Risk for COVID-19 may be higher among those with cancer, Wuhan data suggest
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Risk for infection with SARS-CoV-2 — the novel coronavirus that causes COVID-19 — appeared more than twice as high among individuals with cancer than the general population, according to an analysis of data from a tertiary care hospital in Wuhan, China.
“We propose that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward,” Jing Yu, MD, of the department of radiation and medical oncology at Zhongnan Hospital of Wuhan University, and colleagues wrote in a research letter published in JAMA Oncology. “For patients who require treatment, proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection.”
The COVID-19 outbreak began in Wuhan in December, and a report based on 138 patients with the virus at Zhongnan Hospital of Wuhan University suggested hospital-acquired transmission accounted for 41.3% of admitted patients.
Because patients with cancer often undergo treatment or monitoring in a hospital setting — and because of the immunosuppressive nature of chemotherapy, radiotherapy and other cancer treatments — Yu and colleagues assessed the incidence and outcomes of SARS-CoV-2 infection among individuals with cancer treated at their tertiary cancer institution.
Investigators reviewed medical records of 1,524 patients with cancer admitted to the department of radiation and medical oncology from Dec. 30 through Feb. 17.
Researchers determined 12 of those patients contracted the infection, equating to an estimated infection rate of 0.79% (95% CI, 0.3-1.2). This was more than double the estimated 0.37% cumulative incidence in Wuhan over the same period (OR = 2.31; 95% CI, 1.89-3.02).
Seven of the 12 individuals with cancer who contracted the infection had non-small cell lung cancer; there was one case each of rectal, colon, pancreatic, breast and urothelial cancers.
Five of the patients were undergoing active treatment for cancer. Three were receiving chemotherapy with or without immunotherapy, and two were being treated with radiotherapy.
Median age of those with cancer and the virus was 66 years (range, 48-78), and eight were aged older than 60 years.
As of March 10, three of the 12 patients with cancer and the virus had died and six had been discharged.
Yu and colleagues also assessed the link between SARS-CoV-2 infection and age and concurrent NSCLC diagnosis.
They determined 228 of the 1,524 individuals with cancer who were screened had NSCLC. Of these, 48.7% were aged 60 years or younger and 51.3% were aged older than 60 years. Incidence of COVID-19 in the NSCLC subgroup appeared higher among patients aged older than 60 years compared with those aged 60 years or younger (4.3% vs. 1.8%).
“It is hypothesized that patients with cancer may be susceptible to an infection during a viral epidemic owing to their immunocompromised status,” Yu and colleagues wrote. “This study highlights the following observations: Patients with cancer from the epicenter of a viral epidemic harbored a higher risk [for] SARS-CoV-2 infection ... compared with the community. However, fewer than half of these infected patients were undergoing active treatment for their cancers.
“Next, we observed that older patients (> 60 years) and patients with NSCLC may be at risk [for] COVID-19,” the researchers added. “Nonetheless, a population study of 1,099 patients with COVID-19 did not indicate that age was associated with susceptibility to infection. A larger sample size in patients with cancer will resolve these potential associations.” – by Mark Leiser
Disclosures: The authors report no relevant financial disclosures.
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Alexander Kutikov, MD, FACS
This report was preceded by an earlier report by Liang and colleagues that encompassed a larger cohort. In that report, data were collated throughout China — not just Wuhan province. These suggest that patients with active cancer or those with a history of cancer harbor a higher risk for getting seriously ill from or dying of SARS–CoV-2 infection (HR = 3.56).
Yet, these reports clearly are extremely preliminary. Patients with cancer generally are more likely to be older and to have other comorbidities that may predispose them to the risk for severe COVID-19 syndrome.
Nevertheless, modern oncologic care must adjust to the new reality of the COVID-19 era. Especially in the early stages of the pandemic, oncologists must carefully balance risks of cancer treatment delay vs. SARS–CoV-2 exposure or morbidity. They also must consider the impact of social distancing disruption, and be responsible in appropriately allocating health care resources during this extremely challenging time.
As the authors of the JAMA Oncology research letter suggest, care intensity — especially for indolent cancers that don’t pose an immediate risk or for those patients on posttreatment surveillance — must be calibrated extremely thoughtfully.
Reference:
Liang W, et al. Lancet Oncol. 2020;doi:10.1001/jamaoncol.2020.0980.
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