Background Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. Patients and Methods In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and June 11, 2020. The primary endpoint was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary endpoints. Results From April 4 to June 11, 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18-2.52), ECOG PS ≥ 2 (OR 3.23, 95%CI: 2.27-4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01-1.16) and admission to ICU (OR 3.62, 95%CI 2.14-6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except cytotoxic chemotherapy in the subgroup of patients with detectable SARS-CoV-2 by RT-PCR, which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00-2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment interrupted or stopped following diagnosis of COVID-19. Conclusions Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis.

Our analysis suggests an added value of radiomics features as prognostic and predictive biomarker in HNSCC treated with CRT/BRT. Moreover, the radiomics signature provided additional information to HPV/p16 status to further stratify patients. External validation of such findings is mandatory given the risk of overfitting.

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Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic On January 30, 2020, the World Health Organization formally announced that the novel coronavirus disease (COVID-19) caused by SARS-CoV-2 is a worldwide health emergency. Subsequently, all National Health Systems and each medical center faced the exceptional emergency and severe changes in their organizations. Consequently, there were various implications that needed to be addressed for oncology patients. In this sense, there are some practical and important issues in the management of head and neck cancer patients: (i) they are usually older and usually present with medical comorbidities (e.g., COPD and other tobacco-related diseases) that are associated with a higher risk of severe complications associated with COVID-19; (ii) high risk of SARS-CoV-2 exposure (transportation, daily radiation fractions, multiple consultations with multidisciplinary team members); (iii) cancer treatment can potentially and theoretically increase the risk of more severe complications of COVID-19 [1]. Of interest, the main risk factors for head and neck squamous cell carcinoma (HNSCC), tobacco and alcohol, also increase the risk for COVID-19 infection. One Chinese study reported an increased risk of cancer-related deaths associated with notorious difficulties of access to oncologic care. In addition, a nationwide analysis in China indicated that the risk of severe respiratory complications leading to admission to the intensive care unit, invasive ventilation, or death was much higher in cancer patients than in patients without cancer (39% vs. 8%, p = 0.0003). Moreover, patients who underwent chemotherapy or surgery in the past month had a numerically higher risk of clinically severe events than did those not receiving chemotherapy or surgery, irrespective of age, smoking history or co-morbidity (odds ratio 5.34, p = 0.0026) [2-5]. The majority of hospitals will be treating thousands of COVID-19 patients in the next few weeks and thus, there is an urgent need to preserve patient and staff safety. For this reason, the Center for Diseases Control (CDC) in the United States recommends that healthcare facilities interrupt elective care and restrict their activities to providing urgent and emergency visits and procedures. It is recommended that all elective and non-time sensitive procedures and admissions must be rescheduled [6]. There is a critical need to share skills and expertise to propose recommendations for the diagnosis and treatment of HNSCC patients throughout the COVID-19 pandemic. As healthcare professionals and HNSCC experts, we aim to offer emergency guidelines aiming to reduce the risk of patient harm, by reducing their risk of exposure to SARS-CoV-2, without compromising their treatment and outcome. As a disclaimer, this is a general guideline and the following recommendations are suggested to help the multidisciplinary teams in the diagnosis and treatment of HNSCC patients, considering local constraints...

There is controversy regarding prognosis and treatment of young patients with oral cavity cancer compared to their older counterparts. We conducted a retrospective case-matched analysis of all adult patients younger than 40 years and treated at our institution for a squamous cell carcinoma of the oral cavity. Only non-metastatic adult patients (age >18) with oral tongue cancer were eventually included and matched 1:1 with patients over 40 years of age, at least 20 years older than the cases, with same T and N category and treatment period. Sixty-three patients younger than 40 had an oral cavity squamous cell cancer out of which 57 had an oral tongue primary during the period 1999-2012, and 50 could be matched with an older control. No difference could be seen between younger and older patients with regard to overall, cancer-specific, or progression-free survival. The patterns of failure were similar, although in young patients, almost all failures occurred during the first 2 years following treatment. Although overall survival shows a trend toward lower survival in older patients, cancer-specific survival and analysis of pattern failure suggest that disease prognosis is similar between young and older adults with oral tongue cancer. Further work is needed to identify the younger patients with poorer prognosis who overwhelmingly fail during the first year after treatment and could benefit from treatment intensification. Until then, young adults ought to be treated using standard guidelines.

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