Uncertain times are upon us, around the world, as we globally respond to the coronavirus (COVID-19) that is affecting us all on some level. Many members of our bladder cancer community are directing questions our way about how the this virus might affect their health and treatments. We will be answering many of these questions after consulting with the members of our Medical Advisory Boards. Please keep in mind that circumstances around this issue vary from region to region, and are changing by the hour, so some information may be rather general in nature. Some provinces may have their own guidelines. You may also wish to check out the Bladder Cancer Advocacy Network’s (BCAN) FAQ page here for further questions and answers.
As always, all of us here at BCC wish to support our community as best we can, but it’s important to emphasize that BCC staff are not medical professionals. It’s important to first turn to your medical team for advice, when possible.
Have a question? Send us an email at info@bladdercancercanada.org and we’ll do our best to answer it.
Can I receive the COVID-19 vaccine while having BCG treatments? If not, is there a waiting period before I can receive the vaccine?
There should be no hesitation to provide the COVID-19 vaccine to patients with non-muscle invasive bladder cancer. However, we have no direct evidence to guide us on the optimal timing of COVID-19 vaccination in patients receiving intravesical BCG. There are two important questions to consider: (1) is it safe to give the vaccine while being treated, and (2) will the vaccine be effective if administered during treatment.
Safety: BCG was originally developed as a vaccine, and its use in the bladder has some parallels to a regular vaccine. Both BCG and the COVID19 vaccines cause an inflammatory reaction. The National Advisory Committee on Immunization (NACI) makes broad recommendations guiding the timing of other vaccines relative to the COVID19 vaccines that is based on the time to achieve an optimal antibody response, but this is not relevant in the context of BCG therapy. Furthermore, in bladder cancer patients BCG is used to treat the cancer, and delays in BCG treatment due to vaccination could in fact harm patients. At the same time there is a risk of harm to patients if the vaccine is withheld longer than necessary.
Based on what we know about the mechanisms of the COVID-19 vaccines and how BCG works, we suggest that patients should have at least one week off BCG on each side of the vaccine (but ideally 2 weeks). This is easily achieved in patients receiving maintenance BCG where we think treatment can be delayed by a short time without negative effects. However, it may be more important that patients receiving induction BCG do not experience a delay before or during treatment. In these patients it is reasonable for patients to have 48 hours off BCG before and after the COVID-19 vaccine. If a patient has the opportunity to receive the COVID-19 vaccination before starting induction BCG it would be reasonable to wait one week after vaccination to start the BCG, and then administer the 2nd dose of the vaccine one week after the last dose of BCG.
This suggested approach is based on expert opinion after consultation with doctors specializing in infectious diseases and NACI. Ultimately patients should discuss BCG and COVID-19 vaccination with their treating physician so that treatment and vaccination timelines can be adjusted, and any symptoms can be managed should they occur.
Efficacy: BCG is an immune stimulator, and there is some evidence that it may improve the efficacy of vaccines. Therefore, there is no current concern that BCG treatment will detract from the efficacy of the vaccine.
You may also be interested in watching the following informative presentation “COVID19 in 2021: Focus on Vaccine in Bladder Cancer Patients” by Dr. Peter Black, Chair of our Medical Advisory and Research Boards, which was presented during a recent B.C. support group meeting via Zoom.
I heard there is a study underway where BCG is being used to protect against COVID-19. Does that mean that my BCG treatments are protective against COVID?
There are several studies being conducted around the world investigating the use of the BCG vaccination (in the skin, not the bladder) to protect against COVID19 infection. Several epidemiological studies have investigated the risk of COVID19 infection in different populations that have or have not received the BCG vaccination. Since, these studies have come to conflicting conclusions, we do not know if prior BCG vaccination is protective. Furthermore, there is currently no direct evidence to indicate that intravesical (in the bladder) BCG therapy is protective. It might be, but in the meantime, patients need to observe all the recommended public health measures and seek vaccination when eligible.
It is important to note that both vaccines currently available in Canada (Moderna and Pfizer) are mRNA vaccines that do not pose a risk to patients with a suppressed immune system. The only uncertainty of administering the vaccines to patients with a suppressed immune system is that these patients might not be able to mount an adequate immune response after vaccination, so that the vaccine might be ineffective.
Will my next round of BCG treatments be delayed beyond the normal 3-4 month interval?
We have been advised by our Medical Advisory Board that at many centres, BCG maintenance treatments have been cancelled for the time being due to the COVID-19 crisis. However, your health care team would really be best able to answer your questions as they are familiar with your case and what care they are planning to provide.
Does receiving treatment for non-muscle invasive bladder cancer increase my risk of getting COVID-19?
The diagnosis of patients and their required treatment can be very different. According to our Medical Advisory Board, it needs to be clear that none of the treatments for non-muscle invasive bladder cancer (NMIBC) affect the risk of getting COVID-19, except through the exposure of being in the health care facility setting. Some doctors think they can safely delay treatments for 3 months and they may consider this as an option to avoid the patient visits required for treatment. Treatment for NMIBC should not make the course of COVID19 more severe.
As always, it’s best to consult your health care team when you have questions and are feeling concerned, anxious or unsure.
Will the treatment of my bladder cancer be affected by COVID-19?
It’s always best to consult your health care team with questions like these.
Your concerns and your wellbeing are a high priority of your attending doctors, nurses and other health care professionals but these times are unprecedented and you will need to heed their recommendations and follow their directives. In many cases, the most critical patients will receive treatments in priority. Some attending urologists have deferred 6 and 12 month bladder cancer cystoscopies as an example and may be cutting back on seeing new patients because their facility’s OR time is being reduced. In other cases (ie. metastatic bladder cancer), doctors will continue with the recommended treatment plan as they have a relatively narrow window of treatability. Since the COVID-19 situation is fluid and changing daily, each hospital and health care system may need to restrict access to therapies further depending on the local level of infection.
Will receiving chemotherapy affect my immune system’s ability to fight COVID-19?
Chemotherapy treatment does affect your body’s immune system and all patients currently receiving treatment (or have received treatment in the past few months) should take care to isolate themselves from the increased risk of becoming affected by all viral and bacterial infections. Read our article Protecting Yourself During the Coronavirus for some helpful tips on how to protect yourself.
What to do if I see blood in my urine during these exceptional circumstances? Is it still urgent to do a follow-up with a doctor?
It’s important to remember that blood in the urine can be a symptom of many conditions, some critical and some not. There are also a number of other important considerations such as if you have previously been diagnosed with bladder cancer or recently had a TURBT or BCG treatment. These are all important criteria in determining the seriousness of blood in the urine.
Diagnosis should be sought in in accordance to current healthcare priorities and protocols at healthcare facilities. If you were previously diagnosed with bladder cancer, it’s important to reach out to your health care team by phone for advice. If this is the first time you are seeing blood in your urine, a reasonable place to start is with a call to your family physician for further instructions.
The medical supply chain is currently under great pressure. Will this impact my ability to order ostomy supplies?
We know that there are many patients that are ordering extra supplies to ensure that they are not stuck without supplies if the global situation does not improve soon. Other patients are ordering their usual quantities, in an effort to not contribute to depleting the supply that is needed for others. This is a personal decision and we do not feel strongly that one option is more appropriate than the other. We do know that some suppliers have indicated that delivery may be delayed due to the higher than normal order volume. You may want to keep this in mind when placing your order.
I do not currently have a family physician to turn to. I am afraid of going to the walk in clinic or emergency, due to the COVID-19 situation and the potential risk to my general health. Where do I go?
Many doctor’s offices have turned to meeting with patients via Telehealth.
There are also a number of public Telehealth options available. Information about provincial services are included below:
British Columbia: https://www.healthlinkbc.ca/services-and-resources/about-8-1-1
Alberta: https://www.albertahealthservices.ca/maz/telehealth.aspx
Saskatchewan: https://www.ehealthsask.ca/services/telehealth
Manitoba: https://mb.211.ca/agencies/mb-telehealth/
Ontario: https://www.ontario.ca/page/get-medical-advice-telehealth-ontario
Quebec: https://www.quebec.ca/en/health/finding-a-resource/info-sante-811/
New Brunswick: https://www2.gnb.ca/content/gnb/en/departments/health/Tele-Care.html
Nova Scotia: http://www.nshealth.ca/virtual-care
Prince Edward Island: https://www.princeedwardisland.ca/en/information/health-and-wellness/811-telehealth
Newfoundland and Labrador: https://www.811healthline.ca/
Nunuvut: https://www.gov.nu.ca/health/information/telehealth
North West Territories: https://www.hss.gov.nt.ca/en/services/nwt-healthnet/telehealth
Yukon: https://ykhealthguide.org/
Canadian Women’s Health Network has a source for telemedicine at this link:
http://www.cwhn.ca/en/yourhealth/provincialhealthlines
