During the early days of the COVID-19 pandemic, the illness was thought to cause a fever and mostly respiratory symptoms, including a cough and shortness of breath. But a recent multi-hospital study found that two-thirds of COVID-19 patients in the United States have experienced stomach or gastrointestinal (GI) symptoms, sometimes before or instead of other signs. Early reports from China described GI symptoms in as many as 50 percent of COVID-19 patients.
Early concerns for cancer patients were that they were more vulnerable to infection and also disproportionately suffered severe respiratory symptoms, especially in some lung cancer patients who may already have breathing difficulties. Now, based on recent studies, experts are adding two new concerns for cancer patients to be aware of:
- Patients with GI cancers may experience more severe symptoms, such as nausea and diarrhea.
- Cancer patients experiencing GI symptoms may have to determine whether the signs are related to their cancer or a potential COVID-19 infection.
“It may be very challenging to differentiate between GI symptoms caused by cancer versus a COVID-19 infection,” says Pankaj Vashi, MD, Vice Chief of Staff and Gastroenterologist at our hospital in Chicago.
Many cancer patients experience nausea, vomiting, weight loss and other digestive issues from cancer or treatments such as chemotherapy or radiation therapy. In fact, GI symptoms are so common among cancer patients that many may have a GI doctor on their care team, even if they don’t have a GI cancer, such as colorectal or stomach cancer.
Now, research indicates that GI symptoms also are common in COVID-19 patients. A study of symptoms in patients with COVID-19 published in Gastroenterology found that 61 percent of patients had at least one GI symptom, including loss of appetite, diarrhea and nausea. GI symptoms appeared before respiratory symptoms in 14 percent of patients in the study, and for 20 percent, the primary symptom was GI-related.
“COVID-19 should be considered in patients presenting with new or acute-onset digestive symptoms, even in the absence of respiratory complaints, fevers, or other typical COVID-19 symptoms,” Walter Chan, MD, MPH, Director of Gastrointestinal Motility at Brigham Women’s Hospital in Boston, told Reuters Health. “Failure to identify COVID-19 patients with primarily digestive symptoms may lead to delayed care, inadequate isolation and further transmission.”
Patients with GI cancers who are infected with COVID-19 may also be more likely to have severe nausea, loss of appetite and diarrhea from the virus, Dr. Vashi says. “These patients may need early hospitalization to combat dehydration and prevent kidney damage,” he says. “We advise our cancer patients to seek medical attention as soon as they develop respiratory or GI-related symptoms.”
Dr. Vashi recommends that cancer patients take extra precautions, such as isolating themselves from others, including family members, if anyone in the household suspects they have the virus or that they may have been exposed to it. The U.S. Centers for Disease Control and Prevention (CDC) provides helpful COVID-19 guidance on ways to protect yourself and family members living in the same household.
If you are a cancer survivor or in active treatment and are concerned about how the COVID-19 situation may impact you or your care, please contact your care team.
