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03-04-2020 | Oncology | News | Article

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Early data point to predictors of severe COVID-19 in cancer patients

Author: Shreeya Nanda

medwireNews: An analysis of cancer patients with comorbid COVID-19 in Wuhan, China, has identified factors associated with an increased risk for a more severe clinical course.

The researchers report a significant correlation between severe clinical events and receipt of anticancer therapy in the 14 days prior to the COVID-19 diagnosis, with patchy consolidation on computed tomography (CT) at admission the other significant factor.

They drew on the records of three designated COVID-19 hospitals in Wuhan to identify 1276 patients with a laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 13 January and 26 February 2020. Of these, 28 patients had a prior diagnosis of solid cancer, giving a prevalence of SARS-CoV-2 of 2.2%.

Lung cancer was the most common tumor type in these patients, at 25.0%, followed by esophageal (14.3%) and breast (10.7%) cancer. The majority (71.4%) acquired SARS-CoV-2 in the community, with the remaining 28.6% acquiring the infection while undergoing anticancer treatment in hospitals. Just under a quarter (21.4%) had received anticancer treatment in the 14 days prior to the diagnosis of COVID-19.

In all, 53.6% of patients developed severe clinical events, defined in the study as admission to an intensive care unit, use of mechanical ventilations, or death.

Multivariate analysis adjusting for age and sex showed that receipt of anticancer therapy within 14 days was associated with a significant 4.079-fold increase in the risk for severe clinical events, while patchy consolidation on CT at presentation was associated with a 5.438 times increase in risk.

At data cutoff, 35.7% of patients had been discharged, the same proportion remained in hospital, and 28.6% of patients had died, report Min Zhou, from Tongji Hospital in Wuhan, and co-workers in the Annals of Oncology.

They highlight the much lower rates of critical COVID-19 cases and mortality in the general population, at 4.7% and 2.3%, respectively, noting that: “Patients with cancer are particularly susceptible to respiratory pathogens and severe pneumonia, because they are at an immunosuppressive state due to malignancy and anti-tumour therapy.”

Zhou et al stress, however, that despite their findings “delaying anti-tumour treatment cannot be recommended as a reasonable choice to reduce the infection risk in the ongoing pandemic.”

They instead recommend that “cancer patients receiving anti-tumour 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 team continues: “In addition, at least 7 days prior to anti-tumour treatment, cancer patients should stay in the observation ward and in isolation from other patients. Stronger personal protection, including protection mechanisms for their families should be made for cancer patients.”

The author of a linked editorial comments that “[w]hile these sobering numbers are cause for serious concern for cancer patients, caution is needed in the interpretation of these findings: this series of patients is small, and the data collected retrospectively.”

William Oh (Icahn School of Medicine at Mount Sinai, New York, USA) also points out that “extrapolation to other countries may be problematic” for various reasons, such as the differences in prevalence of tumor types in China and Western countries and the fact that most standard anticancer therapies are administered in outpatient settings in the USA and other countries.

He nonetheless concedes that these data represent “an important preliminary contribution to our understanding of the risk and effects of COVID-19 infection in cancer patients, and may allow oncologists to tailor clinical management of COVID-19 to our patients.”

Oh adds: “At the very least, cancer patients must practice social distancing or isolation and be candidates for early and rapid evaluation for symptoms suspicious for COVID-19, including testing for virus and chest radiography.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

3 April 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Ann Oncol 2020; doi:10.1016/j.annonc.2020.03.296
Ann Oncol 2020; doi:10.1016/j.annonc.2020.03.297

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