Rethink Real Talk: Ask An Oncologist Part 1

Recently, Rethink held its first-ever live Zoom interview with an expert: Dr. Christine Brezden-Masley, Medical Oncologist and the Director of the Marvelle Koffler Breast Centre at Mount Sinai Hospital in Toronto, Canada.  

We asked her to set the record straight on all things COVID-19 and cancer-related*. She also took the time to answer some pressing questions from our breast cancer community to help empower us all during these uncertain times.  

Here’s a summary of the candid convo between Dr. Brezden-Masley and MJ DeCoteau, Rethink’s Founder and Executive Director. To catch the full interview, visit our YouTube page here. 

Why are cancer patients at an increased risk for COVID-19 infection? 

Cancer patients who are in active chemotherapy are immunosuppressed and part of the vulnerable population (along with the elderly). We have to protect and keep them safe, in hospital and at home, by educating on ways to ensure they minimize the infection to themselves and to others.  

If you’re on hormone therapy, like Tamoxifen, you’re not at any increased risk. 

How long are you considered immunosuppressed after active chemotherapy? 

Typically, after 2-3 weeks, you’re theoretically back to normal. Usually, the white blood cells of an active cancer patient are at their lowest 7-10 days after chemo and then rebound after that when your immune system normalizes. We are built with a regenerative bone marrow so typically that happens after 2-3 weeks, which does help in terms of normalizing your risk.  

What are some recommended considerations while you’re waiting for surgery? 

If you’re practising physical distancing, washing your hands, doing everything you’re supposed to do, your risk of a COVID-19 infection is low, so you really want to focus on doing that obviously and taking your breast cancer treatment. Physical activity is important, it’s good for mental health and those are key ingredients in getting you through all of this. I think a well-balanced diet, exercise, getting some fresh air, these are all important to life and every day. Nothing specific is going to halt a cancer’s growth except the true treatment. 

Can you speak to the safety of the current hospital triage process and long-term impact of surgery delays? 

The whole point of trying to safely delay surgeries was because we were anticipating a huge surge of COVID-19 positive patients. Fortunately, we haven’t seen that in Canada, so that means we can start opening up breast surgeries. 

We’ve triaged women who have received neo-adjuvant chemotherapy, these women were the first in line for surgery. Remember, 75% of breast cancers are driven by estrogen and women do tend to wait two, even four weeks to have breast cancer surgery. Typically, they’re not rapidly growing tumours so we’ve had these patients start anti-estrogen therapy to safely bridge these women prior-to their surgery.  

After discussing all these patients at our tumour boards where you have the surgeons, radiologists, pathologists and oncologists, we’re capturing all that data so that we will have information on the safety of delaying some of these surgeries. Now, it’s still individualistic to every cancer patient and this is specific to new diagnoses of cancer. 

What else has shifted in terms of patients accessing care?  

We’ve now moved into this virtual version of cancer care across Canada. Many oncologists have been all working together trying to provide safe care to our cancer patients. If a woman has a concerning breast lesion, obviously get in touch with your family doctor. It’s all very individual. We’re going to see those with triple-negative rapidly-growing breast cancer in clinic and probably start them on chemotherapy. For metastatic patients who are in the maintenance phase, they can likely safely delay coming into the clinic for 4-6 weeks. 

How are you addressing patients’ fears? 

Certainly, anybody diagnosed with cancer is very anxious and this is a diagnosis that changes everybody’s lives. By educating our patients, having conversations with them, I think it decreases the fear and the anxiety a little bit knowing that everyone is working together. What we’re trying to ensure is that once this pandemic clears, and this day will come, that our backlog won’t be too significant. Some of our strategic plans include looking at treatments and clinics to run on the weekends, and longer hours. We want to ensure we provide support for our cancer patients.  

For those on Tamoxifen there is a risk of blood clots. Given that severe cases of COVID-19 can have blood clot complications, is there a higher risk of this complication for women on Tamoxifen? 

Tamoxifen does have that risk, though it’s very small. There is no relationship that I’m aware of Tamoxifen leading to a COVID-19 infection or worse complications. If you get sick with COVID-19, it’s probably very safe to stop for the two-to-three weeks while you’re sick and restart it. 

This is more of a long-term treatment to block estrogen. It’s not that if you stop blocking estrogen the cancer suddenly wakes up and starts growing. It’s a really slow process. So stopping it for two weeks if you do get an infection would be safe.

As someone living with Metastatic Breast Cancer (MBC), is there a benefit to know if I’ve had a previous COVID-19 infection, and should I get antibody testing when it becomes available in Canada? 

You can have your antibodies tested when it does become available but by all viral infections that we’ve had before, we tend to build the army of our lymphocytes to help fight future infections. So, if you’ve already been infected with COVID-19 and have recovered, theoretically you should be immune to it. Again, we’re still learning with this coronavirus.

If patients are positive on active chemo, Ontario Health requires two negative COVID-19 nasal swabs, separated by at least 24 hours, before restarting or starting chemotherapy. They can be very painful and uncomfortable, and the onus is on the patient to come into the hospital to get tested. The good news is we’ve become very fast at getting results, typically within 24 hours.  

What are your thoughts on a COVID-19 vaccine?  

Until a vaccine is made available, we’re going to be living in a different world. I think there will be many vaccines that will be effective. Right now, they’re being clinically tested so they’re looking at antibody production, they’re looking at safety. But remember, as with any medication, the longer the medication is out, the more data we can obtain from it. We have to trust that the safety will be there and that it will be effective knowing that ongoing data will be collected to ensure ongoing safety and effect of the vaccines. 

* Note: This is not a replacement for medical advice or regular check-ins with your healthcare team. Also, the views and opinions expressed by our experts do not necessarily reflect the position of Rethink Breast Cancer. 

Looking for more COVID-19-related breast cancer resources? Click here. 

Christine Brezden-Masley, MD PhD FRCPC is a practicing Medical Oncologist and the Director of the Marvelle Koffler Breast Centre at Mount Sinai Hospital as well as the Medical Director of Cancer Program for Sinai Health System in Toronto, Canada. She obtained her PhD in Medical Biophysics at the Princess Margaret Hospital in Toronto and her Medical Degree from the University of Toronto. She is currently an Associate Professor at the University of Toronto and senior scientist for the same Clinical Research Group at the Lunefeld-Tanenbaum Research Institute for Sinai Health System in Toronto, Canada. She is also on the Rethink Breast Cancer Board of Directors and on the Rethink Scientific Medical Advisory Committee.