Findings Support Screening of COVID-19 in Patients with Cancer

In a retrospective case study of coronavirus disease 2019 (COVID-19) in hospitals within Wuhan, China, which will appear in Annals of Oncology, researchers found that patients with cancer demonstrated deteriorating conditions and poor outcomes from the COVID-19 infection. 

Given these findings, it is recommended that patients with cancer receiving anti-tumor treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 co-infection. However, delaying anti-tumor treatments cannot be recommended according to the researchers.

“[Patients with cancer] should receive anti-tumor treatment in the setting of vigorous screening for COVID-19, including chest CT scan and nucleic acid testing, and the same should be extended to their companions. Treatment strategies likely to cause immunosuppression should be avoided or have dosages decreased, and patients who are generally in poor condition should not receive such treatments,” the authors wrote. “In addition, at least 7 days prior to anti-tumor treatment, [patients with cancer] should stay in the observation ward and in isolation from other patients. Stronger personal protection, including protection mechanisms for their families should be made for [patients with cancer].”

Clinical data was collected from medical records from January 13, 2020 to February 26, 2020, and univariate and multivariate analysis was performed to assess the risk factors associated with severe events defined as a condition requiring admission to an intensive care unit, the use of mechanical ventilation, or death. The study subjects included were patients with cancer who had laboratory confirmed COVID-19 from 3 designated hospitals in Wuhan, China. 

In this cohort of 28 patients with cancer infected with COVID-19, lung cancer was found to be the most frequent cancer type (n = 7; 25.0%) and 8 patients (28.6%) were suspected of contracting the disease from hospital-associated transmission. Clinical features that were found present in the cohort included:

• Fever (n = 23; 82.1%)

• Dry cough (n = 22; 81%)

• Dyspnea (n = 14; 50.0%)

• Lymphopenia (n = 23; 82.1%)

• High level of high-sensitivity C-reactive protein (n = 23; 82.1%)

• Anemia (n = 21; 75.0%)

• Hypoproteinemia (n = 25; 89.3%)

Common chest CT findings were ground-glass opacity (n = 21; 75.0%) and patchy consolidation (n = 13; 46.3%). Overall, 53.6% of the patients had severe events, 21.4% were admitted to the ICU, 35.7% had life-threatening complications, and mortality was 28.6%. Additionally, if the last anti-tumor treatment was within 14 days, it significantly increased the risk of patients developing severe events (HR, 4.079; 95% CI, 1.086-15.322; P = 0.037). Further, patchy consolidation on CT upon admission was correlated with a higher risk for developing severe events (HR, 5.438; 95% CI, 1.498-19.748; P = 0.010). 

Because Wuhan saw a dire shortage of medical resources trying to cope with the influx of patients in the early stages of the outbreak, some patients were not admitted to the hospital in time; hence, the researchers presume that delayed admission contributed in increased mortality. 

In the study cohort, 71.4% of the patients were prescribed at least 1 antiviral agent and about one-third of patients received more than 1 antiviral agent. However, there is no drug currently proven to be effective against COVID-19. Systemic steroids remain controversial in the treatment of viral pneumonia, though more than half of the patients in this study were treated with steroids and a significant reduction in the incidence of severe events did not occur. 

“The comparisons between cancer and non-cancer patients with COVID-19 infection could reveal more useful information, as would comparisons of less severe cases not included in our study population,” the authors wrote. “Thus, future studies with larger sample sizes and prospective study designs are warranted to further explore the risk factors and severe events in COVID-19-infected cancer patients.”

Reference:

Zhang L, Zhu F, Xie L, et al. Clinical characteristics of COVID-19-infected cancer patients: A retrospective case study in three hospitals within Wuhan, China. Annals of Oncology. doi:10.1016/j.annonc.2020.03.296.