COVID-19 and Lung Cancer: A Comprehensive Overview from Outbreak to Recovery

Abstract

Lung cancer patients have been associated with an increased risk of COVID-19 infection, pulmonary complications, and worse survival outcomes compared to the general population. The world’s leading professional organizations provided new recommendations for the diagnosis, treatment, and follow-up of lung cancer patients during the pandemic as a guide for prioritizing cancer care issues. Telemedicine was preferred for non-urgent consultations, and screening programs were temporarily suspended, leading to possible diagnostic delays along with an estimated increase in cause-specific mortality. A vaccine campaign has recently emerged as the main weapon to fight the COVID-19 pandemic, inverting this negative trend. This work aims to provide a comprehensive overview of the epidemiology and immune-pathophysiology of SARS-CoV-2 infection in cancer patients, highlighting the most relevant changes in the clinical management of lung cancer patients during the pandemic.

Outcomes of Thoracoscopic Lobectomy after Recent COVID-19 Infection

“…It is fair to ask if COVID-19 is a risk factor for complications after VATS lobectomy, given that some patients, after the infection, present alterations in the pulmonary tissue, such as fibrosis and mediastinal lymphadenopathy, that may complicate the surgical dissection. In addition to that, long-term effects of COVID-19 infection, known as Long COVID [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], include the persistence of respiratory symptoms after COVID-19 infection.…”

Prospective Observational Study of COVID-19 Vaccination in Patients with Thoracic Malignancies: Adverse Events, Breakthrough Infections and Survival Outcomes

“…Still, a meta-analysis of 52 studies early on in the pandemic revealed a devastating 25% case fatality rate of cancer patients in case of COVID-19 infection [ 19 ]. The most endangered population was patients with hematological malignancies, but it seems that close behind, patients with thoracic malignancies had one of the highest rates of mortality [ 9 ]. Patients with thoracic malignancies suffered from a longer and more severe course of COVID-19 because of their underlying illness, COPD and smoking damage to the lungs, resulting in 62–76% of hospitalizations and 25–33% of deaths directly attributed to COVID-19 [ 8 , 10 , 20 , 21 ].…”

“…Prior COVID-19 infection was not an exclusion factor but was documented and reported, as well as all of the cases of breakthrough COVID-19 infections, with date and severity, according to WHO and NIH guidelines [ 9 ]. Breakthrough infections were considered as: mild (symptoms of acute upper respiratory tract infection without pneumonia), moderate (radiological evidence of pneumonia), severe (pneumonia with dyspnea and hypoxemia) and critical (pneumonia with acute respiratory distress syndrome, respiratory failure, shock and multiple organ dysfunction) [ 9 ]. In case of severe distress (clinical signs of pneumonia—fever, cough, dyspnoea, plus one of the following: respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 < 90% on room air) patients were hospitalized and treated accordingly.…”

“…Since vaccine production could not meet high demand, some priority groups were set to receive vaccination amongst the first, and cancer patients were definitely one of them [ 8 ]. Patients with thoracic malignancies had an increased risk of COVID-19 infection, morbidity and mortality due to their underlying disease, smoking status, pulmonary damage, immunocompromised state and cancer treatment [ 9 ]. Initial reports have revealed that as much as 60–75% of SARS-CoV-2 infected patients with thoracic malignancies needed hospitalization due to severe COVID-19 disease course, were less likely to receive intensive care unit treatment if needed and that the infection resulted in a devastating 25–33% mortality [ 8 , 10 ].…”

An Examination of US COVID-19 Vaccine Distribution in New Jersey, Pennsylvania, and New York

“…As of August 2022, we identified over 17 articles on COVID vaccine hesitancy including a wide range of example groups such as health care workers [ 31 ], those with a disease [ 32 ], older populations [ 33 ], children [ 34 ] as well as groups historically affected by structural racism where COVID only made inequalities worse including poorer health outcomes [ 35 ]. Yet in all of these articles, few recommendations beyond improving outreach methods were given.…”