The spread of novel betacoronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly escalated to a pandemic unseen for generations.1 With ramifications not before witnessed during peacetime, the medical community stands to face a very tough year.
Cancer patients represent a population at elevated risk for serious viral disease due to the immunosuppressive nature of both malignancy and anticancer treatments such as chemotherapy.2–4 Therefore, cancer patients may be at an increased risk of COVID-19 infection and henceforth face a poorer prognosis.
This week the Video Journal of Hematological Oncology (VJHemOnc) spoke to Professor David Marks, the Lead Clinician of the Bristol BMT Unit, University Hospitals Bristol, UK. Prof. Marks outlined his personal opinions regarding the COVID-19 outbreak, and how it may impact hematological cancer patients.
Talking on the risks to cancer patients posed by COVID-19, Prof. Marks said:
“All cancer patients appear to have a high risk of getting severe COVID-19, this means pneumonia and a higher chance of mortality.” He went onto say, “patients with the very highest risk are allograft patients who are close to transplant or are on immune suppression for graft-versus-host disease.”
A recent paper published in The Lancetinvestigated a cohort of 1590 COVID-19 cases in China. 1.1% of patients in this cohort were reported to have had a history of cancer; a rate higher than the incidence of cancer in the overall Chinese population, which is 285.83 [0·29%] per 100,000 people, according to 2015 cancer epidemiology statistics.5, 6
Cancer patients were found to have a higher incidence of severe events – defined as admission to ICU requiring invasive ventilation, or death – when compared with non-cancer patients (seven [39%] of 18 patients vs 124 [8%] of 1572 patients; Fisher’s exact p=0·0003).5
Additionally, cancer patients who have undergone chemotherapy or surgery in the past month had a 33% higher rate of serious events (three [75%] of four patients) compared to those not receiving such treatments (six [43%] of 14 patients).5
With cancer history representing the highest risk of severe events in those infected with COVID-19, physicians need mitigation strategies.5 Prof. Marks also gave us an update on the advice he is giving to his hematological oncology patients:
“The goal of these patients must be to avoid getting the virus. Reducing the number of visits to hospital is a goal, and many will have telephone consultations or less essential therapy postponed. I am advising my patients to wash their hands ten times a day, especially before they eat.”
The aforementioned paper suggests an intentional delay in adjuvant chemotherapy or elective surgery for stable cancer in endemic areas. Further to this, the researchers also propose stronger personal protection provisions for cancer patients and survivors as well as the intensification of surveillance or treatment measures for cancer patients infected with COVID-19. This advice is especially pertinent for elderly patients and those with other comorbidities.5
Prof. Marks discussed the use of personal protective equipment (PPE) amongst UK health care workers commenting that “A recent change in the national recommendations was that for patients being assessed for possible COVID-19, staff are not required to wear full PPE and that plastic aprons, surgical masks and gloves were sufficient.
This is a concern to many of us as increasingly, a high percentage of patients who are being assessed will have COVID-19 and could infect staff. The workforce is expected to be depleted significantly over the next few weeks.”
Additionally, the specific pressures COVID-19 infection places on the vulnerable may present further challenges to the NHS, as if the number of cases continues to grow “we expect there will be insufficient ICU beds and insufficient ventilators to meet the needs of the UK population. All efforts are being made to expand the number of ventilators, but it is clear some difficult decisions will need to be made.”
While this pandemic is likely to rapidly proliferate over the coming months, the science is also rapidly growing to meet the current unmet need; trialing vaccines and other drug options such as HIV agents in combination and chloroquine and remdesivir. However, if vaccination if found to be safe and efficacious “realistically, there will be no usable vaccine for 12 to 18 months.” said Prof. Marks.
Written by Thomas Southgate
Please be advised that the content found on this page is not comprised of the current clinical or governmental advice on the COVID-19 outbreak
Chen 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. TheLancet. 2020 Jan; 395(10223):507–513.
Reusser P. Management of viral infections in immunocompromised cancer patients. Swiss Medical Weekly. 2002;132:374–378.
Sica A, Massarotti M. Myeloid suppressor cells in cancer and autoimmunity. J Autoimmun. 2017 Dec;85:117–125.
Komada Y, Zhang SL, Zhou YW et al. Cellular immunosuppression in children with acute lymphoblastic leukemia: Effect of consolidation chemotherapy. Cancer Immunology. 1992;35:271–276.
Guan w, Chen R, Wang W, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China Wenhua Liang. The Lancet. 2020 Feb;20(2)335–337.
Zheng RS, Sun KX, Zhang SW et al. Report of cancer epidemiology in China, 2015. ZhonghuaZhong Liu Za Zhi. 2019 Jan;41(1):19–28
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