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What People With Cancer or Compromised Immune Systems Need to Know about Coronavirus (COVID-19)

National Center for Health Research: Updated November 15th, 2022


The coronavirus can infect anyone, young or old, healthy or frail. People with cancer and other serious health conditions, and their loved ones, need to be especially careful. Here’s what you need to know.

Some cancer treatments, such as chemotherapy, targeted therapies, immunotherapy, and radiation, can weaken the immune system and possibly cause lung problems. People who have weakened immune systems or lung problems are more likely to have serious symptoms if they become infected with this virus. Anyone with cancer in the lungs (whether lung cancer or cancer that has spread to the lungs) is especially at risk if they develop COVID-19.

What is coronavirus?

Coronaviruses are a large group of viruses that can cause respiratory illness. The new (novel) coronavirus is called SARS-CoV-2 and the illness it causes is called coronavirus disease 2019, which is why it’s abbreviated as COVID-19.  Since it is new, nobody has immunity from it.

How does COVID-19 spread between people?

The virus usually spreads through close contact with other people, especially through droplets when a person coughs or sneezes – or even when they breathe normally. These droplets can travel through the air and can be inhaled or get into the noses, mouths, or eyes of people nearby.

It is most contagious when the person has symptoms, but it is possible to catch the virus from infected people who have no symptoms at all. In addition, these droplets (as well as fecal matter containing the virus) can end up on surfaces where it can survive for short periods of time.

Symptoms tend to start between 2 and 14 days after coming into contact with the virus. Although some people have compared the symptoms to a cold or flu, not everyone with COVID-19 has those types of symptoms. In fact, some people (especially children, teens, and younger adults) have very mild symptoms or none at all, which is why getting tested is so important before you spend time with others. These symptoms have been reported in people with COVID-19:

·       Fever or chills

·       Cough

·       Shortness of breath or difficulty breathing

·       Fatigue

·       Muscle pains

·       Headache

·       New loss of taste or smell

·       Sudden confusion (delirium)

·       Skin rash, redness on toes/fingers

·       Chest pains

·       Sore throat

·       Congestion or runny nose

·       Nausea or vomiting

·       Diarrhea

·       Skipping meals

·       Abdominal pains

·       Sneezing

·       Changes in the mouth or tongue

Studies out of the United Kingdom show that the most common symptom associated with COVID-19 is a sore throat, with fever and loss of smell becoming rarer in patients. Tim Spector, a professor of genetic epidemiology at King’s College London, reported that “COVID starts in two-thirds of people with a sore throat,” which is something to keep an eye out for if you think you may have COVID.

Most people who are infected with this coronavirus have mild symptoms and can recover at home in about 2 weeks. However, symptoms can become severe. These are the ones that require immediate medical attention:

  • Difficulty breathing or shortness of breath
  • Persistent chest pain or pressure
  • Confusion or inability to awaken
  • Blueish color in the lips or face

People who are older than 60 or with other medical conditions are more likely to develop severe illness and complications from COVID-19. The most serious complications include pneumonia, stroke, blood clots, organ failure, and death.

How can I protect myself and others?

If you live in the U.S., the best way to protect yourself and others it to get one of the 3 vaccines available. The vaccines are widely available throughout the U.S. in multiple locations from community health centers to local pharmacies. Treatment options for COVID-19 do not cure the virus but FDA has designated treatments can help prevent hospitalization and death. The FDA has approved one drug treatment for COVID-19 and granted emergency use authorizations (EUAs) for 12 drug treatments, two of which were later rescinded. However, several of the remaining 10 treatments are now rarely used. Details about available treatments are described here.

What if you are pregnant?  Research shows that COVID infection is dangerous to pregnant women and that vaccinating pregnant women is safe.  For example, a study of more than 24,000 newborns, of whom almost 17,000 were exposed to a mRNA COVID vaccine in the first or second trimesters when their mothers were vaccinated, found no differences in preterm birth rates, neonatal hospitalizations, congenital abnormalities or infant mortality.  A small study found that most infants born to COVID-vaccinated mothers had persistent antibodies at 6 months, compared with infants born to mothers who had been infected with SARS-CoV-2.

In contrast to vaccination, a COVID infection increases the chances of serious harm for pregnant women.  A retrospective study of more than 14,000 pregnant women found that those with COVID infections were more likely to die or have serious illness related to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2 compared to pregnant women who did not have a COVID infection (13% vs 9%).  All 5 maternal deaths in the study were women who were infected with COVID.

What should I do if I develop symptoms?

If you develop more than one of the symptoms listed above, get tested for COVID, using an at-home test. That’s the fastest way to get results, but keep in mind that the rapid tests (whether at home or anywhere else) are not as accurate as the PCR test. If you have symptoms but your rapid test is negative, test yourself again a day or 2 later, because the tests get more accurate after a few days of symptoms.

If you have symptoms that worry you, call your doctor whether or not you test positive. If you have severe symptoms, such as difficulty breathing, persistent chest pain or pressure, confusion or inability to awaken, or blueish color in the lips or face, you need to call 911. Tell the 911 operator that you think you have COVID-19 so the responders can take the necessary precautions to protect themselves.

People who experience mild symptoms can usually stay home and will recover in about 2 weeks. People are discouraged from simply showing up at the doctor’s office with symptoms: Call them first so you have tell them about your symptoms and any other health problems so that they can help decide what to do. If you do become sick, you can take the following steps to protect others:

  • Get tested for COVID-19, ideally with a PCR test to confirm the results (positive or negative) of your at-home test
  • Wear a face mask
  • Stay home, unless you need essential medical care
  • Stay away from others in your home as much as possible
  • Cover your mouth and nose when you cough or sneeze, properly dispose of tissues, and wash your hands
  • Monitor your symptoms and temperature

If you were not tested for COVID-19, you should follow those steps until at least one or two weeks have passed since you first noticed symptoms or your fever or other symptoms go away for 3 full days without medicine. If you have been diagnosed with COVID-19 based on test results, you should follow those same steps until you have 2 negative test results taken 24-hours apart, and your symptoms improve.

What if my cancer treatment is delayed?

When a person is diagnosed with cancer, they are likely to want treatment as soon as possible.  Treatment or testing may seem more urgent than it really is, especially with cancers that often grow slowly, such as prostate cancer or breast cancer. And, if you don’t have COVID-19, you don’t want to be exposed to it during cancer surgery, testing, or follow-up appointments.  Talk to your doctor about what is the best strategy to get the treatment you need when it is safe to do so.

Questions?

We are here to help by answering your questions.  We do not provide medical care.  If you have questions contact info@center4research.org and we’ll get back to you as soon as possible.

 

Tips for Testifying at the Breast Implant FDA Meeting


The National Center for Health Research is available to help patients edit their public comments before the FDA Advisory Committee. Our organization has decades of experience testifying at FDA meetings regarding breast implants and other medical devices, so we’ve seen great patient presentations and ones that were not effective at all.  For example, it’s important to keep in mind what kinds of patient experiences  the FDA will consider, and to not rush your statement.  These tips should help!

Specific Tips for Testifying at the Breast Implant FDA Meeting
  1. The patient voice is important so if you are a patient, please testify as a patient. Don’t try to testify as a scientist or medical expert, unless you are a professional in that field.  If you are both a medical professional and patient, be sure to say so in your first or second sentence.
  2. If you were in a clinical trial for breast implants be sure to say so.  Did the doctor ever follow up with you to include data on your health in the years after your surgery?  If you told your plastic surgeon of your health problems, were you no longer contacted for the study?
  3. Focus on the issues that the FDA cares about.  They have made public those 7 issues:  BIA-ALCL; Breast implant illness; Use of registries for implant surveillance; MRI screening for silent silicone gel rupture; Use of surgical mesh in breast procedures; Use of real-world data and patient perspectives in decision making; and Informed consent.
  4. Do NOT talk about how terribly your doctor treated you.  That is not the jurisdiction of the FDA, so they just won’t listen.
  5. Do NOT list all of your symptoms.  List a few and focus on how the worst ones have affected the quality of your life and health.
  6. Do NOT get into a discussion of the chemicals in breast implants unless you are a chemist.
  7. Do NOT insult FDA or doctors. If you point out that FDA and doctors need to better inform patients of the risks, etc, that would be more persuasive than insults.
  8. Did your doctor assure you that your health problems were unrelated to your implants? As a result, did you delay getting the medical care you needed?  What could FDA do to better educate doctors about implant health problems?
  9. Did your health problems start immediately or gradually over the years?  (If the latter, point out that’s why long-term studies are needed).
  10. Did your plastic surgeon ask you if you had any autoimmune symptoms or diagnoses before getting implants?  If the plastic surgeon knew you had such medical problems, did he tell you that breast implants were not studied by the implant manufacturers on women with such medical issues?
General Tips for Testimony Presentations
  • Decide on one clear message and make that message clear early and perhaps often – don’t make it a surprise at the end because they may miss it.
  • Clearly state your main points – preferably no more than 3.
  • Use simple sentence structure – it’s easier to follow.
  • Time yourself speaking out loud and make sure your statement/presentation is significantly SHORTER than the time allotted so that you WON’T need to rush and WILL have time for eye contact.  There is nothing worse than testimony that is read too quickly.

How to keep your statement short?  Take out extraneous examples, use words with fewer syllables (each syllable takes a second to say), don’t make side comments (weather, how nervous you are, etc.) that you hadn’t planned on.

 For example: Mr. Chairman, Members of the Committee, I want to thank you for the opportunity to testify today. = 29 syllables.

Thank you for the chance to speak today  = 9 syllables and just as polite.  You have thanked them and they already know who they are, you don’t have to remind them.

Opportunity = 5 syllables.   Allowing = 3 syllables.  Chance = 1 syllable.

If You Are Using PowerPoint
  • If you use PowerPoint give enough time for your audience to understand EACH Slide.  If you don’t have time to do that, take the slide out.
  • Use graphics (cartoons, photos, humorous drawings, simple graphs) to illustrate your points. A picture is worth a thousand words– that’s really what PowerPoint is for.
  • PowerPoint with lots of words is not an effective or entertaining presentation and not an effective way to share ideas.
  • Slides with words should be simple without a lot of background decoration or other distractions.
Example Format for Testimony  (Fill in the blanks)

My name is ___ and I traveled from STATE at my own expense, so I have no conflicts of interest.

Thank you for the chance to share my story with you.

I first got breast implants at the age of ___ because I ____ (very briefly mention reason).

The health issues started __ months (or years) later, but I didn’t realize it was related to my implants. [Briefly describe your symptoms in one sentence, such as “I was exhausted all the time, my hair was failing out, and I couldn’t concentrate.”]  My doctors told me ________.

I didn’t know what was wrong, but when I read about the experiences of other women online, I __________.

I got my implants out in YEAR and my symptoms [did or did not improve, gradually or immediately].  (describe briefly)

I know from experience that breast implants can harm women’s health.  Doctors and women need to be warned about the health problems that breast implants can cause.  It would help if the FDA warned them.  [Some of the women plan to say: The patients need a short, easy to read check list, like the 2-page check list that was required for Essure patients last year.]

OR:  One of the questions you’ll be voting on is ____.  I urge you to listen to my experiences and vote ____.

 

Letter for Breast Pain

Here is our sample letter of medical necessity written for a woman who has chronic breast pain or back pain caused by the weight of her implants, but does not have capsular contracture (her breasts do not feel hard). If you would like our assistance in personalizing your letter, please take our short survey and we will email you soon.  Click Here to download this letter as a word document that you can edit.

[Date]

[Insurance company] Claims Department
Address Line 1
Address Line 2

RE: Letter of Medical Necessity for [patient name]
Group/policy number: [Number]
Date(s) of service: [Dates]
Diagnosis: [Code & Description]

Dear [Insurance company] Claims Department:

I am writing on behalf of my patient, [patient name], to document medical necessity for explantation of two breast implants. [Patient name] has reported chronic breast pain. [Patient name] requires an explantation with permanent removal of both implants. On behalf of the patient, I am requesting coverage for this procedure.

[Patient name] is a [age]-year-old female with chronic breast pain. [Patient name] has been in my care since [date]. As a result of her pain, my patient has experienced significant deficits in her daily functioning, including [not being able to reach above her head, etc]. She has previously tried [any pain medications, including Tylenol] to relieve her pain. The attached medical records document [patient name]’s clinical condition and medical necessity for permanent explantation of both breast implants. There is no equally effective course of treatment available for the recipient that is more conservative or less costly.

In addition to her chronic pain on a daily basis, undergoing mammography has become too painful and the results are too inaccurate. Breast implants can interfere with the accuracy of mammography because the implant can hide breast tumors so that they are not visible on the mammogram. Inaccuracy is exacerbated when the patient has breast pain, as [Patient name] does. The lack of accurate mammograms makes it difficult to diagnose breast cancer at an early stage when it can be treated more effectively and with less radical treatments. Removal of her breast implants will allow her future mammography screenings to be much less painful and much more accurate.

According to the medical policy of [insurance company], my patient’s breast implant removal should be covered since she has severe pain that has negatively impacted her daily functioning. Her severe breast pain keeps her from [lifting her arms above her head, getting dressed, sleep, add relevant tasks]. Surgical implant removal is the standard treatment for breast pain and capsular contracture, and is clinically appropriate for my patient’s illness. This surgery is not primarily for the convenience of the patient or provider.

The [insurance company] policy [policy number] states the following within the plan under the “[TITLE OF SECTION OF RELEVANT POLICY LANGUAGE]” section:

[RELEVANT POLICY LANGUAGE].”

[Patient name]’s severe breast pain meets the above-stated criteria for [breast implant removal/medical necessity]. Removal of her breast implants and scar tissue surrounding them will relieve her breast pain and improve her daily functioning. Based on the language above, this procedure should be considered medically necessary.

My patient is requesting coverage for the [surgery name and CPT code #s]. Medical documentation is included.

Based on this information, I ask that you offer coverage for [Patient name]’s medically necessary explant surgery. Should you require additional information, please feel free to contact me at [phone and email contact information]. I look forward to hearing from you.

Sincerely,

[Dr. signature]
[Dr. name, title]
[Provider identification number]

Enclosures: (Attach as appropriate)
Clinic notes and lab reports

 

Letter for Capsular Contracture

Here is our sample letter of medical necessity written for a woman with hard or painful breasts caused by capsular contracture (classified as Baker III or IV). If you would like our assistance in personalizing your letter, please take our short survey and we will email you soon.  Click Here to download this letter as a word document you can edit.

[Date]

[Insurance company] Claims Department
Address Line 1
Address Line 2

RE: Letter of Medical Necessity for [patient name]
Group/policy number: [Number]
Date(s) of service: [Dates]
Diagnosis: [Code & Description]

Dear [Insurance company] Claims Department:

I am writing on behalf of my patient, [patient name], to document medical necessity for explantation of two breast implants. I have diagnosed [patient name] with [Baker III/IV] capsular contracture and severe breast pain. [Patient name] requires an explantation with permanent removal of both implants. On behalf of the patient, I am requesting coverage for this procedure.

[Patient name] is a [age]-year-old female with [Baker III/IV] capsular contracture and severe breast pain. [Patient name] has been in my care since [date]. As a result of her pain, my patient has experienced significant deficits in her daily functioning, including [not being able to reach above her head, etc.]. I diagnosed her with chronic pain resulting from her breast implants. She has previously tried [any pain medications, including Tylenol] to relieve her pain. The attached medical records document [patient name]’s clinical condition and medical necessity for permanent explantation of both breast implants. There is no equally effective course of treatment available for the recipient that is more conservative or less costly.

In addition to my patient’s chronic pain on a daily basis, undergoing mammography has become too painful and the results are too inaccurate. Breast implants can interfere with the accuracy of mammography because the implant can hide breast tumors so that they are not visible on the mammogram. Inaccuracy is exacerbated when the patient has severe capsular contracture, as [Patient name] does. The lack of accurate mammograms makes it difficult to diagnose breast cancer at an early stage when it can be treated more effectively and with less radical treatments. Removal of her breast implants will allow her future mammography screenings to be less painful and much more accurate.

According to the medical policy of [insurance company], my patient’s breast implant removal should be covered since she has severe capsular contracture and breast pain. Her significant breast pain prevents her from [lifting her arms above her head, getting dressed, add relevant tasks]. Surgical implant removal is the standard treatment for chronic breast pain and capsular contracture and clinically appropriate for my patient’s illness. This surgery is not primarily for the convenience of the patient or provider.

The [insurance company] policy [policy number] states the following within the plan under the “[TITLE OF SECTION OF RELEVANT POLICY LANGUAGE]” section:

RELEVANT POLICY LANGUAGE

[Patient name]’s [Baker III/IV] capsular contracture and breast pain meets the above-stated criteria for [breast implant removal/medical necessity]. Removal of both her breast implants and scar tissue surrounding is the standard treatment to relieve her severe breast pain, eliminate her capsular contracture, and improve her bodily functioning. Based on the language above, this procedure should be considered medically necessary.

My patient is requesting coverage for the [surgery name and CPT code #s]. Medical documentation is included.

Based on this information, I ask that you offer coverage for [Patient name]’s medically necessary explant surgery. Should you require additional information, please feel free to contact me at [phone and email contact information]. I look forward to hearing from you.

Sincerely,

[Dr. signature]
[Dr. name, title]
[Provider identification number]

Enclosures: (Attach as appropriate)
Clinic notes and lab reports

Letter for Ruptured Silicone Gel Implants

Here is our sample letter of medical necessity written for a woman with at least one ruptured silicone gel breast implant. If you would like our assistance in personalizing your letter, please take our short survey and we will email you soon.  Click here to download this letter as a word document you can edit.

[Date]

[Insurance company] Claims Department
Address Line 1
Address Line 2

RE: Letter of Medical Necessity for [patient name]
Group/policy number: [Number]
Date(s) of service: [Dates]
Diagnosis: [Code & Description]

Dear [Insurance company] Claims Department:

I am writing on behalf of my patient, [patient name], to document medical necessity for explantation of two breast implants. [Patient name] has undergone [MRI/ultrasound/mammogram/a comprehensive clinical exam] and there is clear evidence that [her right/ her left/both her] silicone gel breast implant[s] [is/are] ruptured. [Patient name] requires an explantation with permanent removal of both implants and scar capsules. On behalf of the patient, I am requesting coverage for this procedure.

[Patient name] is a [age]-year-old female who has been in my care since [date]. [As a result of her ruptured implant[s], my patient has experienced [pain] as well as significant deficits in her daily functioning, including [not being able to reach above her head, etc.]. [She has previously tried [any pain medications, including Tylenol] to relieve her pain.] She is unable to safely undergo mammography to screen or diagnose breast cancer, because the pressure of the procedure would spread the leaking silicone throughout the breast area and surrounding tissue and potentially to her lymph nodes, and from there to organs such as the lungs and liver. In
addition, even without mammography the leaking silicone [has migrated/can migrate] to her lymph nodes and from there to other organs, and [has resulted/can result] in the formation of granulomas that resemble lumps caused by breast cancer tumors. The FDA and general expert consensus have recommended explantation for all patients with both extracapsular- and intracapsular-ruptured silicone gel breast implants.

The attached medical records document [patient name]’s clinical condition and medical necessity for permanent explantation of both breast implants. There is no equally effective course of treatment available for the recipient that is more conservative or less costly.

According to the medical policy of [insurance company], my patient’s breast implant removal should be covered since she has [a] ruptured silicone gel implant[s]. Surgical implant removal is the standard treatment for a ruptured silicone gel implant and clinically appropriate for my patient. This surgery is not primarily for the convenience of the patient or provider.

The [insurance company] policy [policy number] states the following within the plan under the “[TITLE OF SECTION OF RELEVANT POLICY LANGUAGE]” section:

[RELEVANT POLICY LANGUAGE]

[Patient name]’s ruptured silicone gel implant[s] meets the above-stated criteria for [breast implant removal/medical necessity]. Removal of both her breast implants and intact scar tissue surrounding them is needed to prevent silicone gel leakage during the explantation surgery. Based on the language above, this procedure should be considered medically necessary.

My patient is requesting coverage for the [surgery name and CPT code #s]. Medical documentation is included.

Based on this information, I ask that you offer coverage for [patient name]’s medically necessary explant surgery. Should you require additional information, please feel free to contact me at [phone and email contact information]. I look forward to hearing from you.

Sincerely,

[Dr. signature]
[Dr. name, title]
[Provider identification number]

Enclosures: (Attach as appropriate)
Clinic notes and lab reports