A global effort to understand the riddles of COVID-19 and cancer

Abstract

A global effort to understand the riddles of COVID-19 and cancer Cancer has found a formidable foil in COVID-19, and this has brought to the fore the early concerns that COVID-19 could have a deeper impact on oncology patients. Two studies now provide insights into the enigma surrounding the determinants of the worsening of COVID-19 symptoms in patients with cancer. Vivek Subbiah S evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease 2019 (COVID-19) have brought an unprecedented level of disruption globally. Every oncology stakeholder, especially patients, families and clinicians, face reconciling the particular challenges brought on by the intersection of these two life-threatening diseases. Two studies in Nature Cancer, by Albiges et al. 1 and Rugge et al. 2 , provide key insights into the determinants of the outcome of severe COVID-19 in patients with cancer. The understanding of COVID-19 relies heavily on the timely dissemination of knowledge arising from the most impacted areas. Initially faced with the critical need for guidelines on the delivery of cancer care in the context of COVID-19, expert panels from oncology societies and health ministries examined emerging data from Asia to issue recommendations and enable oncologists and patients navigate the pandemic while balancing the risks and benefits of specific cancer-directed care 3-5. The prevailing concerns for oncologists and patients with cancer alike center on cancer diagnostics, as well as cancer-specific clinical and treatment characteristics, and the risk of negative outcomes concurrent with COVID-19. The earliest studies of this topic demonstrated conflicting findings. Specifically, one early report from New York City analyzed a cohort of 5,688 patients with COVID-19, of whom 334 (6%) also had cancer. Although a higher frequency of endotracheal intubation was noted among those with cancer (relative risk = 1.89; 95% confidence interval (CI) =1.37-2.61) without stratification by age, this series did not find a significant difference between the patients with cancer and those without cancer, in their mortality 6. In contrast, another multi-center study of 14 hospitals in the Hubei province of China enrolled 641 patients with COVID-19 (105 with cancer

Continuing Cancer Therapy through the Pandemic While Protecting Our Patients: Results of the Implementation of Preventive Strategies in a Referral Oncology Unit

“…Despite the small number of patients diagnosed with COVID-19, the outcome indicates a significant risk for cancer patients of developing complications and dying, in line with other studies that have indicated their vulnerability to COVID-19 [ 25 , 26 , 27 ] and possible adverse prognostic factors [ 25 , 28 ]. Patients in impaired clinical condition at the time of infection had worse outcomes, in accordance with previous data [ 29 ]. Most patients with SARS-CoV-2 infection at our site, and half of the symptomatic patients requiring hospitalization, had been diagnosed with plasma cell dyscrasias, although they accounted for only one of five recorded deaths.…”

COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials

“…Patients participating in clinical trials often have progressive advanced-stage cancer, are undergoing active treatment and usually make several visits to clinics and hospitals for study-related procedures, which potentially increases their exposure to SARS-CoV-2 infection at multiple points. Thus, prioritization for vaccination is imperative, particularly considering that patients with cancer also seem to have an increased risk of severe COVID-19 and complications and mortality from the disease [7][8][9][10][11][12][13][14] . Due consideration should also be given to other well-recognized risk factors for severe COVID-19, such as advanced age (≥65 years), comorbidities (for example, chronic pulmonary, cardiovascular or renal disease) and other sociodemographic factors (such as overcrowded housing, single-parent households and ethnicity) 29 , when prioritizing patients with cancer for vaccination, with priority given to those at most risk.…”

“…Multiple studies have revealed that patients with cancer have an increased risk of complications and mortality from COVID-19, including 30-day mortality of 30% in hospitalized patients with COVID-19 and cancer compared with 21% in those without cancer [7][8][9][10][11][12][13][14] . Given the greater severity of the disease and higher risk of death, patients with cancer are considered a high-priority subgroup for COVID-19 vaccination.…”

Assessing the Country-Level Excess All-Cause Mortality and the Impacts of Air Pollution and Human Activity during the COVID-19 Epidemic

“…The inconsistency between all-cause and COVID-19 mortality can be explained by the potential impact of COVID-19. For instance, studies have reported an increased risk of death in hospitalized COVID-19 patients with cancers, fever, or acute respiratory distress syndrome [ 36 , 37 , 38 , 39 ].…”