Advice for Oncology Patients COVID-19

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National Children’s Cancer Service

CHI at Crumlin COVID-19 Helpline

CHI at Crumlin COVID-19 Helpline

If you have a general query related to COVID-19, CHI at Crumlin have set up a helpline Monday – Friday 9am to 5pm on (01) 4096117.

If you have a specific clinical query, please continue to contact the oncology department in the usual manner.

We continue to advise families to seek medical care appropriately through the same channels as before (your GP, your emergency room, your clinical nurse specialist, your local hospital) and not to avoid or postpone review if concerned.

Click here for information for all CHI families attending the hospital during COVID-19

Click here for Information for patients and/or parents/guardians of patients who are receiving chemotherapy or who have completed chemotherapy within the last 6 months

Click here for Information for patients and/or parents/guardians of patients who are have completed chemotherapy longer than 6 months previously

Click here for Resources for Children

Click here for Information for survivors of childhood cancer

A: Information for patients and/or parents/guardians of patients who are receiving chemotherapy or who have completed chemotherapy within the last 6 months

Updated 17 July 2020

  1. COVID-19 has thankfully not affected children to the same extent as it has adults.

  2. As the restricted movements of people are now lifting, it remains important to continue to be vigilant with the important recommendations: appropriate social distancing, washing of hands regularly and cough/sneeze etiquette. In addition staying at home as much as possible continues to be recommended for patients receiving chemotherapy, although possibly not as severely restricted as before with cocooning/shielding. For example, walking outdoors appears to be relatively safe.

  3. Be compliant with measures currently in place nationwide, as published by the HSE at https://www2.hse.ie/coronavirus/ as such guidelines may change at short notice.

  4. Hospital visits for scheduled treatments and/or interventions/investigations continue to be an essential component of your child's care.

  5. Despite some restrictions easing, your child can still only be accompanied by one parent/guardian when coming to the hospital. Access into the hospital remains strictly controlled.

  6. Please ensure the parent/guardian who brings them to the hospital is well, and does not have a fever or cough and is not undergoing self-quarantine following return from international travel

  7. Elective chemotherapy and theatre schedules continue as usual where possible. Any delays or rescheduling will be communicated to you by phone.

  8. All active treatment clinics are continuing for now. Appointment time slots are continued to be issued by phone to minimise numbers in the waiting area of HOOPS. If early arrival, please wait in your car until your time slot. Please do not attend these scheduled appointments if your child has recently developed a cough or a fever.

  9. All children on oral chemotherapy should continue this unless instructed otherwise by their CNS/Consultant.

  10. Follow up clinics/long-term follow up clinics are slowly re-emerging however may still be deferred or possibly conducted by telephone/virtually. Parents are continued to be notified individually to confirm these details.

  11. Elective imaging/scans are being performed however due to some restrictions still in force, the dates of such may change.

  12. We may still be required to swab your child for COVID-19 in advance of a scheduled theatre visit. If this is the case we will communicate this to you in advance.

  13. If your child has a fever, please call your local hospital or St. John's ward (after 5pm) or HODU (8am to 5pm), as you would normally.

  14. Please do not arrive into the HODU unannounced for routine assessment of a temperature. Phone first so that an assessment can be made about where to place you and your child on arrival to hospital.

  15. Please inform the Nurse or Doctor on the phone if your child has any of the following in addition to fever: cough, sore throat, runny nose, difficulty breathing

  16. Continue to please inform us if you or your child has been exposed to anyone with known/suspected COVID-19 or anyone who is awaiting a COVID-19 test result or anyone who has had recent foreign travel.

  17. Please attend your shared care centre if your child is unwell as is normal practice

B: Information for patients and/or parents/guardians of patients who are have completed chemotherapy longer than 6 months previously

Updated 17 July 2020

There is unfortunately very little information to guide us with specific recommendations here however the general recommendations, from international sources (including that from theInternational Harmonisation Group for late effects of childhood cancer – IGHG: see https://www.ighg.org and from our colleagues in the Children's Cancer Leukaemic Group – CCLG), are promising with less restrictions being necessary. The guidelines below are from CCLG:

  • Patients with the following do not need to cocoon/shield:

  • Significant chronic cardiac morbidity (this does not include patients with mild reduction in left ventricular fractional shortening / ejection fraction but who are asymptomatic)

  • Symptomatic lung disease, but which is not severe enough to warrant shielding (this does not include patients with asymptomatic mild restrictive lung function test abnormalities or patients who have received bleomycin but who are asymptomatic)

  • Significant chronic renal morbidity

  • Significant chronic liver morbidity

  • Significant chronic neurological disease (this does not include patients treated for CNS tumour who have mild cerebellar symptoms or weakness)

  • Adrenal insufficiency taking replacement steroid therapy (only applies to patients aged 16 years and over, and only when specifically advised by the patient's endocrinologist)

  • Diabetes mellitus (only applies to adult patients)

  • Pregnancy

  • Obese (body mass index [BMI] of 40 or higher) (only applies to adult patients)

  • Patients who have previously received Total Body Irradiation (TBI) or left sided abdominal radiotherapy treatment (this is different to the current government recommendations but is in agreement with recommendations from both the UK BMT community and the Royal College of Paediatrics and Child Health)

  • Patients under any organ specialist should follow the specialist advice from these teams.

For these long-term follow-up patients and circumstances, it is recommended:

  1. Avoid contact with someone who is displaying symptoms of coronavirus. These symptoms include high temperature and/or new and continuous cough

  2. Avoid non-essential use of public transport when possible

  3. Work from home, where possible. Your employer should support you to do this. Please refer to employer guidance for more information

  4. For survivors in education, to return when social distancing can be followed. Please discuss this with your school, college or university

  5. Use telephone or online services to contact your GP or other essential services

Patients in the following groups remain extremely vulnerable and cocooning/shielding continues to be recommended:

  • Solid organ transplant recipients

  • On immunosuppressive therapy or severely immunocompromised

  • Sickle cell Disease, HbSS (this does not include patients who have had a haemopoetic stem cell transplant with normal engraftment)

  • Severe symptomatic respiratory morbidity (depending on advice of patient's relevant treating specialist team)

  • Severe symptomatic cardiac morbidity (depending on advice of patient's relevant treating specialist team)

  • Pregnant with known heart or lung disease.

Resources for Children

Please click on the links below for useful information for children prepared by our Psychology team, as well as some additional resources.

I feel worried about Coronavirus (COVID-19)

My Coronavirus (COVID-19) Test Story

Social Distancing - Staying Home and Staying Safe

Superheroes and Masks

Talking to Children about Illness

Coronavirus Explained for Children

Survivors of childhood cancer: COVID-19 Recommendations

Updated 14 April 2020

There is some concern amongst survivors of childhood cancer relative to their COVID-19 related risk-status. It is important to therefore note the following:

1. The majority of survivors of childhood cancer will not be at-risk, as defined by the at-risk group of patients by the HSE - https://www2.hse.ie/conditions/coronavirus/at-risk-groups.html).

2. Please continue to follow the current restrictions on movement outside of your home that remain in force, since 27/03/2020, for all.

3. If any survivor has a long-term medical condition, regardless of the cause of such, it is recommended that you practice further measures to shield yourself. Such medical conditions include, as a matter of example heart disease, lung disease, diabetes, cerebrovascular disease (such as a stroke), kidney/renal disease, liver disease and high blood pressure. These further measures include not leaving your home if at all possible.

4. Out of this at-risk group, as detailed above, there is a further vulnerable group of people for whom additional protective measures (collectively termed - cocooning) are recommended. The HSE website, details these measures further and explains who is included in this group - https://www2.hse.ie/conditions/coronavirus/cocooning.html.

For comprehensiveness, this group includes the following people:

  • are over 70 years of age - even if you're fit and well

  • are solid organ transplant recipients

  • have cancer and are undergoing active chemotherapy or radical radiotherapy for lung cancer

  • have cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment (i.e. receiving treatment for such)

  • are having immunotherapy or other continuing antibody treatments for cancer

  • are having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

  • have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

  • have severe respiratory conditions including cystic fibrosis, severe asthma and severe COPD

  • have rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)

  • are on immunosuppression therapies sufficient to significantly increase risk of infection

  • are pregnant and have significant heart disease, congenital or acquired.

These extra measures (cocooning) are outlined in the above website.

5. If you are unsure if you need to 'cocoon' please ask your doctor for further advice.

6. The International Guideline Harmonization Group (IGHG) for Late Effects of Childhood Cancer have published their guidelines on COVID-19 – this can be accessed at: https://www.ighg.org/. Please be aware these are international guidelines and it remains important to follow the guidelines implemented by your local jurisdiction first and foremost.