This guidance has been produced specifically for people with cancer by One Cancer Voice charities in partnership with NHS England. Please note, information is rapidly changing and we will endeavour to update this page as updates are received. Last updated: 23/06/2020
The Government is advising everybody to:
- Stay alert
- Stay at home as much as possible
- Work from home if you can
- Limit contact with other people
- Keep your distance if you go out (2 metres apart where possible)
- Wash your hands regularly
Do not leave home if you or anyone in household has symptoms of coronavirus.
In the first instance, please refer to wider Government guidance on:
- Staying at home if you think you have coronavirus (self-isolating)
- Staying alert and safe (social distancing)
- Staying alert: what you can and cannot do
- Staying safe outside your home
- How to protect clinically extremely vulnerable people (shielding)
The Government also have a wide range of information to help people at this time, including on employment, financial support, school closures and childcare.
For more information on the next steps for the clinically extremely vulnerable and shielding, see Q26.
Cancer services during the restoration and recovery from COVID-19
The NHS is currently moving into the next phase of its response to the COVID-19 outbreak: to restore and recover all services for patients. If you need to access care or treatment for suspected or diagnosed cancer, arrangements have been put in place to keep you safe from COVID-19.
If you have a worrying symptom, and you think it might be cancer, please contact your GP surgery straightaway. GP surgeries are offering online consultations and/or remote triage so that people do not have to attend in person unnecessarily.
If you have been asked to go to hospital for further investigation or for treatment if you are diagnosed with cancer, it is important that you attend. The NHS is reorganising the way that it delivers services to keep you safe:
- COVID protected hubs have been established for cancer surgery across the country to keep patients safe. These are in COVID protected areas of a hospital or on separate hospital sites. The model is now being expanded to cover diagnostics too.
- Wider measures are also being taken by all hospitals treating COVID patients to ensure that COVID and non-COVID patients are kept separate. This may include using separate entrances for COVID and non-COVID patients, ensuring staff and patients do not move between different parts of the hospital, and making sure that, as far as possible, staff are social distancing both inside and outside clinical areas.
- The staff caring for cancer patients will be vigilant for any symptoms that they or their families are showing and are required to self-isolate in line with government guidance. Staff will be tested for the virus if they are displaying symptoms. Hospitals are also introducing testing for staff not displaying symptoms where there is testing capacity to do so.
- All patients can support NHS staff to maintain COVID-protected environments by being aware of any symptoms they or their family may be displaying, and by following the advice of the clinical teams working with them. If a patient is uncertain whether they should come into the hospital, they should discuss this with their clinical team.
The NHS is here for you if you need it: help us to help you.
You can also call our free Support & Information Line on 0800 111 4855 or email us.
Following the prime minister's announcement on 23rd March to stay at home (other than for food, health reasons or essential work), please find Government guidance on staying at home if you think you have coronavirus (self-isolating), how everyone can help stop coronavirus (social distancing) and how to protect extremely vulnerable (shielding).
It is important that you seek clinical advice if you have a worrying symptom. GP surgeries have been advised to offer online consultations and remote triage so that people do not have to attend in person unnecessarily. Please do contact your GP surgery directly if you are worried about a possible cancer symptom, for example if you have any of the following symptoms for no explainable reason:
- Bleeding that doesn’t come from an obvious injury
- A lump
- Weight loss
- Or any type of pain that won’t go away.
You can find a fuller list of the symptoms to look out for on the Be Clear on Cancer website.
If you have been asked to go to the hospital for further investigation, it is important that you attend. The NHS is reorganising the way that cancer diagnosis is delivered so that you can undergo diagnostic tests in places protected from the coronavirus. Because of that, you may be asked to self-isolate for seven days before any diagnostic procedures, even if you do not have coronavirus symptoms. You should discuss with the clinical team at the hospital if you have any concerns about attending. Most people who go to their GP with symptoms do not have cancer. However, if you do have cancer, earlier diagnosis can mean more effective treatment and improved chances of survival.
If you have been asked to attend hospital, the only reason you should not go is if you have any symptoms of coronavirus. In this case, you should tell the hospital, cancel your appointment and self-isolate. The clinical team will discuss with you about when your appointment can be safely rescheduled.
People with certain cancers and those who have received or are receiving certain treatments are at risk of severe illness if they catch coronavirus (Covid-19). This includes:
- people with cancer who are undergoing active chemotherapy
- people with cancer who are undergoing 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 other continuing 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.
The Government updated their guidance for these people on 31 May, and advises them to continue to take precautions in order to keep themselves safe:
1. If you wish to spend time outdoors (though not in other buildings, households, or enclosed spaces) you should take extra care to minimise contact with others by keeping 2 metres apart.
2. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household (ideally the same person each time).
3. You should stay alert when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size.
4. You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
5. You should strictly avoid contact with anyone who is displaying symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, your sense of taste or smell).
The NHS has written to people in these groups with advice and information about what to do
during this time, and where to access support. This advice will be in place until at least the
end of June.
Please visit the Government website for more information regarding shielding advice. If you are affected, and have a scheduled hospital or other medical appointment during this period, talk to your clinical team to ensure you continue to receive the care you need and determine which of these are absolutely essential.
The government has updated its guidance for people who are shielding taking into account that COVID-19 disease levels are substantially lower now than when shielding was first introduced. The number of cases is falling and the average rate of incidence of the virus has fallen from around 1/40 to 1/1000 cases per week, delivering greater reassurance that it is safe to cautiously reflect this in the guidance for those who have been advised to shield
Everyone who has received a letter advising that they are clinically extremely vulnerable should register online if you need any extra support. This may include having essential groceries delivered to your home or setting up regular calls with an NHS volunteer if you are experiencing feelings of isolation.
Information on the support available to people who are shielding can be found here.
The criteria for cancer patients were carefully defined, based on those with greatest clinical risk. If you are unsure of your risk and what measures you should be taking, you should speak with your hospital specialist. If this is not possible, you should contact your GP.
Your clinical team may inform you that you no longer need to shield if you are no longer considered to be ‘clinically extremely vulnerable’. Your clinical team should discuss this with you. If you have any questions regarding this, you should contact your clinical team.
You may have received a text saying that you no longer need to shield if your GP or clinical team feels that you are no longer considered to be ‘clinically extremely vulnerable’. Your clinical team should discuss this with you, but you may receive a text from the Government about this before this conversation has taken place. If you are not sure why you have received this text, you should contact your clinical team.
Q8a. I don’t think I should be considered as clinically extremely vulnerable, but I have received a letter saying I am. What should I do? / I have received a letter saying I am considered as clinically extremely vulnerable but I do not want to follow the guidance.
The criteria for cancer patients were carefully defined, based on those with greatest clinical risk. Some cancer patients may receive a letter because they have other conditions that place them in the highest risk cohort.
We understand that the restrictions imposed by shielding are difficult, both for you and for your family members and/or carers. The Government has issued shielding guidance, strongly advising you to stay at home as much as possible and keep visits outside to a minimum (for instance once per day) until at least the end of June. This is the safest thing to do to protect you from illness/complications of COVID-19.
However, this is guidance and whether you follow the guidance or not is a personal decision for you to make. You may decide, having weighed up the risks and the implications of shielding, that you do not want to follow the guidance.
You may also choose to remain in your own home at all times if you do not feel comfortable with any form of contact with others. Before deciding, we would ask you to discuss the matter with your GP or hospital specialist and those that may provide care for you. This may be particularly relevant for patients who are receiving end of life care. Please do talk to somebody before you decide what to do.
If you are unsure of your risk and what measures you should be taking, you should speak with your hospital specialist. If this is not possible, you should contact your GP.
Some people may receive the letter more than once because they have more than one condition that places them in the highest risk cohort. Some people may receive a letter from the central NHS point and their local clinical team or GP, as both have identified them as clinically extremely vulnerable.
Absolutely not. This is about identifying those people most at risk so they can take measures to protect themselves from developing serious illness from Covid-19. It is also about making sure they can access care and support during this time, including social care and help with practical needs such as getting medicines.
If you fall ill from COVID-19, or any other condition, and require treatment in hospital, you will still be treated as normal and will not be denied any medical intervention because you are in the shielding group.
- Will it be postponed?
- Should I still go to hospital appointments?
- How will my hospital decide whether I am a priority for treatment? Will there be national rules?
- If treatment, including stem cell transplants, are deferred and I begin to relapse will this limit my eligibility for future lines of treatment?
- Should I start chemotherapy treatment (particularly if it is a 2nd/3rd line for "mop up") or postpone?
- As a stage 4 patient will I be given life support if I have breathing difficulties due to the virus?
- If I get the virus and recover, will this affect my cancer treatment and outlook?
The NHS is currently moving into the next phase of its response to the COVID-19 outbreak: to restore and recover NHS services so that they start to operate as they did before the pandemic. This means that cancer diagnosis, treatment and care are continuing, and the NHS is working to ensure that these services return to operating as they did before. Changes are being made to the way services are delivered to keep patients and staff safe.
- COVID-protected hubs have been established across the country to ensure that cancer treatment continues. The hubs support hospitals across the NHS and independent sector to work together to maximise capacity and ensure that people receive the treatment that they need. Some patients may start to see their treatment move to a different hospital as these hubs are set up. You will remain under the care of your treating hospital and clinical specialist team and should contact them with any questions about your treatment and care.
- Most hospitals have started to use more telephone consultations as a way of helping people to avoid long waits in clinics and for treatment. You may be called to arrange your treatments in this way, and planned treatments may need to be moved to help with running a smooth service.
- Some patients may have their chemotherapy at home or have fewer radiotherapy appointments, to reduce visits to hospital while continuing with their treatment.
- For some people, it may be safer to delay surgery. Your doctor may suggest a different treatment in the meantime, such as chemotherapy or hormonal therapy.
Wider measures are also being taken by all hospitals that are treating COVID patients to ensure that COVID and non-COVID patients are kept separate. For example, there may be separate entrances for COVID and non-COVID patients, all patients admitted to hospital as an emergency will be tested for COVID, and patients going into hospital for surgery or another elective procedure will be asked to isolate for 14 days and be offered a COVID test wherever possible.
Your clinical team are best placed to talk with you about your treatment and appointments.
They will work with you to determine the best course of action in each individual situation. If
you have any concerns or questions about your treatment, please speak to your clinical
You should call the chemotherapy care line. If the chemotherapy care line is not available in your area, please speak to your clinical team about who you should call in this situation.
Your clinical team are best placed to talk with you about the effect on your treatment and appointments. They will work with you to determine the best course of action in each individual situation.
There is guidance if you think you or someone in your household have coronavirus: click here
We understand that this may be a worrying time and you may find staying at home and having limited contact frustrating. At times like these, it can be easy to fall into unhealthy patterns of behaviour, which can make you feel worse. Simple things you can do to stay mentally and physically active during this time include:
- look for ideas for exercises to do at home on the NHS website
- spend time doing things you enjoy – reading, cooking and other indoor hobbies
- try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and recreational drugs
- try spending time with the windows open to let in fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight. Get out into the garden or sit on your doorstep if you can, keeping a distance of at least 2 metres from others.
The NHS outlines the common symptoms of coronavirus on its website. If you are experiencing symptoms of any infection or illness, including coronavirus, you should contact your cancer team know as you would normally. You can do this as well as calling 111 for advice about coronavirus symptoms.
It is not yet known whether reinfection is possible, although many experts think it is unlikely.
If your clinician is diagnosed with coronavirus and you have not seen them recently, then you are unlikely to have been exposed to coronavirus. Health professionals are working to contact anyone who has been in close contact with people who have coronavirus. If you are concerned about the impact this will have on your treatment, contact your hospital for advice.
You should contact your clinical team with questions about your individual treatment including any trials you are part of.
The National Institute for Health Research (NIHR) issued guidance earlier during the pandemic response which recognised that much research would need to pause, not least because many clinical research teams were asked to redeploy to help with providing patient care. The NIHR has now published a framework to support work towards the restoration of research that they fund and/or support.
This depends on the type of cancer and the treatment you have had. Most people make a full recovery after cancer treatment and their immune system either recovers fully or is not affected. See Q3 for further information.
If your child with cancer falls into any of the clinically extremely vulnerable groups outlined in Q3, they and others in the household should follow the measures to ‘shield’ them.
The government has set out the following advice on attending school for children and young people who fall into any of the clinically extremely vulnerable groups outlined in Q3 or who live with someone who is clinically extremely vulnerable:
- Children and young people in eligible year groups are strongly encouraged to attend (where there are no shielding concerns for the child or their household).
- Children, young people and staff who have been classed as clinically extremely vulnerable due to pre-existing medical conditions have been advised to shield. We do not expect people in this category to be attending school or college, and they should continue to be supported to learn or work at home as much as possible.
- If a child/young person or staff member lives in a household with someone who is extremely clinically vulnerable, as set out in the guidance on shielding, it is advised they only attend an education or childcare setting if stringent social distancing can be adhered to and, in the case of children, if they are able to understand and follow those instructions. This may not be possible for very young children and older children without the capacity to adhere to the instructions on social distancing. If stringent social distancing cannot be adhered to, we do not expect those individuals to attend. They should be supported to learn or work at home.
Please refer to the wider guidance on which pupils can attend school on the Government website for more information
There is currently no vaccine for this form of coronavirus. Research is being done to develop a vaccine, but this will take many months.
There are currently no medicine shortages as a result of COVID-19. The country is well prepared to deal with any impacts of the coronavirus and we have stockpiles of generic drugs like paracetamol in the event of any supply issues. The Department of Health and Social Care is working closely with industry, the NHS and others in the supply chain to ensure patients can access the medicines they need and precautions are in place to prevent future shortages.
There is no need for patients to change the way they order prescriptions or take their medicines. Patients should always follow the advice of doctors, pharmacists or other prescribers who prescribe and dispense their medicines and medical products. The NHS has tried-and-tested ways of making sure patients receive their medicines and medical products, even under difficult circumstances. If patients order extra prescriptions, or stockpile, it will put pressure on stocks, meaning that some patients may not get the medicines or medical products they need.
- Only patients undergoing active chemotherapy for lung cancer?
No. Everyone undergoing active chemotherapy is included.
- Patients who have received chemotherapy in the past three months?
People’s immunity remains compromised for some time after finishing chemotherapy and clinical teams will be aware of this when considering their highest clinical risk patient lists. If you have completed chemotherapy in the last 3 months, please contact your care team to discuss your specific circumstances. In the meantime, you should follow the Public Health England guidance on ‘shielding’ - in summary, stay at home and avoid face-to-face contact until at least the end of June.
- Patients with blood disorders who are immunocompromised but not receiving chemotherapy?
Yes. These patients are included within ‘people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment’.
- Patients having radiotherapy for metastatic lung tumours?
Yes. These patients are included within ‘people with cancer who are undergoing radical radiotherapy for lung cancer’.
- Patients with metastatic cancer in the lungs who are not currently receiving treatment?
People with metastatic cancer in the lungs could be more vulnerable and therefore at highest clinical risk from Covid-19. Vulnerability will depend on the type of cancer and treatments that you have had.
If you have not received a letter, please contact your care team to discuss your specific circumstances. In the meantime, you should follow the Public Health England guidance on ‘shielding’ – in summary, stay at home and avoid face-to-face contact until at least the end of June.
- Patients having any targeted treatments (more than just antibody treatments)? Would anti-angiogenesis targeted drugs fit into that?
Yes, all these treatments carry excess risk and therefore people receiving these treatments would be included. These patients are included within ‘people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors’.
- Transplant patients?
Yes, if they have had a transplant within the last 6 months, and if they are taking any immunosuppression. These patients are included within ‘people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs’.
- Patients autologous as well as allogeneic transplants in the last 6 months?
- All patients with rare diseases?
No, how rare the disease is not relevant. The issue is whether the disease significantly increases the risk of infection. If a patient has a rare disease and that disease significantly increases their risk of infection, they will be included in the category of clinically extremely vulnerable people.
Recently, the UK Government advised that you can spend time outdoors, if you wish,
with your own household, or if you live alone with another household. Following this,
and alongside current scientific and medical advice the UK Government is planning to
relax shielding guidance in stages.
From 6 July, the guidance will change so you can meet in groups of up to six people
from outside your household – outdoors with social distancing. For example, you might
want to enjoy a summer BBQ outside at a friend’s house, but remember it is still
important to maintain social distancing and you should not share items such as cups
If you live alone (or are a lone adult with dependent children under 18), you will be able to form a support bubble with another household. From 1 August, you will no longer need to shield, and the advice will be that you can visit shops and places of worship, but you should continue maintaining rigorous social distancing.
Why is the guidance changing now?The roadmap has been developed in line with the latest scientific and medical advice and with the safety and welfare of those who are shielding in mind. Current statistics show that the rate of catching coronavirus in the community continues to decrease. On average less than 1 in 1,700 in our communities are estimated to have the virus, down from 1 in 500 four weeks ago. Unless advised otherwise by your clinician, you are still in the ‘clinically extremely vulnerable’ category and should continue to follow the advice for that category, which can be found here.
We will monitor the virus continuously over coming months and if it spread too much, we may need to advise you to shield again.
What support is available to people who are shielding until the end of July?
There are a number of ways that those who are shielding can access food and other essentials:
• Make use of the supermarket priority delivery slots that are available for this group. When a clinically extremely vulnerable person registers online as needing support with food, their data is shared with supermarkets. This means if they make an online order with a supermarket (as both a new or existing customer), they will be eligible for a priority slot.
• Use the many commercial options now available for accessing food, including telephone ordering, food box delivery, prepared meal delivery and other non supermarket food delivery providers. A list has been shared with local authorities and charities.
• A free, standardised weekly parcel of food and household essentials. If you have registered for this support online before 17 July you will continue to receive weekly food box deliveries until the end of July.
• If you need urgent help and have no other means of support, contact your local council to find out what support services are available in their area.
• For anyone facing financial hardship, the government has made £63 million available to local councils in England to help those who are struggling to afford food and other essentials. NHS Volunteer Responders Support will continue to be available through the NHS Volunteer Responder Scheme beyond the end of July. NHS Volunteer Responders can support you with:
• Collecting shopping, medication (if your friends and family cannot collect them for you) or other essential supplies;
• A regular, friendly phone call which can be provided by different volunteers each time or by someone who is also shielding and will stay in contact for several weeks
• Transport to medical appointment. Please call 0808 196 3646 between 8am and 8pm to arrange support or speak to your health case professional for transport support. A carer or family member can also do this on their behalf. More information is available here.
Any essential carers or visitors who support you with your everyday needs can continue to visit unless they have any of the symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, their normal sense of taste or smell). People in the clinically extremely vulnerable group should continue to access the NHS services they need during this time.
This may be delivered in a different way or in a different place than they are used to, for example via an online consultation, but if they do need to go to hospital or attend another health facility for planned care, extra planning and protection will be put in place.
Mental health support
It is normal during these uncertain and unusual times to feel anxious or feel low.
Follow the advice that works for you in the guidance on how to look after your mental health and wellbeing during coronavirus (COVID-19).
If you feel you need to talk to someone about your mental health or you are looking
for more support for someone else, we would urge you to speak to a GP and seek
out mental health support delivered by charities or the NHS.
Income and employment support
At this time, people who are shielding are advised not to go to work. This guidance remains advisory. Those shielding will be eligible for Statutory Sick Pay (SSP) on the basis of their shielding status until the 31 July. SSP eligibility criteria apply From 1 August, if clinically extremely vulnerable people are unable to work from home but need to work, they can, as long as the business is COVID safe.
The Government is asking employers to work with them to ease the transition back to a more normal way of life for their shielding employees. It is important that this group continues to take careful precautions, and employers should do all they can to enable them to work from home where this is possible, including moving them to another role if required. Where this is not possible, those who have been shielding should be provided with the safest onsite roles that enable them to maintain social distancing. If employers cannot provide a safe working environment, they can continue to use the Job Retention Scheme for shielded employees who have already been furloughed.
What support will be available after July?
From 1 August, clinically extremely vulnerable people will continue to have access to priority supermarket delivery slots if you have registered online before 17 July for a priority delivery slot. NHS Volunteer Responders will also continue to offer support to those who need it, including collecting and delivering food and medicines. The NHS Volunteer Responders Scheme has been expanded to offer a new Check in and Chat Plus role. This new role has been designed to provide peer support and companionship to people who are shielding as they adapt to a more normal way of life.
If you are vulnerable or at risk and need help with shopping, medication or other essential supplies, please call 0808 196 3646 (8am to 8pm). Government is committed to supporting local councils and voluntary sector organisations to respond to those who have specific support needs and requirements during the COVID-19 pandemic.
Details of the support and advice available can be found here. The updated shielding guidance should not affect any social care or support you were receiving prior to the start of shielding. Individuals should continue to contact their local council if they have any ongoing social care needs.