Researchers from Zhongnan Hospital of Wuhan University (Hubei, China) have investigated the incidence and outcomes of COVID-19, a syndrome caused by the novel coronavirus SARS-CoV-2, in cancer patients from a single institution. They have also suggested factors that put cancer patients at a higher risk of developing the virus.
A Research Letter, recently published in JAMA Oncology, discusses the findings that highlight the importance of how cancer is managed during the COVID-19 pandemic to reduce the number of patients with cancer developing the viral infection. Read more about the considerations when making cancer treatment decisions during the COVID-19 pandemic here.
In December 2019, Wuhan had it’s first patients diagnosed with COVID-19. Since then, the SARS-CoV-2 infection has spread rapidly at a global scale via droplet contamination.
A previous study carried out at Zhongnan Hospital of Wuhan University, implicated that hospital-acquired transmission accounted for almost half of the cases at this institution. The authors’ note that in the latest study, patients with cancer could be more susceptible to being infected by SARS-CoV-2 due to factors including immunosuppressive treatment, comorbidities and return visits to the hospital.
The researchers reported the incidence of SARS-CoV-2 infection in 1524 patients admitted to the Department of Radiation and Medical Oncology at Zhongnan Hospital of Wuhan University, over the time period 30 December 2019 – 17 February 2020.
It was discovered that 12 patients had developed COVID-19 (0.79%). This is a higher incidence than the incidence of all COVID-19 cases reported in the same time period in Wuhan, 41,152 of 11,081,000 cases (0.37%).
The study also looked at factors contributing to an increased risk of developing COVID-19 as a cancer patient. The median age of infected patients was 66 years (ranging between 48–78). Eight out of 12 (66.7%) COVID-19 patients were older than 60 years of age.
Of the total 1524 patients with cancer, 228 had non-small-cell lung cancer (NSCLC). Importantly, seven out of the 12 cancer patients (58.3%) that were infected with SARS-CoV-2 had NSCLC, and five patients (41.7%) were being treated either with chemotherapy alone or combined with immunotherapy or radiotherapy.
By 17 February 2020, three patients had developed SARS and one patient required intensive-level care. The researchers completed follow-up and as of 10 March 2020, 6 patients (50%) had been discharged and three deaths (25%) were recorded.
It is also important to note that less than half of COVID-19-positive patients were undergoing active treatment for their cancer, suggesting this does not have as bigger impact on virus development as previously thought.
The authors concluded that patients with NSCLC older than the age of 60, had a higher risk of developing COVID-19 in comparison with patients younger than 60. Overall, patients with cancer were demonstrated to have a higher risk of SARS-CoV-2 infection compared to the population.
Based on these findings, alongside other findings related to hospital transmission of COVID-19, the authors propose that “aggressive measures should be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward. For patients who require treatment, proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection”.
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Source: Yu J, Ouyang Wen, Chua M et al. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. doi:10.1001/jamaoncol.2020.0980 (2020) (Epub ahead of print).