How COVID-19 Affects Patients with Cancer

As the new coronavirus, called COVID-19, continues to spread across the world, it has many experts trying to determine how it affects patients with cancer.

From what is currently known, patients with the disease are a highly vulnerable group. However, just how vulnerable remains to be unknown. Researchers from China conducted a small study using data from 28 patients who were infected with COVID-19 and being treated at three different hospitals in Wuhan, China, from Jan. 13, 2020, to Feb. 26, 2020.

“There is an urgent need to answer the following questions, including whether COVID-19-infected cancer patients will have distinct clinical courses and worse outcomes, such as death from the infection or severe pneumonia, and whether cancer patients should receive

anti-tumor treatments as usual in epidemic areas,” the researchers wrote.

They examined risk factors that are associated with severe events, which they defined as a condition requiring admission to an intensive care unit (ICU), the use of mechanical ventilation or death.

The patient population consisted of mostly men (60.7%) who were a median age of 65 years old. Lung cancer was the most frequently seen diagnosis in 25% of patients, followed by esophageal (14.3%) and breast (10.7%) cancer, and 35.7% of patients had stage 4 disease. In addition, 39.2% of patients had at least one or more coexisting chronic diseases.

The researchers learned that eight patients (28.6%) developed COVID-19 while undergoing therapy in the hospital and 20 (71.4%) contracted the virus from their communities — most (67.9%) were from Hankou, the starting point of the outbreak. Within two weeks of a COVID-19 diagnosis, 21.4% of patients received at least one type of cancer treatment, such as chemotherapy (10.7%), targeted therapy (7.1%), radiotherapy (3.6%) or immunotherapy (3.6%), and one patient received combination chemotherapy and immunotherapy.

Upon admission, more than 80% of patients experienced fever, dry cough, abnormally low levels of lymphocytes in the blood and high levels of high-sensitivity C-reactive protein, which measures levels of inflammation in the body. Nearly 90% of patients showed hypoproteinemia, a condition where there is an abnormally low level of protein in the blood. Three quarters of the population had trouble breathing and half showed signs of anemia.

The researchers discovered that patients with cancer showed deteriorating conditions and poor outcomes from COVID-19. More than half (53.6%) developed severe events, 21.4% were admitted to ICU, 35.7% had life-threatening complications and 28.6% of the patients died.

“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,” the researchers wrote. “It was found that within 14 days, anti-tumor therapies were significantly associated with occurrence of severe clinical events in COVID-19 infection.”

However, the researchers noted, increased rate of death could be attributed to delayed hospital admission and a shortage of medical resources at the start of the coronavirus outbreak.

They recommended the following for patients with cancer who are undergoing therapy: vigorous screening for COVID-19 infection, avoiding treatments that cause immunosuppression or having dosages decreased in case of COVID-19 co-infection.