Care Considerations for Older Myeloma Patients During COVID-19

French blood cancer researchers provided some recommendations around older patient care during COVID-19 in The Lancet Oncology. The guideliines were intended to limiit hospiital admissions and exercise caution when starting or continuing treatment for a population that has greater risk because of cumulative factors such as age and potentially greater immunosuppression. 

The Société Francophone d’Onco-Gériatrie (SoFOG) and the French cooperative group for clinical research in geriatric oncology DIALOG (GERICO-UCOG) endorsed the following suggestions:

1. When considering cancer treatment during COVID-19, the treatment decisions should factor in: cancer type, disease extent, prognosis, treatment options and potential for viral infections
2.  Evaluation of life expectancy should be part of the treatment decision process
3. Alternatives to standard therapy that have fewer side effects on the immune system (like targeted therapies vs. chemotherapies) are better than no treatment at all
4. Personal protection (mask wearing, hand washing and confinement) and reduced clinic visits (like more spaced treatments or less frequent routine testing) can help
5. Balancing COVID-19 exposure with undertreatment of the cancer is essential. Talk to your doctor!
6. Age isn't always the most essential factor. Undertreatment based on age does patients a disservice.

According to the Center of Disease Control (CDC) in the United States, the following people are at greater risk for getting COVID-19: 

• People 65 years and older (8 out of 10 deaths of COVID-19 were of people over the age of 65)
• People who live in a nursing home or long-term care facility
• People of all ages with underlying medical conditions, particularly if not well controlled, including those with:
  • Chronic lung disease or moderate to severe asthma
  • Serious heart conditions
  • Immunocompromised conditions (caused by cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
  • Severe obesity (body mass index [BMI] of 40 or higher)
  • Diabetes
  • Chronic kidney disease undergoing dialysis
  • Liver disease