Cancer and COVID-19 Patients
CDC Guidance for people at higher risk of serious illness
Takeaways of the cancer discussion
* Most common cancers among patients are lung (20.95%), git (12.38%), breast (10.48%), thyroid (10.48%), and hematological (8.57%).
* Worst outcomes were for the lung cancers (33.33% CFR) and the hematological cancers (18.18% CFR.)
* Incidence of COVID-19 in cancer patients is high 0.79% vs 0.37% COVID-19 rate.
* Prevalence of cancer in COVID-19 patients is 2%. Prevalence of cancer in general population is 0.29%.
* Hematological cancer patients had a case rate of 10% for COVID-19 compared to less than 1% case rate in non-hematological cancer patients.
* Hematological cancers have 37% CFR vs. 25% CFR in patients with solid tumors.
* Immune system cancer patients did not have increased risk of getting CVOID-19 compared to other hematological cancer patients.
* Cancer patients have weak immune systems.
* Cancer patients with recent (within the last month) procedures/chemo have a higher risk of COVID-19 complications.
* Prevention should be aggressive.
* Elective procedures should be delayed if possible.
* Treatment should be intense and early for cancer patients.
* ICU admission increases the risk of contracting COVID-19
Liang et., al
Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China
Highlights:
1. 2007 cases from 575 hospitals
2. Cancer patients have a higher risk of developing COVID-19 compared to other individuals.
3. Patients with cancer had poorer outcomes compared to non-cancer patients of COVID-19
4. More patients with SARS-COV-2 get multiorgan organ failure compared to SARS-COV and MERS-COV
5. Caners patients are at a higher risk of getting infections because of the weak immune system due to the cancers and the cancer treatment.
6. 1% of the COVID-19 patients in this study had cancer. This is higher than 0.29% of the cancer patients in general population. 3x higher prevalence.
7. 28% had lung cancers. The highest cancer type with COVID-19.
8. 25% of the cancer and COVID-19 had received chemotherapy or surgery within the last one month.
9. Patients with lung cancer did not have a higher probability of severe events compared to other cancers (see below for the definition of the severe event.)
10. 25% were cancer survivors.
11. Cancer patients deteriorated more rapidly than non-cancer COVID-19 patients.
Compared to patients without cancers
1. Cancer patients were older mean age 63.1 y, vs. 48.7 y.
2. More likely to have a h/o smoking 22% vs 7%
3. Had more severe baseline CT manifestations. 94% vs 71%
4. No difference in sex, other baseline symptoms, or other comorbidities.
5. Patients with cancer had a higher risk of severe events e.g. invasive ventilation need, or death. 39% vs 8%
Cancer patients with chemo or surgery within the last one month vs no such procedure
1. Higher risk of severe event 75% compared to 43%
Suggestions
1. If possible postpone elective surgeries and chemotherapy (stable cancer.)
2. Stronger personal protection measures are needed in the cancer patients.
3. More intense surveillance and treatment needed in the cancer patients with covid-19.
Dai et., al
Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak
Highlights:
1. 105 cancer patients with COVID-19 were enrolled. Control group was 536 non-cancer COVID-19 patients
2. 11.43% death rate in patients with cancer compared to 3.8% in patients without cancer.
3. Death rate:
1. Hematological cancers: 33.33%
2. Lung cancers: 18.18%
3. Patients with metastatic cancers had high risk of death: 95%
He et., al
COVID-19 in persons with haematological cancers
1. 128 hospitalized cancer patients and 226 healthcare workers.
2. 10% of the cancer patients developed COVID-19
3. 7% of the healthcare workers developed COVID-19
4. Patients with hematological cancers had a CFR of 62% compared to 0 in the healthcare workers that had COVID-19.
5. Hematological cancer patients had a case rate of 10% for COVID-19 compared to less than 1% case rate in non-hematological cancer patients.
6. Hematological cancers have 37% CFR vs. 25% CFR in patients with solid tumors.
7. Immune system cancer patients did not have increased risk of
American Society of Clinical Oncology
COVID-19 Increases Overall Risk of Death, Complications in Patients With Cancer, Study Shows
(They refer Dai et., al study noted above.)
