With the coronavirus outbreak developing daily, we want to make sure everyone affected by cancer gets the information they need during this time.

We’ll be monitoring the latest government and NHS health updates from across the UK and updating this blog post regularly as new guidance emerges. But for the most up to date guidance, please visit government and NHS websites. You can find a full list of links on our coronavirus information page.

We’d also recommend speaking to your cancer team if you have any questions or worries about coronavirus.

If you’re currently undergoing or about to start cancer treatment, it’s important to keep up to date with NHS guidance to limit the chances of exposure – especially if the virus becomes more prevalent. Your specialist might want to discuss the possibility of delaying treatment in some situations, if they felt the risks outweighed the benefits for you personally.

– Martin Ledwick, Cancer Research UK’s head information nurse.

23 March: London NHS trust postpones treatment for 2 weeks

A hospital in London has announced it has postponed outpatient chemotherapy appointments and cancer surgery for 2 weeks to protect people with cancer who may be at high risk of developing severe illness from coronavirus. Urgent operations will go ahead.

While a commitment to continuing cancer treatment in England was announced last week, NHS England has advised specialists to discuss the possibility of delaying treatment if the benefits outweighed the potential risks. They’ve also issued guidance on managing cancer treatment and care during the coronavirus pandemic for health professionals. Decisions will be made by specialists and local NHS Trusts, so it’s worth speaking to your cancer team if you have any questions about your treatment.

As the virus becomes more common across the UK, it’s likely to add more pressure to cancer service delivery across the UK. It’s our understanding that case by case treatment decisions, based on patient risks and benefits, are still being made across cancer services in Scotland, Northern Ireland and Wales. If you’re concerned, we’d recommend you speak to their doctor and follow any updates to NHS guidance.

The coronavirus pandemic has placed unprecedented pressure on our health service, and although the NHS is doing everything in its power to give routine cancer care as usual, there are difficult decisions that NHS Trusts and health boards are being forced to make. People with cancer are among those at higher risk of complications because cancer and treatment can weaken their immune systems. Doctors will be taking this into consideration when deciding treatment can safely go ahead. If anyone affected by cancer has received specific guidance and is concerned, they should speak to their cancer specialist.

Martin Ledwick, Cancer Research UK’s head cancer information nurse.

21 March: New ‘shielding’ measures introduced by Public Health England

Public Health England have introduced new ‘shielding’ measures for people at high risk of developing severe illness from coronavirus because of an underlying health condition.

The new guidance says people should stay at home at all times and avoid face-to-face contact for 12 weeks. Visits from people who provide essential support – such as health professionals or social care – should continue, according to the latest guidance.

Anyone who should be adopting this advice should receive a letter by Sunday 29 March or be contacted by their GP, if you haven’t received a letter but think you fall into one of the categories listed below, please discuss your concerns with your GP or clinician.

Nicola Sturgeon announced similar guidance for Scotland, with up to 200,000 people with ‘extreme health vulnerabilities’ being contacted in the next few days. And 70,000 letters will be sent in Wales, advising the ‘most vulnerable people’ to stay indoors for 12 to 16 weeks.

Similar guidance is likely to be developed for Northern Ireland, but this has yet to be published.

How do I know if I’m ‘extremely vulnerable’?

The latest Public Health England guidance applies to the following groups:

  1. Solid organ transplant recipients.
  2. People with specific cancers:
    • People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer.
    • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment.
    • People having immunotherapy or other continuing antibody treatments for cancer.
    • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
    • People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
  3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
  4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID)
  5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
  6. Women who are pregnant and have significant heart disease.

21 March: Guidelines for delivering chemotherapy issued by NICE

The National Institute of Health and Care Excellence (NICE) have issued new guidelines for health professionals delivering systemic anticancer therapies like chemotherapy in England. It includes minimising face-to-face contact by offering video or phone consultations, reducing the time people spend in waiting areas and asking people to attend their chemotherapy appointments alone if possible, to reduce the risk of spreading infection.

NICE guidelines are usually adopted in Wales and Northern Ireland. Scotland is developing separate guidelines.

20 March: Clinical trials update

Yesterday, the National Institute of Health Research announced plans to pause the set up of new clinical trials or new trial sites, except for nationally prioritised coronavirus (COVID-19) studies. The aim is to free up staff to focus on coronavirus studies or care for patients during the outbreak.

And if you’re currently taking part in a clinical trial, the protocol may change to help minimise hospital visits. It’s best to check in with your trial team about how this might affect you.

The COVID-19 outbreak is a rapidly evolving situation, and it’s placing unprecedented strain on healthcare systems around the world. So local NHS trusts and health boards are making decisions around clinical trials on a case by case basis. For the most part recruitment has paused for the time being, but there are some trials which will be still running. For

patients currently on trials, these trials may be more flexible on protocol during this period including switching face to face hospital check-ups to over the phone, and finding different ways to get drugs to patients without them coming into a hospital. Patients need to speak to their doctor to find out if this applies to them.

– Stephen Nabarro, head of clinical operations and data management at Cancer Research UK.

19 March: Northern Ireland outlines new response measures

Health Minister, Robin Swann, has outlined new COVID-19 plans for Northern Ireland. They include halting non-urgent appointments and procedures, taking Northern Ireland in line with measures implemented in the other UK nations earlier this week. Cancer surgeries and other urgent procedures will continue.

18 March: Boris Johnson releases new advice for ‘vulnerable groups’

The UK Prime Ministers says the country is taking ‘drastic measures’ to help curb the coronavirus outbreak, including recommending that vulnerable groups avoid social contact for 12 weeks.

How can cancer affect the immune system?

Some types of cancer – like leukaemia and lymphoma – can lower your ability to fight infection by affecting your immune system.

Some cancer treatments can also weaken the immune system. Chemotherapy, for example, can stop the bone marrow making enough white blood cells, which are a vital part of the immune system. This effect is most prominent during treatment, but the effects can last for some time afterwards.

For more information visit our coronavirus and cancer page, which we’ll be updating with the latest advice.

17 March: ‘Vital cancer treatments will continue’

NHS Scotland has announced it will postpone non-urgent elective care as part of its ongoing coronavirus preparations. But “vital cancer treatments, emergency, maternity and urgent care” will continue.

Similar measures have been announced in Wales and England, with the commitment to continuing cancer treatments in England outlined in a letter from NHS chief executive, Simon Stevens.

But while there is a commitment to continuing cancer treatment, NHS England has advised specialists to discuss the possibility of delaying treatment if the benefits outweighed the potential risks. They’ve also issued new guidance on managing cancer treatment and care during the coronavirus pandemic for health professionals. Similar guidance is likely to be developed by NHS services in Scotland, Wales and Northern Ireland, but these have yet to be published.

A national cancer treatment response group has been established in Scotland, which will provide advice around cancer treatments and ensure measures are being taken to protect those living with cancer. Here’s where you can find the latest NHS advice in Scotland.

16 March: UK Government advises social distancing

UK Government has issued advice for everyone in the UK about social distancing to reduce the spread of coronavirus. This includes advice for cancer patients.

Katie