North Cancer Treatment Centre Glan Clwyd Hospital LL18 5UJ

Dear Cancer Forum,

As the Clinical Director of Betsi Cadwaladr University Health Board’s (BCUHB) Cancer Division, I am writing to update you with recent information regarding the Covid-19 pandemic.

As you will know from the media, Covid-19 is a new form of coronavirus, which was first recognised in Wuhan, in China, but which is now affecting many countries across the world. In the majority of people, this is a mild illness characterised by a new or persistent cough and temperature. However in approximately 14% of people the symptoms are more severe and may require hospital admission. A smaller group of people may require treatment in intensive care and sadly some of these people may die. It has been identified, from evidence from China and Italy, that there are certain patients who are more vulnerable to developing the more severe form of Covid-19.

These include patients with specific types of cancer:

• People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment • People having immunotherapy or antibody treatments for cancer • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors • People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

As a result of this, and to try and protect patients, anyone who meets these criteria has been advised to self-isolate for 12 weeks in order to reduce their chance of coming into contact with anyone who has this disease and then developing it themselves. We fully recognise that for some this can feel a worrying and difficult time and for those who live alone this can be a challenging and potentially lonely time. You will shortly receive a letter from the Welsh Government setting out the advice and sources of help and support in your local community. If you are employed, this is also proof that you will not be able to go to work whilst you are self-isolating and can be shared with your employer. If you are able to, you can work from home, if your job allows it. You will not need to get a fit note from your GP.

We are in the process of reviewing each patient to identify further what additional treatments or therapies can be safely delayed or modified without adversely affecting their health. Also, where some forms of systemic anticancer therapy (SACT) offer only a modest benefit, and the risk of developing a more severe form of Covid-19 whilst on this treatment is felt more likely, patients are being counselled accordingly. All three Cancer Centres in Wales are working together to ensure a consistent approach to managing our patients in this way. Clearly any advice regarding appropriate treatments are always made in consultation with patients, taking into account not only their cancer, but any other conditions they may have, as well as their wishes and preferences. What the full impact of the Covid-19 Pandemic is likely to be on patients undergoing cancer treatments remains under regular review both locally and nationally. If there are further modifications to treatments received by patients which needs to occur to keep patients safe we will up-date patients and their families as soon as the information becomes available. We are going to be shortly issuing a list of frequently asked questions (FAQ) which we will share with this group to support people at this time. Furthermore the Public Health Wales website is being regularly updated with any advice, recommendations and links that could be useful to the public.

Yours sincerely,

Dr Caroline Usborne Clinical Director for Cancer Service Betsi Cadwaladr University Health Board

Cyfeiriad Gohebiaeth ar gyfer y Cadeirydd a'r Prif Weithredwr / Correspondence address for Chairman and Chief Executive: Swyddfa'r Gweithredwyr / Executives’ Office, Ysbyty Gwynedd, Penrhosgarnedd Bangor, Gwynedd LL57 2PW Gwefan: www.pbc.cymru.nhs.uk / Web: www.bcu.wales.nhs.uk