Coronavirus and cancer – guidance for young people aged 19+

Young adults with certain cancers are more at risk of getting severely ill if they catch coronavirus. This is also the case if you’re having, or have had, certain cancer treatments. The government calls this being ‘clinically extremely vulnerable’.  This applies to you if you’ve:

• Had a solid organ transplant – kidney, liver, pancreas, heart or lung

• Are on active chemotherapy
• Are on radical radiotherapy for lung cancer
• Are at any stage of treatment for a blood or bone marrow cancer such as leukaemia, lymphoma or myeloma
• Are on immunotherapy or other continuing antibody treatments for cancer
• Are having other targeted cancer treatments which can affect the immune system such as protein kinase inhibitors or PARP inhibitors
• Have  had a bone marrow or stem cell transplant in the last 6 months
• Are on medication that compromises your immune system
• Have severe long-term lung disease, for example cystic fibrosis or severe asthma
• Have a rare disease that increases your chance of infection
• Are pregnant and have significant heart disease

Your local cancer team is responsible for letting you know how at risk you are of becoming seriously ill if you get COVID-19. They should tell you if your risk level changes. Get in touch with them if you’re not sure.

The government is relaxing shielding for clinically extremely vulnerable people from 6 July. This is in preparation for stopping shielding on 1 August.

From 6 July the advice is:

• Stay at home as much as possible. You don’t need to keep two metres apart from people you live with.

• If you want to you’ll be able to meet in a group of six people outdoors. This includes people living in different houses. You’ll still need to keep two metres (about three steps) apart from anyone you don’t live with

• If you live alone or are a single parent with children under 18, you can create a ‘support bubble’ with one other household of any size – this means you can go inside each other’s homes, stay overnight, and you do not need keep two metres apart. You can only do this with one other household, and they must not ‘bubble’ with any other households
• If you don’t live alone, you can create a ‘support bubble’ but only with someone else who does live alone – this means you can go inside each other’s homes, stay over, and you do not need to keep two metres apart. You can only do this with one other person, and they must not ‘bubble’ with any other households
• You shouldn’t go into enclosed spaces, like shops, pubs or the home of anyone not in your support bubble
• When you are outside keep two metres apart from other people, and wash your hands when you get home
• Don’t go to any group events, including gatherings of friends and families in
  private spaces. This includes things like parties, weddings and religious services
• Completely avoid contact with anyone who is displaying symptoms of COVID-19
• You should go to any medical appointments your cancer team asks you to

This advice covers the whole of England, apart from Leicester and certain surrounding areas.

From 1 August shielding will be paused. The advice is:

• You can go to work, if working from home isn’t an option for you. This is only the case though if the place where you work is COVID-safe. Your employer still has a legal duty to protect you at work so you’re not disadvantaged because you have cancer
• You can go outside to buy food, for exercise, and to worship. But remember to keep two metres apart from people you don’t live with or who aren’t in your bubble.

More information on protecting yourself as shielding eases

We know that even though shielding is lifting across the UK even for Extremely Vulnerable groups, from 1 August, your clinical team knows your individual circumstances and will advise on what is right for you. If you are in the group called ‘extremely vulnerable’ you are still likely to be advised to take extra precautions to protect you from all types of infections, not just COVID-19.  This could mean your local clinical team still advises you to avoid crowds, not attend university, college or work, and distance yourself if house-hold members are unwell with things like flu, D&V, chicken-pox, shingles or cold sores, and certainly if they have any COVID-19 symptoms.

From 19 June until 31 July, people shielding are advised:

• To stay at home as much as possible
• Avoid close contact with the people you live with
• You can go outside for unlimited exercise
• You can take part in non-contact outdoor activities such as hiking and golf
• You can meet outdoors with people from one other household, in a group of no more than eight, once a day
• You shouldn’t go into enclosed spaces, like shops, pubs or other people’s homes
• You should avoid busy places and follow strict social distancing outside
• You should always keep your hands clean and wash them thoroughly when you get home
• You should not go to work, shops or the chemists
• You shouldn’t have any visitors
• You should go to any appointments your cancer team ask you to.

From 1 August:

People in Scotland who have been shielding no longer have to, although the link below gives more specific advice for certain groups, such as those awaiting transplant and people undergoing cancer treatment.

More information on shielding in Scotland

We know that even though shielding is lifting across the UK even for Extremely Vulnerable groups, from 1 August, your clinical team knows your individual circumstances and will advise on what is right for you. If you are in the group called ‘extremely vulnerable’ you are still likely to be advised to take extra precautions to protect you from all types of infections, not just COVID-19.  This could mean your local clinical team still advises you to avoid crowds, not attend university, college or work, and distance yourself if house-hold members are unwell with things like flu, D&V, chicken-pox, shingles or cold sores, and certainly if they have any COVID-19 symptoms.

Until 16 August, people shielding are advised:

• You can go outside for unlimited exercise.
• You can meet people from another household, but only outside.
• You must maintain good hygiene (frequent hand cleaning) and social distancing (keeping 2 metres away from other people).
• You should not go to work, shops or pharmacies.
• You should not go to other people’s homes, or have visitors.
• You should avoid close contact with other people inside the home.
• You should go to any medical appointments your healthcare team ask you to.

A letter is being sent to everyone in Wales who is shielding to tell them this new advice, and that they should follow it until 16 August. There will be another letter later, advising what to do after 16 August.

Planned changes 16 August

From 16 August, Welsh Government plans to pause shielding for everyone on the shielding list (children and adults) unless the number of COVID-19 cases in the community starts to rise significantly.

You’ll be advised you can go out to more places and see more people, for example, the advice is:

• you can go to work, as long as the workplace is COVID-secure, but carry on working from home if you can
• you can go outside to buy food, keeping 2 metres (or 3 steps) away wherever possible. (Those who are receiving food boxes will continue to receive them until 16 August after which date they will cease but priority shopping slots will continue to be available).
• children and young people can go back to school or college/university.

This guidance will be updated with these changes on 16 August.

We know that even though shielding is lifting across the UK even for Extremely Vulnerable groups, from 1 August, your clinical team knows your individual circumstances and will advise on what is right for you. If you are in the group called ‘extremely vulnerable’ you are still likely to be advised to take extra precautions to protect you from all types of infections, not just COVID-19.  This could mean your local clinical team still advises you to avoid crowds, not attend university, college or work, and distance yourself if house-hold members are unwell with things like flu, D&V, chicken-pox, shingles or cold sores, and certainly if they have any COVID-19 symptoms.

More information on shielding in Wales

From 6 July until 31 July the advice is:

• You no longer need to social distance with other members of your household.
• You can spend time outdoors in a group of up to 6 people from different households, whilst maintaining strict social distancing.
• If you live alone or are a single parent with children under 18, you can create a ‘support bubble’ with one other household of any size – this means you can go inside each other’s homes, stay over, and you do not need to keep 2 meters apart. You can only do this with one other household, and they must not ‘bubble’ with any other households.
• If you don’t live alone, you can create a ‘support bubble’ but only with someone else who does live alone – this means you can go inside each other’s homes, stay over, and you do not need to keep 2 meters apart. You can only do this with one other person, and they must not ‘bubble’ with any other households.
• You must follow social distancing advice strictly whilst outside – for example, keeping a 2 metre distance from other people.
• You should not go to school, work, shops or pharmacies.
• You should not go to other people’s homes, or have visitors.
• You should go to any medical appointments your healthcare team ask you to.

From 1 August:

From 1 August, the government has announced that shielding advice will be paused in Northern Ireland.

Instead, you’ll be advised to follow the same guidance as the rest of the population, and to follow social distancing measures as strictly as possible.

More information on Shielding in Northern Ireland.

More information on staying protected as shielding eases

We know that even though shielding is lifting across the UK even for Extremely Vulnerable groups, from 1 August, your clinical team knows your individual circumstances and will advise on what is right for you. If you are in the group called ‘extremely vulnerable’ you are still likely to be advised to take extra precautions to protect you from all types of infections, not just COVID-19.  This could mean your local clinical team still advises you to avoid crowds, not attend university, college or work, and distance yourself if house-hold members are unwell with things like flu, D&V, chicken-pox, shingles or cold sores, and certainly if they have any COVID-19 symptoms.

Talk to your clinical team if you have a scheduled hospital or other medical appointment during this time. They will make sure you continue to get the care you need and will tell you which appointments you need to go to.

The opportunity to register for food boxes and medicine deliveries has now passed, although these deliveries continue in Scotland until 16 August.

Priority supermarket delivery slots will continue as long as you’ve signed up beforehand.

You can ask your CLIC Sargent Social Worker to refer you to the NHS Volunteer Responders Scheme for help with shopping and collecting prescriptions. This support will continue beyond the end of July.

More information about shopping

Your clinical team may tell you that you no longer need to shield if they believe you are no longer considered to be ‘clinically extremely vulnerable’. Contact them if you have any questions about this

If you’ve had a text saying that you no longer need to shield it will be because your GP or clinical team feels that you are no longer considered to be ‘clinically extremely vulnerable’. Your clinical team should talk to you about this, but you may get a text from the Government about this before they do. Get in touch with your clinical team if you’re not sure why you’ve had a text. GP records are occasionally a little out of date if they haven’t yet received updates from hospital teams, which is why GP text can get out of sync with your latest treatment plan.

Letters were also sent out to people who had other conditions that put them in the ‘extremely vulnerable’ category as well. If you have one of these conditions you may have had a letter for that. If you are at all unsure, speak with your clinical team so they can advise you.

Following the shielding advice can be difficult because it restricts what you can do. That can be hard for a lot of reasons, including what it means for your family, and the effect it has on your mental health.  Shielding is a personal choice. Have a chat with your clinical team so they can advise you and help you make the decision about whether or not to shield.   Government also states that the guidance on shielding for the clinical extremely vulnerable continues to be advisory. You can opt for social distancing if there are reasons why you feel unsafe shielded at home.

Cancer treatment is continuing, but some changes are being made to the way services are delivered. This is to keep patients and hospital staff safe.

• Hubs have been set up across the country to support hospitals to make sure that people receive the treatment that they need. You will still be under the care of your main hospital if your treatment moves to one of these hubs. You should contact your usual clinical team if you have any questions about your treatment.
• Most hospitals have started to use telephone consultations to help
  people avoid long waits in clinics and for treatment. You may get a phone call to arrange your treatment this way.
• Some patients may have their chemotherapy at home. In some areas mobile units have been set up to deliver chemotherapy, so you may be asked to go to one of these.  If you’re on radiotherapy you may have fewer appointments. This cuts down the number of visits to hospital but allows treatment to continue.

Speak to your clinical team if you have any concerns or questions about your treatment.

There are currently no medicine shortages as a result of COVID-19. This means your treatment centre doesn’t have any problems getting the cancer drugs needed to treat you.

If you have difficulty collecting medicines you can ask your social care worker to refer you to the NHS Volunteer Responders scheme to have medicines collected. This service will continue after 1 August.

A National group called “Healthwatch” working with “National Voices” an NHS service user advisory group have completed some research on digital out-patient appointments during the coronavirus lock-down. They produced a report and a good practice guide for patients and professionals. This advice is from their report:

• Ask for a timeslot for when your remote consultation will take place.
• Let your health care provider know how you prefer to talk by phone, video or in-person.
• Find somewhere quiet and confidential and, if this isn’t possible or is tricky, make this clear when you are making your appointment.
• Start with a phone call if you’re not confident with video technology.
• Ask for help if you need it and, if possible, do a practice run with a friend.
• Take some time to prepare in advance, consider what you want to say and key questions you would like to ask.
• Ask your health care provider to summarise the next steps at the end of the appointment.
• Remote consultations can be useful for routine appointments or ongoing care with a health care practitioner.
• Not all appointments are suitable for remote consultations, if you would like to see someone in-person please say so.

All hospitals are taking extra steps to ensure patients, staff and the public are protected from coronavirus and lots of infections that could be picked up in a hospital environment. You will see hand washing, hand sanitisers, surgical masks, gloves and sometimes gowns and visors being used by hospital staff. More space will be allocated between patients and a visitor to manage social distancing as far as is possible in hospital. You may also be screened for COVID-19 when you arrive. Cancer care teams know that your treatments make you vulnerable to infection and have been managing prevention techniques for decades before any of us had heard of Coronavirus, so you can expect your cancer team to know how to keep you safe. If you do see someone not following government guidance, tell a healthcare professional  you trust, or if you feel confident enough, tell the person you noticed they forgot something – we’re all human and in a busy day they may appreciate the reminder.

Travel to appointments and treatment by car if you can. Either driving yourself, or with someone who lives in the same house as you. If driving isn’t an option, use the form of transport that brings you into the least contact with people as possible.

If you think someone in your household might have coronavirus you should follow the government guidance. Let your clinical team know before you attend your appointment.

Staying at home and not being able to spend much time with friends or family may feel daunting and frustrating. Doing what you can to stay mentally and physically active at this time is important. Simple things you can do to include:

• Exercising at home – you’ll find links to some great workouts in our boredom busters article
• Doing things you enjoy – box sets, gaming, baking and other indoor hobbies
• Leading a healthy lifestyle – you’ll find lots of articles about this on our Health and wellbeing pages
• Opening your widows or sitting in the garden – fresh air and natural sunlight are a big boost.

You’ll find lots more ideas at Young Minds and Every Mind Matters.

If you have symptoms of any infection or illness, including  coronavirus, you should contact your cancer team as you would normally do. You should do this as well as calling 111 for advice about coronavirus symptoms.

Shielding has been paused in England, Scotland and Northern Ireland from 1 August 2020 and plan to pause shielding in Wales from 16 August. This applies to most young people receiving cancer treatment, but those who are considered ‘extremely vulnerable’ should continue taking extra precautions.

Your clinical team know your individual circumstances and will advise on what is right for you. If you are in the group called ‘extremely vulnerable’ you are still likely to be advised to take extra precautions to protect you from all types of infections, not just COVID-19.  This could mean your local clinical team still advises you to avoid crowds, not attend university, college or work, and distance yourself if house-hold members are unwell with things like flu, D&V, chicken-pox, shingles or cold sores, and certainly if they have any COVID-19 symptoms.

For those of you who are advised by your clinical team that you can return to university, college or work, your employer has a legal duty to provide you with the support you need at work so you’re not disadvantaged by your cancer. Talk to your employer about your situation and to arrange a plan for you to return to your workplace if this is appropriate. You should only return to work if your employer has taken steps to make sure your workplace is COVID-safe.

If you believe doing your job at this time puts you at serious danger, and your employer can’t or won’t make reasonable adjustments to protect you, you are legally entitled to take steps to protect yourself. This includes leaving where you work. If your employer fired you over this it would automatically be classed as unfair. Citizens Advice has more information on this. You can also speak to a Welfare Adviser by calling 0800 915 4439 or emailing Welfare.Advice@clicsargent.org.uk.

This really depends on the type of cancer and the treatment you had. Most people make a full recovery after cancer treatment and their immune system either recovers fully or isn’t affected. Unless you fall into the clinically extremely vulnerable category, you’re not at more risk of serious illness if you get COVID-19