COVID-19 Infection Risk in Patients With History of Cancer

During the past several months the novel coronavirus (COVID-19) has taken the world by storm.

According to the John Hopkins COVID-19 Map there are currently 1,447,466 confirmed cases and 83,471 deaths worldwide; with a mortality rate of 5.77%. Although many individuals will recover from this infection there are several populations of concern. Many of these populations are elderly patients, as well as patients with underlying conditions such as asthma/COPD, cancer, diabetes and heart disease. A similarity that many of these groups have in common is a weakened immune system. This respiratory infection overwhelms the bodies ability to respond to pathogens and predisposes patients to acquire other respiratory infections such as pneumonia.

Due to the characteristics of this infection, an issue surfaces when faced with starting or continuing patients on chemotherapy. Essentially, chemotherapy affects both healthy and cancerous cells, weakening the immune system and subjecting patients to the risk of acquiring infections they wouldn’t normally obtain. The conundrum here is starting/continuing elective chemotherapy or surgeries with the possibility of other infections taking advantage of an already weakened immune system that is not only trying to recover from chemotherapy, but also COVID-19.

In the absence of a pandemic such as this, patients are instructed to avoid contact with anyone with a spreadable infection, including those with even the common cold. Protective measures (masks) are advised when going out in highly populated areas and proper hygiene is recommended (washing hands). At this time these infection prophylactic procedures cannot be stressed enough and self-quarantining is highly recommended.

Data for the COVID-19 infection rate in patients with cancer or a history of cancer is currently limited. However, preliminary findings have shown an association between severe events from COVID-19 in cancer patients versus non-cancer patients. This data comes from a Chinese study done by the National Clinical Research Center for Respiratory Disease in accordance with the National Health Commission of the People’s Republic of China. In this study they analyzed data from 575 hospitals in 31 different provinces of China. Patients were analyzed if they were diagnosed with COVID-19 and hospitalized. From the 1,590 patients included for analyses, 18 had a history of cancer (1%; 95% CI 0·61–1·65); 7 of the 18 patients had severe events during their course of treatment for COVID-19 (39%), compared with 124 of the 1,572 patients with no history of cancer (8%).

Additional data can be found in the Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). This report was done to help guide what may be done next in areas not yet affected by the virus. It is reported that cancer patients with a confirmed COVID-19 diagnosis had a 7.6% mortality rate. This is approximately 2% higher than the current overall COVID-19 global mortality rate using the John Hopkins COVID-19 Map.

Information is still being collected on this subject matter as the infection continues to spread throughout the world. The American Society for Clinical Oncology is advising patients to continue to practice social distancing, proper hygiene and recommending practitioners to suspend any elective/nonessential surgeries.

Peter Austin

Fairleigh Dickinson University School of Pharmacy & Health Sciences PharmD. Candidate

References:

1. John Hopkins University. Coronavirus COVID-19 Global Cases by John Hopkins CSSE. Available at: https://coronavirus.jhu.edu/map.html. Access on April 8, 2020.
2. Liang W., Guan W., Chen R., et. al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncology. 2020;21(3):335–337.
3. American Society of Clinical Oncology. COVID-19 Patient Care Information. Available at: https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19. Accessed on April 8, 2020.
4. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available at: https://www.who.int/publications-detail/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(COVID-19). Accessed on April 8, 2020.
5. Foy M., ASCO’s Response to the COVID-19 Pandemic Focused on Cancer Care. American Society of Clinical Oncology Daily News. 2020. https://dailynews.ascopubs.org/do/10.5555/ADN.20.200081/full/