Cancer and COVID-19: what to do when the world is on lockdown

Special thanks to Registered Dietitian and Head of Dietetics Lucy Eldridge of the The Royal Marsden Hospital for her contributions to the dietary advice in this article.

The current COVID-19 situation is like nothing we’ve ever known, and you might have some worries, or questions about it.

As a person with cancer, you are likely to be at a very high risk for developing complications from a COVID-19 infection, which could be serious.^MAC,NHS

During these times, it’s important to take the risks seriously and make careful and sensible adjustments to daily life – both to help minimise the likelihood of you catching COVID-19, and to avoid it spreading among other people too.

The information provided in this article is here to provide you with some advice and guidance, however above all, you should follow the advice of your medical team, and your country’s public health body at this time.

How can I stay safe right now?

Because catching the virus could be very serious for you, it’s important that you take as many steps as possible to minimise the chances of that happening.

There are some really simple steps you can take to help look after yourself, and others, during this time:

• Wash your hands frequently with soap and warm water for at least 20 seconds^WHO
• Avoid touching your face and eyes^WHO
• If your government’s public health service advises it, stay indoors, and avoid leaving your house unless it is for the essential, permitted purposes^GOV2
• Practice social distancing, and stay the recommended minimum distance away from other people (check your government’s public health advice for what this distance is)^WHO

I see some people wearing face masks and gloves – should I be?

When it comes to face masks and gloves, advice around the world is different.^NSC The best thing you can do is check your government’s public information for their recommendations.

It’s important to remember though, that wearing a mask and gloves doesn’t give you complete protection from the virus.^NSC You should still carry out important measures like washing your hands and avoiding touching your face.^NSC    

Will hand sanitising gels kill the virus?

Washing your hands with soap and warm water is the best way to remove the virus.^CDC However, if you are caught in a situation where only hand gel is available, it may help – but it must contain at least 60% alcohol,^CDC and you must completely cover your hands, between your fingers, around your nailbeds, and your wrists.^KAM

As you rub the hand gel in, you should also try and make sure your hands are wet with the gel for at least 30 seconds^KAM – alcohol gels will evaporate quickly though, so you may need to reapply while you rub it in.

Should I be cleaning anything that comes into my house, like groceries, or mail?

According to the World Health Organization, the chances of catching COVID-19 from a package that has been moving around, travelling, and exposed to different temperatures and conditions is very low, and there is currently no confirmed case of anybody catching COVID-19 from food, or food packaging.^WHO2,GOV

However, you may still feel more comfortable cleaning items that come into your house. If this is the case, you can use disinfectants, or bleach (only after carefully diluting it following the instructions on the bottle), to sterilise items coming into your house if you want to.^PAT,CDC2

Do only use this on items that are encased in plastic or glass though (that is, not on fresh produce), so that you don’t risk getting any residues or harmful chemical from the bleach or disinfectant in your mouth or on your skin.

Currently, research shows that the virus doesn’t survive on surfaces for longer than 72 hours,^WHO2 so if food will keep without freezing or refrigerating, you can also isolate it for those 72 hours, for example in a cupboard, or the boot of your car.

As always, remember that frequent handwashing is also important – especially when preparing food, and after handling packages.

I have to leave home for appointments and to get my treatment… how should I do this? How do I get supplies like food and medicine?

The best source of advice on this are the people in your medical team – if you have any questions about how to get to or from your appointment, or if you need to take any other precautions (like wearing a mask), they can answer your questions.

If you need to go to the supermarket, pharmacy, etc. the best thing you can do is ask for help. See if a friend or family member can go on your behalf or check social media for local volunteer groups who might be able to help you.

Whenever you are away from home, be careful to avoid touching your face, wash your hands when you get to the hospital or clinic (and back home), and practice social distancing.

I feel like my physical and mental health are really suffering right now… what can I do?

It’s completely understandable that you are finding things more difficult right now – being separated from friends and family and spending a lot of time indoors aren’t exactly ‘normal’ for most people. 

Your physical health

Staying indoors might mean that you are finding it more difficult to exercise and get enough sunshine. Or you might be struggling to get ingredients to cook with.

Our physical health can have a big impact on how we feel,^NHS2 so if you’d like to try and get more exercise in, then have a look for some video workouts online. Some of these might be a bit difficult if you have particular mobility needs – if so, try a YouTube search for ‘home workouts for people with cancer’, and you’ll find lots of helpful ideas. Don’t be discouraged if your fitness isn’t great – with commitment your strength will build up!

Some people struggle to find the motivation to exercise on their own. If that’s the case, why not try exercising over a video chat with a friend? That way you’ll have somebody to chat to and you’ll have each other for encouragement.

Diet and nutrition while in lockdown

There is no diet that has been shown to prevent or cure COVID-19, however maintaining good nutrition is important – in in particular, protein, energy, vitamins and minerals.^BDA

You may be worrying about being able to access food and groceries at this time. Have a look online to find a local volunteer group or aid organisation that can support you with this. For example in the UK, we have the NHS Volunteer Responders Scheme, and COVID-19 Mutual Aid UK.

When you do manage to get to the shops (or find a service or a friend/family member who can support you), consider building up a store of basic foods such as canned meat, beans or fish, ready meals, long-life milk, cans of custard or rice pudding, breakfast cereals, tinned fruit/vegetables, long-life fruit juice, cans or packets of soup. For more ideas, the British Dietetic Association have develop this poster. The information here was developed for elderly adults but is just as relevant for younger adults during times like these.

Finally, you may want to consider taking a Vitamin D supplement. This vitamin is important for lots of different processes in your body, but especially in helping regulate the amount of calcium and phosphate in your body, which helps to keep bones, teeth and muscles healthy.^BDA

Vitamin D occurs in some foods, but we get a lot from the sun^BDA,WAC – when ultraviolet rays from sunshine hit our skin, that stimulates our bodies to start producing the vitamin.^WAC

Ideally you should try and spend some time outdoors in the sun every day, however not everyone has easy access to direct sunshine, and isolation might be making it especially difficult. If this reflects your situation, and you can’t access a garden or a balcony to get sunshine, then consider taking a Vitamin D supplement (but speak to your medical team first!) – typically a daily dose of 10 micrograms is recommended for adults and children over the age of 1.^BDA

Your mental health

It can be really hard being isolated. Some people might have family at home, and some might be on their own right now – both situations come with challenges! Being worried about catching COVID-19 (or a loved one catching it) can also be a really big source of anxiety for some people.

See if any of the following situations sound familiar to you.

Above all though, never feel afraid or ashamed to ask for help. These are completely unprecedented times, and we’re all facing situations that are new to us. If you think you could do with some extra help, reach out to a friend, family member, or your doctor, and they can give you the love and support you need.

My family are driving me mad!

Having a lot of people cooped up together – and maybe having children home from school – can mean that personal space and time get a bit lost, and arguments become more frequent. If you find your family is struggling, then take some time to reflect together.^NSP Be compassionate towards yourself and others and acknowledge that you each have your own needs. Ask what you can do to help and share what people can do to help you in turn.

If children are arguing over toys, talk to them about sharing and schedule time for the ones they can’t always share (like videogames). Find activities and routines that they can do together, or get them involved in tasks around the house, like baking, cooking, cleaning, gardening, etc.^NSP

Some people feel guilty about taking time for themselves, but this is so important. Alone time gives us the space to reflect on our day and acknowledge our own feelings and thoughts. Doing this – through meditation, keeping a diary, or even just sitting somewhere quietly on your own for a while – gives you the time and space to process your day, and potentially address any mental health struggles you are having before they get more difficult to manage.^PAT2

I’m worried about me or somebody I love / a friend catching COVID-19

Many people are affected by anxiety, and for many different reasons. It’s normal to be worried about something like this – COVID-19 isn’t something anyone would expect you to be used to.^NHS2

Anxiety and stress can have a lot of effects on your health – they can affect your sleep and how you feel day-to-day, and anxious thoughts can feel all-consuming sometimes.^MIN

In these situations, the best thing you can do is ask for some help. Either reach out to your friends and family for a sympathetic ear or ask your doctor for support.

If you want to try some self-help activities for managing worries and anxiety, have a look online, for example UK-charity Macmillan Cancer Care’s advice for people with cancer who are struggling with worries.

I feel really lonely right now

Loneliness isn’t often talked about, but it’s something a lot of people experience. In the UK alone, almost 12 million people report feeling lonely ‘always’, or ‘often’.^COO,ONS

In times like these, being social is difficult, but not impossible – technology can be a big help. Why not try:

• Staying connected with video calls to friends and family^NHS2,CAM,PRI
• If you enjoy playing online games, see if you can find one where you can talk to other players online^BUS,PRI 
• Arrange social events (like live-streamed yoga, or a viewing party, or even a dinner party) online with friends^PRI
• Have a regular routine, and plan activities into it that can distract you, or give you a purpose^CAM,PRI