Any decisions about your cancer treatment and care should be made by your treating team in consultation with you. (NICE 2021) This includes any proposed changes to your treatment if you test positive for COVID-19.

If you have symptoms that could be side-effects of your cancer treatment, such as a fever, it is important that you contact your treating team so they can check whether these are related to your cancer treatment or other infection. Do not assume that the symptoms are related to COVID-19 until you have been assessed.

If you test positive to COVID-19, your treating team will consider a number of factors to help them decide if your cancer treatment should be interrupted or changed, and how your COVID-19 care should be managed. These may include the following things:

• Whether your COVID-19 symptoms are mild or severe
• Your vaccine status – how many vaccinations you have had and how long it is since your last vaccination
• How suppressed (low) your immune system is
• The type of cancer treatment you are having
  • Some studies show that chemotherapy may be associated with worse outcomes from COVID-19 infection than some other treatments, such as immunotherapy and hormone-blocking (endocrine) therapy.
• The stage of cancer you have and where you are in your treatment regimen
• Other underlying health conditions you may have, such as diabetes and high blood pressure.

If your treating team is considering interrupting your cancer treatment, or changing the way it is delivered to you, they will talk to you about any potential risks of a treatment delay versus the risks of continuing treatment while unwell with COVID-19. They will also consider the potential risk to other patients and clinic/hospital staff if you stay on schedule and continue treatment at a medical facility while unwell.

Some of the changes to your treatment that may be considered include:

• Shorter, more intensive treatment regimens, such as for radiotherapy
• Longer gaps between immunotherapy treatments
• Postponing non-urgent, elective surgery, such as reconstruction surgery
• Attending hospital on your own without family members or other supporters
• Using telehealth for some appointments
• Using oral treatments or subcutaneous injections rather than intravenous (IV) treatments
• Using chemotherapy in the home services – some medications are suitable for use at home and some health funds cover these services.

Vaccination

The best way to protect yourself from getting COVID-19, and from serious illness if you do get it, is to be vaccinated against COVID-19. In Australia, everyone aged five years and over can be vaccinated.

People who are severely immunocompromised, including people receiving chemotherapy treatment or a recent bone marrow transplant, are recommended to have three “primary” doses of a COVID-19 vaccine as part of their initial vaccination schedule, and then a booster (4^th) dose three months later.

For more information about COVID-19 vaccines for people affected by cancer, visit Cancer Australia’s Frequently Asked Questions (FAQs) about COVID-19 vaccines for people affected by cancer. These FAQs are updated regularly as new information and evidence emerges.

Other protective measures

Although vaccination offers the best protection against severe illness, we know that vaccines may not work as effectively in people who are immunocompromised compared to people who are not immunocompromised. If you are immunocompromised, you are likely to be at higher risk of contracting COVID-19 and becoming more ill with it than people in the general population. You and your close contacts should continue with protective measures even if they are not required for everyone in your state or territory. These include avoiding people who are sick, avoiding large crowds, wearing a N95, KN95 or P2 mask when in public, washing your hands regularly and maintaining physical distancing.

Some organisations have developed information and useful tips to help you prepare for and manage your care if you are diagnosed with COVID-19:

• CreakyJoints and Global Healthy Living Foundation (GHLF) Australia: COVID-19 self-care guide. This resource provides pre-planning information about self-managing COVID-19 for people with chronic health conditions.
  Visit https://ghlf.org.au/covid-19-self-care-guide/
• The Royal Australian College of General Practitioners (RACGP): Managing COVID-19 at home with assistance from your general practice. This guide provides information to assist people with COVID-19 to manage their symptoms at home in collaboration with their general practice.
  Visit https://www.racgp.org.au/clinical-resources/covid-19-resources/patient-resources/managing-mild-covid-19-at-home

For more information on COVID-19 treatments, including newly approved oral treatments for COVID-19, visit the following information on the Australian Government Department of Health website.

• COVID-19 treatments
• Oral treatments for COVID-19

The following helplines can also provide information and support if you are worried about COVID-19: 

• The Australian Government’s National Coronavirus Health Information Line – Phone: 1800 020 080
  • Operates 24 hours a day, seven days a week.
• Cancer Council Helpline – Phone: 13 11 20
  • A free, confidential telephone information and support service run by Cancer Councils in each state and territory. Call if you have a question about cancer, or if you're seeking emotional or practical support.
• Breast Cancer Network Australia Helpline – Phone: 1800 500 258
  • A free, confidential telephone service for women and men diagnosed with breast cancer, and their family and friends.