this year?
- What is self-isolation? How does self-isolation work when someone in the household gets sick?
If you are currently on treatment your medical team will give you information about infection, what to do if you feel unwell, and the steps to take if you do get sick. If you get a fever while on chemotherapy, you should follow these instructions carefully.
If you have completed treatment, your GP will be your first port of call. It’s best to ring them first, and they can then assess you over the phone. If needed, they may be able to still see you in person.
It's important to get any changes in your breasts checked out, even if you've had a mammogram recently. Give your doctor a call - you may be able to have an appointment with them over the phone or via video. Doctors are still referring patients to breast clinics, so even if you are unable to see your doctor, you should still be able to have any changes checked out.
You won’t need to wear a mask unless you’re unwell with the symptoms of a cold. If this is the case, you must notify the hospital before you go and they’ll tell you how to proceed. Washing your hands frequently and trying not to touch your face are more important than wearing a mask. If you do need to wear a mask, the hospital will talk to you about this – they’ll give you a mask and will also talk you through the proper procedure when wearing a mask.
Ibuprofen (e.g. Nurofen) and other anti-inflammatory drugs are effective in lowering a fever and may be taken if a person has COVID-19. However, many doctors recommend paracetamol as it is easier to dose and has less side effects.
Anti-inflammatory drugs generally are not recommended for patients having treatment, especially those who are having chemotherapy as they may suppress the normal inflammatory response, which is how the immune system fights infection.
It is very important that those having chemotherapy remember that if they have a fever higher then 38°C that this is a sign of infection and they must phone the oncology clinic urgently.
If you are going through treatment at the moment, your doctor will most likely recommend you have a flu vaccination. Anyone who has cancer is entitled to a free vaccine. You should talk to your cancer doctor or nurse about this and about the best time to have the vaccine.
If you are one of the few breast cancer patients taking the experimental treatments atezolizumab (Tecentriq) or pembrolizumab (Keytruda), you should discuss the flu vaccine with your oncologist.
Self-isolation is a preventative and protective measure to help stop the spread of COVID-19, and to keep our vulnerable communities safe. That means staying at home with your household groups, and leaving the house only for essential trips and to get fresh air.
We are advising people with breast cancer, particularly those who have had a recent diagnosis and treatment, to limit contact as much as possible with others during this time. This means that if you live with someone else it may be a good idea to nominate them as the person that goes to the supermarket and has contact with others. If you live alone, get in touch with family, a friend or a neighbour to see if they can help out.
Many people who have the coronavirus will not stay in a hospital and will be isolated at home. In this situation self-isolation is more restrictive, in that the person affected must isolate themselves in a separate room with no or minimal contact with the rest of the of the household. This includes not sharing bathrooms or items like plates, cutlery, towels and pillows in order to prevent others in your household getting sick.