Chemotherapy Covid 19

[SC19]

Hi all,

My dad is undergoing chemotherapy - he has had 4 out of 6 - and the hospital have just rang him to say it is his decision whether to carry on with the remaining 2. They are giving us very little information of the risks of not carrying on vs the risks of catching the virus so I wanted to ask for your help in weighing this decision up.

His PSA started off at 43, after 3 sessions of chemo (docetaxel) it was 1.7. Hopefully it is now lower after his 4th session but he hasn't had the bloods done for that yet.

He is otherwise healthy, coping with the chemo ok and so far his bloods have shown his immunity bounces back well. The hospital he has the chemo is not a hospital where coronavirus patients are taken but of course the risk of catching it is there.

Obviously nobody can say definitively what the best thing to do is but does anybody know what the risks of delaying 2 remaining chemo session would be? Can you pick up where you left off, so to speak, or does it need to be 6 sessions in a sequence?

Thank you so much, from a very anxious daughter.

[SC19]

I should also add that my dad is also on ADT, as standard.

[pjoshea13]

I would be concerned about the increased risk of dying, should he catch COVID-19.

Hospitals are to be avoided if possible, at this time, IMO. Particularly if in a COVID-19 hotspot.

-Patrick

[SC19 in reply to pjoshea13]

Thank you Patrick. I’m leaning towards this opinion too. But how important those last 2 chemo sessions are is what is concerning me and whether doing them at a later date reduces their effectiveness.

[pjoshea13 in reply to SC19]

Treatment interruptions occur all the time due to side effects, etc. His doctor might be able to quantify any detrimental effect. There may even be a paper on the subject, but COVID-19 is the bigest threat to his survival at present. (IMO)

Also, blood tests can wait.

& minimize your own exposure to the virus!

Best, -Patrick

[Hidden]

Where is the hospital located?

[SC19]

In the north west of England, so not a particular hot spot but there are a significant number of cases here.

[Tall_Allen]

Tough call. There really isn't data to go by, but the concern with stopping and restarting almost any medicine is resistance - will the delay allow the most docetaxel-resistant cells to multiply? On the other hand, it is immunosuppressive. If he decides to go ahead with infusions now, he should ask for Neulasta with them.

[SC19]

Thanks both for your advice. It really is a tough call! The hospital has said if he was to defer they would resume his treatment in 2 months. We are leaning towards doing this but could resistance still develop within 2 months?

[Hidden]

It looks like he is doing early chemotherapy while still hormone sensitive. This is an optional additional treatment that has shown a benefit which is greater for those with larger tumor burdens. I would think he'll get some benefit for having done 4 out of 6 treatments, but continuing has to weighed against the risks of Coronavirus.

If it were me, I would not continue at this point since 1.The addition of chemotherapy is optional. 2. He has had 4 cycles already and 3. The biggest benefit is for those with large tumor burdens. To me, any additonal benefit he might get is outweighed by the risk.

[SC19 in reply to Hidden]

Thank you so much, this has really helped. Weighing up the risks, I think we are going to postpone.

[Hidden in reply to SC19]

Dealing with cancer, we are constantly weighing the cost and risk against the benefit. We just have make the best decisions we can with the information we have.

Thanks for what you are doing for your father. All of us here know the value of that.

[Stevemarr]

One factor is how widespread the covid 19 is in your area, my area has limited cases, other centers I would stay away.

[Fiddler2004]

This may help you in your decision making...

Https://uwhealth.org/health-wellnes...

[pcfred]

I've had to skip chemo a few times, a couple times doctor suggested, a couple times for one reason or another. Yes, sometimes the numbers increase during that time but hasn't been a big deal. I would skip at least this next one and hope this virus thing subsides.

[Union98]

My husband had lower doses of chemo (10% reduction) when he was first diagnosed. He didn't want to take Neulesta. He was Gleason 7 (4+3) four bone mets, lymph nodes, starting PSA of 73. Three and a half years later he's still undetectable. He's currently on Lupron and Zytiga. My thought would be to wait the two months and let Covid 19 cool down a bit before restarting. There are always exceptions to any rule and a treatment path depends on the person getting it.

[monte1111]

Not a dr. Possibly skip and then add 2 for total of 8? I had 8 in a row and if I had it to do again I think I would ask for 10. But I'm a know nothing. Best of luck.