Risk of COVID-19 for patients with cancer
Authors: Hanping Wang, Li Zhang
Journal: The Lancet Oncology (2020)

The outbreak of coronavirus disease 2019 (COVID-19) is of international concern. We appreciated the Comment from Wenhua Liang and colleagues1Liang W Guan W Chen R et al.Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.Lancet Oncol. 2020; (published online Feb 14.)http://dx.doi.org/10.1016/S1470-2045(20)30096-6Summary Full Text Full Text PDF PubMed Scopus (3273) Google Scholar published in The Lancet Oncology on Feb 14, 2020, which, to the best of our knowledge, was the first to focus on COVID-19 infection in patients with cancer. The authors concluded by use of epidemiological statistics that because the proportion of patients with cancer histories was higher in a cohort with COVID-19 than in the population in China, patients with cancer were more likely to develop COVID-19. They found 18 COVID-19 patients with cancer histories among 1590 COVID-19 patients from 575 hospitals in 31 provincial regions. Of these 16 patients (two of the 18 patients had unknown treatment status), only four had undergone surgery or chemotherapy within the previous month; 12 had recovered from initial cancer treatments (eg, surgery or chemotherapy) and had no obvious immunosuppression. We therefore do not think the COVID-19 infections in the 12 survivors of previous cancers were associated with their cancers. COVID-19 is a highly contagious infection to which everyone, to our knowledge, is susceptible; the most important morbidity factor is exposure to an infection source.2Chen N Zhou M Dong X et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.Lancet. 2020; 395: 507-513Summary Full Text Full Text PDF PubMed Scopus (14363) Google Scholar Furthermore, although the authors indicate that patients with cancer had worse outcomes from COVID-19, they also reported the median age of these patients (63·1 years) to be significantly higher than for those without cancer (48·7 years), suggesting that older age is associated with worse COVID-19 outcomes.3Wang D Hu B Hu C et al.Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.JAMA. 2020; (published online Feb 7.)DOI:10.1001/jama.2020.1585Crossref Scopus (16201) Google Scholar In this COVID-19 outbreak, the major risk for patients with cancer is the inability to receive necessary medical services (both in terms of getting to hospital and provision of normal medical care once there) because of the outbreak. Since January, 2020, more than 30 000 medical workers have gone to Wuhan to help manage patients, prevent the spread of COVID-19, and contain the outbreak, which has affected medical services outside Wuhan because there are now fewer doctors in those regions. Patients are also advised not to visit hospitals because of infection risk. Consequently, some clinical trials are being delayed; enforced quarantine, as is widely the case in Wuhan, complicates hospital attendance for repeat appointments and continuity in care, and when severe complications or emergencies occur in patients with advanced cancers, treatment delays or unavailability are possible concerns. Adverse effects among patients who receive immune checkpoint inhibitors (such as for severe myocarditis and pneumonitis)4Wang Y Zhou S Yang F et al.Treatment-related adverse events of PD-1 and PD-L1 inhibitors in clinical trials: a systematic review and meta-analysis.JAMA Oncol. 2019; 5: 1008-1019Crossref PubMed Scopus (512) Google Scholar are more challenging to diagnose and might not be treated promptly, which might affect their survival. During this epidemic, in addition to better protection, patients with cancer need online medical counselling and appropriate identification and treatment of critical cases. In endemic areas outside Wuhan, decisions on whether or not to postpone cancer treatment need to made on a patient-by-patient basis and according to the risk to the patient and the prevailing situation because delays could lead to tumour progression and ultimately poorer outcomes. We declare no competing interests. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in ChinaChina and the rest of the world are experiencing an outbreak of a novel betacoronavirus known as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2).1 By Feb 12, 2020, the rapid spread of the virus had caused 42 747 cases and 1017 deaths in China and cases have been reported in 25 countries, including the USA, Japan, and Spain. WHO has declared 2019 novel coronavirus disease (COVID-19), caused by SARS-CoV-2, a public health emergency of international concern. In contrast to severe acute respiratory system coronavirus and Middle East respiratory syndrome coronavirus, more deaths from COVID-19 have been caused by multiple organ dysfunction syndrome rather than respiratory failure,2 which might be attributable to the widespread distribution of angiotensin converting enzyme 2—the functional receptor for SARS-CoV-2—in multiple organs. Full-Text PDF