Moderator: Dr. Mohammed Ezzi

Sponsor: AstraZeneca, a global, science-led, patient-focused biopharmaceutical     company

Presenters:

1. Dr. Mary Nyangasi, Head of Division, National Cancer Control Program, Ministry of Health, Kenya
2.  Dr. Catherine Nyongesa, Clinical Oncologist, Texas Cancer Center, Nairobi and Kenyatta National Hospital.

Cancer is a major cause of morbidity/mortality, where 70% of all cancer mortality occurs in low and middle-income countries. COVID origin remains unknown, although the first case was reported in Wuhan, China in 2019, and the official name was declared in Feb 2020. The pandemic has greatly affected cancer patients, their families, and caregivers. Common symptoms of COVID 19 include fever, chills, cough, and shortness of breath or difficulty in breathing, fatigue, and body aches. Control measures include cleaning of frequently used surfaces, use of detergent or soaps and water, disinfection, maintaining social distance, and wearing masks in public places. If quarantined, stay home and monitor your health, check if you have symptoms, stay away from others, especially those at a high risk of COVID infection. There is no specific report of increased incidence of COVID-19 asymptomatic infections in cancer patients, although data from China, the USA, and Italy confirms a higher risk. Cancer cases are grouped into high-priority cases which are life-threatening conditions, clinically unstable, and require intervention. The medium-priority cases are non-critical but delayed intervention could impact the overall outcome. The low-priority cases have a stable condition; hence services can be delayed for the duration of the COVID-19 pandemic or is non-priority. COVID has drastically impacted the screening and diagnosis, treatment, palliative care, and follow-up of cancer patients. Additionally, adjustments have been made for logistics and supplies of cancer drugs and other essential commodities. To counter the effects of COVID on cancer patients, the ministry of health listed cancer as an essential service and recommended that cancer centers remain open and encouraged telemedicine and alternative treatment. Additionally, personal protective equipment and medicines were distributed to the regional cancer centers by use of courier services. Socioeconomic support for vulnerable cancer patients were provided through the Ministry of Labor and Social Services. The current policy guideline is for cancer programs to continue offering services following strict COVID-19 preventive measures, and for the cancer patients to observe all the control measures. In addition, doctors should consider scheduling treatment to avoid delays and rescheduling, minimize outpatient visits, and reduce hospital visits for patients on oral treatment by offering at least 3 courses. Patients can have some tests done near home, and then call the doctor to give a report. Follow-up visits can also be delayed or the patients can visit the nearest hospitals. Also, there is a need for increased surveillance while treating lung cancer patients and the elderly as they may have symptoms similar to those in COVID 19 patients. The caregivers and patients in cancer centers should be screened and positive cases should be referred to the relevant caregivers. Multidisciplinary tumor boards (MDTs) are encouraged in decision-making as they can discuss the benefits and risks of present therapies. Non-life threatening conditions may explore the possibilities of watchful waiting. Additionally, oral therapies may be alternatives to chemotherapies. Adjuvant therapies are highly recommended for patients with resected high-risk diseases who are set to benefit from treatment. Late presentation is a major challenge in cancer management in the country. Vaccination of cancer patients is generally safe, but the timing of vaccination depends on the treatment that the patient is receiving.