Are Patients with Cancer at Higher Risk of COVID-19?

Patients with cancer who are diagnosed with the novel coronavirus (COVID-19) tend to have poorer outcomes, and it is vital that the oncology treatment team screen their patients for the virus before continuing on with treatment, according to a small study conducted in Wuhan, China.

“Cancer patients show deteriorating conditions and poor outcomes from the COVID-19 infection,” the study, which was recently published in the Annals of Oncology, states. “It is recommended that cancer patients receiving anti-tumor treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 co-infection.”

The researchers examined 28 COVID-infected patients with cancer. Of those, the majority (17; 60.7%) were male, and the average age was 65. Eight patients (28.6%) were suspected to have gotten COVID-19 from hospital-associated transmission. Common symptoms observed were:

• Fever
• Dry cough
• Fatigue and dyspnea
• Blood lymphopenia
• High levels of hsCRP

“Anemia and hypoproteinemia were considered to be a major consequence of nutritional deterioration in cancer patients, which may adversely affect immunocompetence and increase the susceptibility to respiratory pathogens,” the researchers wrote.

Patients with Lung Cancer May Have Increased Risk

The most common cancer in the cohort of patients was lung cancer, appearing in 7 patients (25%), and these patients tended to have an earlier onset of dyspnea compared with the general population and the cancer population.

“Patients with lung cancer, with worse baseline lung function and endurance, are more likely to develop more severe anoxia and progress more rapidly with COVID-19” the researchers wrote. “This leads to urgency and increased attention in the COVID-19 infected cancer patients, with special emphasis on patients with lung cancer.”

The Severity of COVID-19 in Patients with Cancer

More than half (53.6%) of the patients involved in the study developed severe events—defined by admission to the intensive care unit (ICU), mechanical ventilation, or death—with 28.6% of the patients dying.

This is far higher than the general COVID-19-infected population, which has an average clinically critical status rate of 4.7%, and a mortality rate of 2.3%.

“Patients with cancer are particularly susceptible to respiratory pathogens and severe pneumonia, because they are at an immunosuppressive state due to malignancy and anti-tumor therapy. It was found that within 14 days, anti-tumor therapies were significantly associated with occurrence of severe clinical events in COVID-19 infection,” the researchers wrote.

However, they noted that since all the cases in this study were from Wuhan, China, the statistics could be skewed a bit because the city, “faced a dire shortage of medical resources to cope with the influx of patients and at early stage of the outbreak, and some patients were not admitted to the hospital in time; hence, it is presumed that delated admission contributed in increased mortality,” they wrote.

Reference

L. Zhang, F. Zhu, L. Xie, et al. Clinical characteristics of COVID-19-infected cancer patients: A retrospective case study in three hospitals within Wuhan, China. Annals of Oncology. March 23, 2020. DOI: https://doi.org/10.1016/j.annonc.2020.03.296. Accessed March 27, 2020.

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