Coronavirus Part 1

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(Here is a preview of an article by one of PCCN-Toronto’s favourite Awareness Night speakers.  He has a regular column in US Too’s Hot Sheet.)

Coronavirus Part 1

(Hopefully There is No Part 2 Because We Will Have Conquered Corona Quickly)

by Mark A. Moyad, MD, MPH

My Hot SHEET column does not come out for a few weeks, so I have been asked to provide some
personal thoughts on the obvious situation occurring. In addition to my public health
background, I have previously worked with other infectious agents that have impacted many
people. Let me be candid here. I am concerned, of course, but I am also incredibly optimistic!

“I bet on science” has been my mantra these past few weeks. I believe we will find a drug(s) or
vaccine(s) or both, and/or find the ability to eventually contain this thing. In the meantime,
we have a sufficient supply of experts giving public health advice, so I do not want to repeat
instructions such as “wash your hands”, … but rather, send a few other reflective thoughts
right now.

First, do whatever is necessary to optimize your lifestyle and personal health right now. What
has been fairly consistent over decades of research is that anything heart healthy is also
immune healthy. Exercise-aerobic and resistance, better diet, no tobacco, minimum to no
alcohol, medication and vaccine compliance, meditation, stress reduction, sleep, controlling or
normalizing cholesterol, blood sugar, blood pressure, healthy metabolic profile… improve your
personal overall mental and physical health. Adequate research has shown that all these things
could simultaneously improve your immune health. Of course, I am not providing a guarantee that
it will prevent or fight the virus, but it cannot hurt. It only helps you, in general,
potentially live better and longer. “Immuno-senescence” is the gradual and expected decline in
immune function with age, but research suggests, just like the heart, brain and the rest of the
body, that this significant reduction in function is not inevitable in everyone. Rather, immune
health can be improved via personal health improvements. Yes, all of that lifestyle stuff I
have been talking about for over 150 consecutive columns (OMG has it been that many!!!) is more
important right now than ever before (heart healthy=immune healthy=prostate healthy=head-to-toe healthy).

Second, no public health person, including myself, should allow a column to guide your specific
situation because cancer patients, including prostate cancer patients have somewhat similar but
simultaneously unique and different situations. They call prostate cancer a heterogeneous
disease, but it is also heterogeneously handled. The spectrum and nuances of all of these
treatments create one of the most unusual situations or relationships with a health care team
in all of medicine. In other words, your health care team should know you almost as well as you
know yourself.

I have been on the phone and in person the past few weeks with countless cancer health care
professionals/researchers from all over the planet, and one thing they all have in common
besides compassion is that they are complete and total nerds (hey, just like me). What am I
talking about? They have a relentless and remarkable appetite for learning (just like most
cancer patients/family members), and most of them have been studying the coronavirus research
in their own personal way trying to decipher what is going on and how that impacts cancer

General advice to the cancer community is not enough, but rather advice specific to your
situation is also critical. You should feel free to engage some or all of your health care team
as to how this coronavirus may or may not impact your scheduled treatments. I am not talking
about calling an already overwhelmed office 24-7 to get an answer, but rather on your next
visit or discussion the topic of this virus and how it may impact your treatment or monitoring
plan is appropriate and absolutely necessary. Some treatments and medications cause temporary
immune-suppression, and some do not. I promise you that the majority of health care teams are
thinking about this. Many individuals reading this will see no change and others, perhaps,
could have a change in their treatment schedule.

Arguably, part of the reason you should be happy with your health care team is simply because
they are open to honest communication with you not only because you are the customer, and they
are the business, but any good relationship is bi-directional in nature. So, if you are about
to receive an injection, radiation, surgery, pills, chemotherapy, … feel free to discuss how
this situation could or could not impact you, and what are the very latest pieces of advice
your team is offering specifically and in general. Again, no column or outside news expert
should replace the relationship you have with your team and now more than ever is proof of this

In addition, I am completely confused by meetings or conferences or events or whatever still
occurring under these current circumstances. (Us TOO is currently working with its support
group leaders on best practices for addressing coronavirus concerns which will involve, among
other things, some recommendations on hosting virtual meetings). It will take more time to
figure out what we really have here, so “first do no harm” and “eliminate the doubt if there is
doubt.” Public health should come first regardless of whether or not in a few months it might
be deemed an overreaction. My advice is that non-emergency meetings or other in person events
should not occur right now. It is that simple. If potentially, the worst-case scenario (people
getting ill or dying) is far worse than the best-case scenario (having a wonderful in person
educational meeting), which of course it is, then please eliminate the possibility of the
worst-case scenario! Egos need to be shelved and public health needs to be prioritized. Again,
it is that simple.

Finally, I hope and wish the very best for you and your family. Health care professionals
working in the field of cancer are some of the most wonderful and compassionate nerds. Use the
time you have with them and others in your support group team to open up a dialogue the very
next time you interact with them-be it in the hospital, office, over the phone, or internet. If
you have new research or evidence to share with your health care team on the virus or
otherwise, then share it please, because part of the beauty of patient advocacy is learning as
much as you can to help you and your team. Patients learn from their health care team, but good
health care professionals also learn from their patients. I am concerned, of course, but I am
also incredibly optimistic! I look forward to modern day science and you of course, kicking
this virus and cancer in the gluteus maximus!

All of my best always,

Mark A. Moyad MD, MPH


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