Hiya Gorgeous!

The COVID-19 crisis has been a source of stress and anxiety for us all—but that’s especially true for cancer patients and their loved ones. While many cancer patients understand they’re at a higher risk of serious complications from coronavirus, they’re also unsure what that really means—or what to do about it.

And even cancer patients who are either stable or in remission know they need to take special care, but may not know how. As a 17-year cancer-thriver myself, I’ve been taking extra precautions during this time, while encouraging and supporting my dad (who has pancreatic cancer) to do the same.

To that end, I want to bring in some expert advice to help guide us. I’ve called on my brilliant friend, Lizabeth Gold, who’s a Registered Dietitian at the Block Center for Integrative Cancer Treatment.

She’s here to share her wisdom and provide you with 8 actionable steps you can take to stay as safe as possible during the coronavirus.

Just know that I’m standing with you, my fellow thrivers. We’ll weather this storm side-by-side.

I’ll let Liz take it from here.

Cancer Patient Care During the Coronavirus

Whether you’re a cancer patient or a caretaker, you’re likely experiencing a lot of fear and uncertainty since the onset of COVID-19.

Today, we’ll help reduce some of that confusion and give you 8 clear steps you can use to stay safer during the coronavirus. But first, let’s establish why that’s necessary.

Why Cancer Patients Should Exercise Care During the Coronavirus

Much is still unclear about the coronavirus in general—and that’s especially true when it comes to its specific implications for cancer patients.

However, we do know with certainty that cancer patients who contract COVID-19 are at a higher risk of severe complications.

While your exact risk level will vary based on your immune system and other health conditions, research shows that cancer patients as an overall population are three times more likely to experience severe complications from COVID-19. Those who are actively undergoing treatment are at higher risk than those in remission.

One possible cause of that increased risk is that COVID complications become severe when the immune system “overreacts” and initiates what is best called an “inflammatory storm”. This high level of inflammation is a major cause of the respiratory symptoms and heart issues you’ve heard about connected to the coronavirus.

Coinciding with this, a new research study found that the immune systems of cancer patients can be altered in subtle ways for long periods of time after treatment. While that alteration is helpful for keeping cancer at bay, it could cause problems for those exposed to infections or viruses like COVID.

Do Certain Cancer Types or Treatments Make You More Susceptible?

The simple answer is yes.

Type of Cancer: Diseases that affect the lungs or immune system (like lung cancer and cancers of the blood, myelomas, or lymphomas) can significantly increase the risk of complications from COVID. These patients should be extra vigilant.

Reach out to your oncologist and ask for specific directions to ensure your safety, especially if you’re receiving treatments. Be sure to ask:

• What special precautions do they recommend?
• Is there anything you should monitor more closely such as blood oxygenation, blood pressure, or temperature?
• Are there any important medications you should keep on hand in case something happens?

Type of Treatment: Bone marrow transplants, immunosuppressive therapies, surgeries, side effects from chemotherapies, and radiation can all affect patient immune status. There are major differences in side effects from one cancer therapy to another and each person’s body reacts differently. Transplant patients may remain at higher risk for up to one year or even longer.

It is important to stay on top of laboratory values that tell you how your immune system is functioning at any particular time. Ask your doctor which lab values you should track and at what frequency for a full picture. If you are able, take care of your lungs and heart by continuing to exercise and carefully monitor for any signs of shortness of breath, chest pain, cough, fever, or muscle aches. Work with your doctor to discuss other ways to minimize organ damage as you go through treatment.

Also, be aware that your treatment regimen may be changed to reduce the time you spend in hospitals and clinics to lessen your risk of infection. Surgery for the very earliest stages of some cancers may be delayed until after the pandemic’s peak. If your treatment is delayed, you can take the time to consult with an integrative cancer center (like the Block Center) and get a cancer-fighting health regimen in place right away.

Stage and Timing of Treatment: Chemotherapy can have a cumulative effect. Early on in the treatment cycle, your body is stronger and your heart, lungs and immune system will be functioning more effectively than if you are at the end of your treatment regimen. Studies have also shown that the more recent your treatment, the more susceptible you will be to complications from COVID. Patients who have relapsed or are metastatic will have a weaker immune response.

Health Status Before Treatment: As with anyone, underlying conditions like asthma, diabetes, COPD, immunodeficiencies, heart disease, high blood pressure, lung disease, kidney disease, smoking and obesity are all risk factors. Having two or more of these conditions increases risk exponentially, even for individuals who do not have cancer. It is critical that you follow all of the directions from your doctor regarding medications and therapies that address any of these conditions.

So What is the Bottom Line?

In short, cancer patients should take a defensive approach to COVID-19.

It’s important to do everything you can to both prevent exposure and support your overall health. Therefore, we’ve put together 8 recommended steps to optimize your health during the pandemic.

It’s worth noting that these simple, immune-boosting behaviors will also help you fight your cancer. Cancer and COVID-19 share a surprisingly large number of risk factors. The nutritional and lifestyle advice we give cancer patients at the Block Center for Integrative Cancer Treatment also specifically targets the biology that puts you at risk for coronavirus infection.

8 Steps to Minimize Coronavirus Risk for Cancer Patients

Step 1: Follow the CDC Guidelines

First and foremost, follow the CDC general guidelines for COVID-19 and then some. Here is a CDC guideline refresher (and some additional considerations for the cancer community):

• Stay home as much as possible. Your main goal should always be to prevent coronavirus exposure in the first place. To that end, ask your doctor if your treatment allows for a change in frequency. For example, a cycle every three weeks instead of every two weeks?
• Wear a mask when going anywhere outside of your own home or car. Keep in mind that wearing a mask is more for the protection of others and does not replace hand washing or social distancing rules. Wash your hands frequently using the 20-second rule and try to avoid touching your face, nose or mouth.
• Keep hand sanitizer with you at all times. Stash some in various places like your car, purse, backpack, coat pocket, etc.
• Practice social distancing everywhere you go including your treatment center. Your treatment center should have strict guidelines in place regarding temperature and symptom checks along with proper procedures for their nurses and technicians.
• Do not leave home if you are experiencing any symptoms. Use this CDC symptom checker if you are unsure.
• Travel in your own car and try to avoid stopping. Pack a lunch and use the bathroom before you go! Use gloves at gas stations and try to pay at the pump versus handing someone your card.
• If you travel out of town, call the hotel and check to make sure they are utilizing extra precautions. Also, plan to take your own wipes and disinfectant to clean all “high touch” areas of the hotel room like doorknobs, buttons and phones.
• If you’re traveling for treatment, inquire with your treatment center. Some centers that cater to out-of-town patients have been able to secure a set of rooms that are specially treated. You can also ask your doctor if it’s possible to transfer your care to a local provider until the COVID crisis is over.
• Find out what procedural changes your particular treatment center has implemented to adjust for COVID concerns. For example, family members may no longer be allowed to accompany you unless absolutely necessary. Some cancer treatments can be safely delayed and certain appointments should be conducted via televisit, if possible.

Step 2: Eat Well

For cancer patients, it’s important to remember that your immune system crosstalks with your gut bacteria and your muscles. As such you should do two things:

• First, make sure to get enough protein. (Basic requirements for protein are about 1 gram of protein for every kilogram of body weight. If you weigh 60 kilograms, or about 135 lbs, shoot for 60 grams of protein daily.) Beans, peas, lentils, nuts, seeds, quinoa and buckwheat are all great sources.
• Second, focus on prebiotic foods. Ingredients like sauerkraut, kimchi, non-dairy yogurts, miso, tempeh, root vegetables, mushrooms, oats, chicory, bananas, lentils and jicama are great for supporting gut health.

A balanced diet also ensures adequate vitamin and mineral intake and this could make a big difference in fighting off the coronavirus. For example, according to a preliminary study of global COVID mortality rates, researchers are finding lower rates of mortality among countries in the southern hemisphere, indicating a possible link between Vitamin D deficiency and complications from COVID. Although more research needs to be done, we do know Vitamin D plays an important role in suppressing inflammation and regulating immunity, so this scenario seems likely.

Step 3: Stay Connected

Make time with friends and family, even from afar. That’s especially important for patients who need both support and social separation for immune health.

Enjoy the extra time at home with your immediate family with fun activities like a family game night or movie marathon. And use technology to create lines of communication to your distant loved ones. Apps like Facetime, Zoom, Google Hangouts and Skype all make it really easy to stay in touch. For older patients who may not be comfortable with technology, an amazing site called Generations on Line can help guide them through using these types of applications.

To start feeling more connected today, sign up for Kris’ free Cancer Patient Support series. You’ll get five days of free resources—including cancer-friendly recipes and tips for managing treatment side effects—based on Kris’ own journey with cancer. You can find those here.

Step 4: Move Your Body

Exercise reduces inflammation and stress. It also increases immune surveillance and regulation. So, as long as your doctor allows it, create a schedule and make exercise a part of your regular routine. Here are some tips:

• • Commit to 30 minutes a day of cardio, strength training, or dynamic stretching if you’re able.
  • Check with your gym to see if they are offering online classes or choose from the thousands of free workout videos on YouTube. (One of my favorites, Yoga with Adriene, has wonderful classes like “Yoga for Uncertain Times” and “Yoga for Mood Swings” all for free!) Most of the large cancer treatment centers have also created light-intensity exercise videos available on YouTube.
  • To help yourself get motivated and have more fun, move with friends. Invite a few loved ones to join you on a Zoom meeting at a set time each day and do your exercise class as a group.
  • If you don’t have a set of weights or any cardio equipment, you can still get a great workout by using the weight of your own body. Climbing up and down stairs (carefully!), push ups, sit ups, planks and squats are all ways to get a really great workout without owning a single piece of equipment! Here’s a great example.

Work with your doctor or physical therapist to choose the exercise that’s right for you. Remember not to push yourself too hard and exercise only when your caregiver is aware and close by!

Step 5: Sleep well

Did you know that sleep regulates a whole host of important things like hormones, parts of the immune system like cytokines, and inflammatory markers like cortisol and C-Reactive protein? Sleep deprivation can lead to higher susceptibility to disease, viruses and stress.

Unfortunately, many cancer treatments can wreak havoc on your ability to get a good night’s sleep. Talk to an integrative specialist for guidance on natural supplements that can help support healthy sleep. Here are a few more tips to improve your sleep quality:

• • • Make sleep a ritual. Go to bed at the same time every night and have a routine for “winding down” gradually.
    • Stay off technology at least one hour before bedtime! The blue light emitted from phones, TVs and computers suppresses melatonin production and can reduce the restorative part of your sleep cycle.
    • Guided imagery or meditation for ten or fifteen minutes can significantly improve sleep quality and optimize circadian rhythms.
    • Reduce the temperature of your bedroom to below 65 degrees, if possible. It is okay to use lots of cozy blankets to stay warm, but the air you breathe should be on the chilly side.
    • Make your bedroom pitch black and quiet. Use blackout shades and turn off all lights including the lights from clocks or random digital devices.
    • Use a sound machine or fan to create “white noise” or use earplugs.

Step 6: Practice Stress Reduction

In such an anxious time, I know that reducing stress is not an easy task. It’s definitely worthwhile, though! Stress can increase inflammation and upregulate cancer pathways. Although it might be difficult to relax with everything going on, it is more important than ever to figure out ways to dial down your stress level.

Exercise, yoga, meditation and nature walks are all great ways to reduce stress—and they’re safe to do while social distancing. If you do decide to venture out for a walk, practice all of the basic COVID precautions and bring your caregiver with you for safety. Go to a quiet place like a park or nature reserve and avoid crowded areas and busy sidewalks.

Meditation is another wonderful way to manage stress. I recommend you try Kris’s Instant Stress Reduction meditation. It’s a great tool even for those who’ve never meditated before—and it’s free! You can listen here.

Step 7: Stay Informed

It’s good to stay on top of COVID developments in the news, but try not to obsess. Designate a specific amount of time to catch up on the news each day, then move on to something else. It’ll add stress if you dwell on it all day long.

It’s more important to keep a line of communication open with your provider, as significant changes are happening almost daily within hospitals and treatment centers. Unfortunately, many vital cancer treatments, surgeries and clinical trials were initially being postponed, but this will change in the coming weeks. As each facility figures out how to safely continue operations, patients should be able to resume their plans. Be a good advocate for yourself, be persistent and don’t be afraid to ask a lot of questions.

Step 8: Seek Help

Finally, if you do start to have any symptoms of COVID, seek medical attention immediately and don’t wait! Shortness of breath (no matter how insignificant), fever, cough, loss of taste or smell, chills, shaking, headache, sore throat and muscle aches are all potential symptoms. Several instances have been reported where people felt fine though they had very low blood oxygenation levels, but then quickly and unexpectedly deteriorated. It is dangerous for anyone to wait to seek help, but it could mean the difference between life and death for a cancer patient, so don’t ignore the signs.

Take Comfort in What You Can Control

I know this is a lot of information to absorb, but you don’t have to apply it all at once. Tackle one step at a time, lean on your support system and implement that change—then start to explore the next step.

While you do, take comfort in the fact that you’re doing all that you can to minimize your risk. I hope that these simple actions give you a sense of agency (and some peace) during these difficult times.

Take Care of Yourself, Sweetheart!

I love this guidance from Liz. Her robust understanding makes me feel a bit more empowered to take care of myself in this uncertain season. I hope it’s done the same for you!

If you’d like to learn more, make sure to visit Liz at the Block Center website.

And remember, you’re the CEO of your own health. As a cancer patient, you can be an active participant in your healing journey—even and especially during the coronavirus.

Your turn: What’s one thing you’re doing to stay well in mind and body during the coronavirus?

Health & heartfelt support,