Cancer and COVID-19
Authors: Dimitrios Moris, Diamantis I Tsilimigras, Dimitrios Schizas
Journal: The Lancet (2020)

We read, with great interest, about the outcomes in a cohort of patients with cancer and COVID-19 by Nicole Kuderer and colleagues.1Kuderer NM Choueiri TK Shah DP et al.Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study.Lancet. 2020; 395: 1907-1918Summary Full Text Full Text PDF PubMed Scopus (1297) Google Scholar The authors showed that among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general and cancer-specific risk factors, with a mortality of 13·3%. More data on the cause of mortality in the CCC19 cohort would have been useful. More specifically, how many patients died because of COVID-19-related issues (eg, acute respiratory distress syndrome or organ failure), and how many died because of background disease progression and relevant complications? Finally, how many of these deaths should be attributed to changes in the therapeutic plan caused by COVID-19, including access to care and delays in management? Information on deaths caused by changes to a patient's care plan is of paramount clinical importance, since data on the incidence of avoidable mortality caused by the effect of the pandemic on health-care resources are scarce. During the pandemic, the management of patients with cancer has been affected at multiple stages, including the triage decisions, surgery, and neoadjuvant therapy as a bridge to reduce admissions and preserve health-care resources.2Schrag D Hershman DL Basch E Oncology practice during the COVID-19 pandemic.JAMA. 2020; 323: 2005-2006Crossref PubMed Scopus (205) Google Scholar Also, when possible, oncologists are modifying or substituting oral for intravenous chemotherapy with oral agents to minimise admissions to hospital. In the same vein, omissions, delays, or fragmentation of care can have clinically important adverse influence on quality of life or survival.2Schrag D Hershman DL Basch E Oncology practice during the COVID-19 pandemic.JAMA. 2020; 323: 2005-2006Crossref PubMed Scopus (205) Google Scholar Unfortunately, the effect on the survival outcomes is not well described in the literature, and data from international cohorts and consortia can be useful. Finally, the authors did not provide any data on the socioeconomic and insurance status of the patients included in their cohort. It would be interesting to know how many patients with cancer lost their insurance, dependent care, or employ­ment, and how these changes affected their access to care and a treatment plan. COVID-19 has caused unprece­dented societal turmoil, triggering a rapid transformation of health-care systems on a global scale. Emerging data show that the COVID-19 pandemic has the potential to amplify pre-existing disparities, especially for patients with cancer.3Anderson G Frank JW Naylor CD Wodchis W Feng P Using socioeconomics to counter health disparities arising from the COVID-19 pandemic.BMJ. 2020; 369m2149Crossref PubMed Scopus (76) Google Scholar, 4Ravi K Ethnic disparities in COVID-19 mortality: are comorbidities to blame?.Lancet. 2020; 396: 22Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar Potential drivers of disparate cancer survival resulting from the pandemic can include variable access to telemedicine, timely diagnosis, and access to treatment. Despite oncology societies proposing guidelines on cancer care during the pandemic, the prioritisation in the delivery of cancer therapies is strongly influenced by the magnitude of potential treatment benefits, therapeutic intent, and the access to care.5Hanna TP Evans GA Booth CM Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic.Nat Rev Clin Oncol. 2020; 17: 268-270Crossref PubMed Scopus (305) Google Scholar All in all, these changes can definitely affect the outcomes of patients with cancer. In this new landscape, when the cancer community is revising the optimal standards of cancer care, research should focus on identifying the factors that contribute to avoidable mortality and facilitate the implementation of strategies to benefit patients. We declare no competing interests. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort studyAmong patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. Full-Text PDF Cancer and COVID-19 – Authors' replyWe thank Dimitrios Moris and col­leagues and Alexandre Malek and colleagues for their insightful commentary about the CCC19 study findings.1 We value the opportunity to further characterise mortality outcomes beyond our initial report.1 Full-Text PDF Cancer and COVID-19Nicole Kuderer and colleagues1 identified several independent prognostic factors to be conferring an increased risk of 30-day all-cause mortality: increased age, male sex, being a former smoker, multiple medical comorbidities, high Eastern Cooperative Oncology Group performance status score (≥2), and an active cancer. However, haematological malignancies, instead of increasing 30-day all-cause mor­tality, were associated with severe clinical outcomes, intensive care unit admissions, and meeting composite severe illness endpoints. Full-Text PDF