THE STORY is that of F., a woman with metastatic breast cancer under treatment since 2019 at the Sant’Orsola-Malpighi Hospital in Bologna. As he writes in a letter he sent to Salute, and as he told in the interview he gave us, he is skipping therapies due to Covid. She fell ill on February 24 and on the 14th day of isolation, now without symptoms, she is still positive. He has already given up on a course of treatment – he should do it every 3 weeks – and for this he is afraid: of having to skip others in case he does not negativize quickly, and that his cancer may progress due to this delay.
“I immediately contacted the oncology department both as soon as I learned of my positivity and just after the report of the healing swab – he writes – and in both cases I was told that, as long as I do not have a negative swab and the letter from the ASL stating the end of isolation, I will not be able to enter the hospital for my therapy. The sad reflection I make is: during a year of pandemic we cancer patients were asked not to be afraid and to continue the therapies, controls, instrumental analyzes and therefore to continue to go to the hospital and spend several hours of our day there , but now that the vaccinated health workers have to put in courage we can’t even get close “. And again: “In a year, a path and a section dedicated to positive / weakly positive cancer patients have not been created so that they can take advantage of life-saving treatments! As if to say that if I break my leg I can go to the orthopedic emergency room for treatment, but if I need treatment to avoid dying of cancer, I cannot go there “. On the phone F. tells us: “I understand that with the symptoms you cannot leave the house, but my question is: what if I had to stay positive for a long time? I don’t do chemotherapy, but I take a biological drug, a monoclonal antibody for HER2 positive breast tumors, and to date no doctor has told me if there may be contraindications for those with Covid, or what it can mean for me to skip cycles “.
Maybe something went wrong in the communication. “So far there have been some cases of Covid positive cancer patients, or slightly positive ones, that we have continued to treat in the Day Hospital, in physically separate rooms”, clarifies a Republic Claudio Zamagni, director of the Addarii Medical Oncology of Sant’Orsola-Malpighi, where breast tumors are treated. “Whenever this situation arises, we evaluate the risks and benefits on a case-by-case basis, and look for the best solution. There are hundreds of different oncological therapies and it cannot be generalized: in the absence of solid data on the interaction of oncological drugs with the virus, of which very little is known worldwide, we must try to use common sense to understand what it is. the lower risk for the patient “. On the one hand, in fact, there may be the danger of worsening the infection and the course of the disease, on the other hand the oncological treatment may not be postponed. “In recent weeks we have treated a lady with Covid in whom delaying cancer treatment could have entailed greater risks than Covid”, continues Zamagni: “In the specific case of the patient who wrote the letter, we are talking about a chronic therapy for the metastatic cancer: a monoclonal antibody that remains in the blood for a few weeks after administration. This allows you to skip one or two cycles without compromising the treatment path. Since we do not know how biologics interact with the virus, we have all the more reason to use a principle of prudence. The risk / benefit ratio changes for everyone and there are many factors to consider “.
In essence, for most of those unable to leave the house, Covid involved having to skip a course of therapy, while urgent cases were treated in the hospital. “The ideal would be to have a Covid oncology department, which however should be the reference for a whole large area or for the Region, because the number of patients who would benefit from it is not so high”, he adds. Andrea Ardizzoni, director of the Department of Oncological and Hematological Diseases of the Sant’Orsola Polyclinic: “For those who, on the other hand, take oral therapies, we have delivered the therapy at home. It is also possible to activate local health care assistance for those who need to be followed at home, for example for blood sampling and the management and cleaning of venous catheters (pic and port, ed.). The vast majority of our patients have activated this service ”.
In short, people are not rejected by the hospital and there is a schedule. Yet F. felt abandoned and, she tells us, even home care did not work in her case. “What I feel like saying is that it is certainly not a question of a lack of courage on the part of health workers. When a patient comes to complain, however, it is still a failure: it means that things have not gone as expected for that person. The importance of doctor-patient communication should never be underestimated “.
There is a final reflection that the patient makes, and which does not concern her treatments, but the entire programming of the anti-Covid vaccination: “Three months after the start of the campaign – writes F. – we who are fragile have not been still vaccinated ”: a request made by doctors and the sick at the same time.
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