Bladder Cancer and COVID-19: What's the deal?
In these unprecedented and uncertain times, bladder cancer patients and their loved ones understandably feel afraid and confused.
The Team at BCA were fortunate enough to discuss these concerns with Dr Ben Tran, a consultant Medical Oncologist in Melbourne, who has a special interest in bladder cancer. We thank Dr Tran for taking the time to answer some of our community's most frequently asked questions.
1/ Am I at increased risk from COVID-19 because I receive intravesical BCG treatments? Will BCG still be available?
There has been a global BCG shortage for some time. As BCG is a living organism, sometimes it grows and sometimes it doesn’t. As you may know, BCG has been used as a vaccine for TB. As a bacteria and as a treatment that will only be exposed to patients’ bladders, it should not directly increase risk of “catching” COVID-19. It is unclear how it would impact the severity of COVID-19 in those who get it. However, the weekly visits to hospital for BCG administration might be an issue. In my practice, I have encouraged patients to complete induction BCG, and have suggested maintenance BCG as optional. There is some research currently testing BCG as a potential treatment for COVID-19: The BRACE trial is intended for healthcare workers and is based on previous study findings that BCG decreases the level of virus in patients infected by viruses similar to SARS-CoV-2.
2/ Do chemotherapy or immunotherapy for bladder cancer increase the risk of catching the COVID-19 virus? (E.g. A patient with stage 4a TCC who is on monthly Durvalumab infusions to maintain stable disease)
Chemotherapy for bladder cancer, such as cisplatin and gemcitabine, can result in weakened immune system. Theoretically, this increases the risk of “catching” COVID-19. Immuontherapy, such as Pembrolizumab or Durvalumab, works by increasing the effectiveness of the immune system in “fighting” cancer. It is unclear how this impacts the risk of “catching” COVID-19. These types of immunotherapy can cause inflammation in the lung in a small proportion of patients.
3/ I’ve had a cystectomy. Am I at increased risk?
Patients who have recently had a cystectomy (within 3 months), will still be recovering and consequently, likely to be deconditioned. For this reason, if they were to “catch” COVID-19, they may have less reserve to cope with the infection. Having had a cystectomy that is uncomplicated and for which patients are fully recovered is unlikely to increase risk.
4/ Will bladder cancer treatments change? Will patients be able to continue their scheduled treatments during this time or is it OK for these treatments to be delayed?
As the health system responds to the COVID-19 situation, and in the scenario that health care workers need to take be isolated due to COVID-19, the resources for treatments such as cystoscopy, surgery, radiotherapy, chemotherapy and immunotherapy may be impacted. This is constantly being assessed and many hospitals/cancer centres around Australia have recommendations on treatments for cancer patients in the scenario that resources/staffing are affected. Please speak to your treating urologist/medical oncologist about the specific plan in place for your hospital.
5/ Will there be changes in regard to clinical trials in Australia?
Many clinical trials either have already been impacted, or will be impacted by COVID-19. Sometimes, this might relate to availability of the “trial drug” which needs to be shipped from overseas. Sometimes, this might relate to resources to run the trials,mainly related to doctors, nurses and study coordinators being isolated due to COVID-19. If you are on a trial, please check with the study coordinator/nurse about their plans for you specifically.
Useful links from our international bladder cancer community on Covid-19:
Bladder Cancer Canada Covid-19 FAQs
Fight Bladder Cancer UK Covid-19 FAQs
Common FAQs answered on all-things Covid-19 for Australians:
Department of Health and Human Services Covid-19 FAQs
Current numbers and Australian response:
Please click here for updates on the current situation and case numbers in Australia.