Resuming activities and in-person events worries cancer patients

The end of the year parties, amid the resumption of in-person events, have left patients who are part of the risk group for Covid apprehensive — especially immunosuppressed, in the case of people undergoing cancer treatment.

The drop in immunity, often caused by both the disease and the treatment, increases the fear of possible contamination, even with vaccination.

According to a survey by Pfizer/BioNTech, among those fully vaccinated, immunocompromised people are three times more likely to contract Covid and become ill with more severe conditions. The researchers analyzed 1.2 million cases reported in the US between December 2020 and July 2021 and concluded that the risk is still small compared to those who are not vaccinated.

Approximately 18% of the cases analyzed were of immunocompromised patients, that is, transplanted people, with HIV, malignant tumors, autoimmune diseases or other immunological diseases. However, approximately 60% of hospitalizations and 100% of deaths were among people in this group.

Maira Caleffi, head of the Mastology Service at Hospital Moinhos de Vento, in Porto Alegre, and volunteer president of the Brazilian Federation of Philanthropic Institutions for Breast Health Support (Femama), makes a reservation: the type of cancer makes a big difference in the impact in immunity and the research does not specify which cancer patients are referred to as immunodepressed.

The data show that the risk of a healthy person contracting Covid after being immunized with the Pfizer vaccine is 6 in 10,000, while for patients categorized as immunocompromised this number is three times higher, 18 in 10,000.

In the case of cancer patients, the reduction of immunity can happen either due to the tumor or due to some types of treatment. That’s because, at the same time that it destroys the malignant cells, chemotherapy and radiotherapy can reduce the defense cells. This creates an environment in which the immune system weakens and makes the patient more susceptible to infectious processes, explains oncologist André Fay, a physician at the Oncoclinics group in Porto Alegre.

Maira Caleffi says that the concern with vulnerability must be greater at the beginning, in general the most aggressive moment of treatment, which can include surgery, chemotherapy and radiotherapy, for example. Afterwards, the therapy can be extended for up to ten years with medications, but it has no impact on the patients’ immunity.

Those undergoing initial treatment realize that sometimes even small exposures can have serious complications. “To give you an idea, after I started chemotherapy, in July of this year, I’ve already caught the flu eight times,” says business administrator Jackeline Goldoni, 49, who lives in Capanema, in the interior of Paraná.

Jackeline discovered breast cancer during a routine consultation in May this year, time of the worst period of the pandemic in Brazil, which was experiencing more than 2,000 daily deaths and had less than 20% of the population immunized with the first dose.

“The first thing my doctor told me was to get the Covid vaccine. It hadn’t yet come for people my age, but he gave me a medical certificate and I ran,” he says. In June, already vaccinated and less than a month after diagnosis, she underwent surgery to remove her breast and place an implant. The following month, chemotherapy began, which since October gave way to radiotherapy treatment.

Out of work since June, when she “locked herself at home”, Jackeline hopes to be able to return to work this month, albeit with shorter shifts. For her, working is a matter of necessity. “I’m going back, but being careful, I want to have a normal life. I’m going to make my family aware that I need to go back and that I need to take care of myself.”

The routine will be challenging, but she already faced something similar when her 14-year-old returned to face-to-face classes (she has another 24-year-old). “It was nerve-racking for me. He came home and I [falava] ‘go take a shower and then come and give me a hug’. You are already in a delicate moment and think ‘Can you imagine getting [Covid]?’”

And she took it, in fact, along with her parents, husband and son. All recovered well, but Jackeline and her parents had more serious conditions: she was hospitalized for four days, and they, for eight days.

A neighbor of Jackeline in Capanema and still without the booster dose, the massage therapist Solange Ilkiu, 56, returned to work as director of the Municipal Department for Women’s Policies, emphasizing the importance of contact with her colleagues and the public she serves.

Both emphasize that they do not intend to reduce general care with the prevention of the disease, such as the correct use of masks, the preference for ventilated environments without crowding. Fay says that care recommendations must be individualized for each patient, taking into account factors of the disease, treatment and epidemiological moment.

“There are situations where there is greater concern and a somewhat stricter degree of restriction is recommended; in others, it is possible to resume activities within the usual care of the entire population, no more and no less.”

Today, however, it is already known that vaccination against Covid-19 is safe and produces immunity in breast cancer patients. For Maira Caleffi, full immunization is highlighted in the prevention of infections that can worsen the health situation.

The doctor advises patients to seek advice to keep the vaccines up to date, in line with the national schedule. The recommendation is not just for those who are already sick: counseling can be found by anyone, free of charge, at any UBS (Basic Health Unit).

Before the concern with Covid, doctors already guided their patients to take greater care to prevent infections during the initial treatment. Fay recommends, for example, the preference for cooked and not raw meals, to avoid contamination via ingestion, and not to remove the cuticle in the manicure, to escape from bruises that act as a gateway for microorganisms.

Along the same lines, Caleffi also highlights the importance of oral hygiene, where contamination can come from. “Regular follow-up with dentists to prevent gingivitis and detect infectious problems in the mouth and gums is very important for the patient who is concerned.”