COVID-19 May Force Some Cancer Patients to Delay Treatment
Early findings involving cancer patients from Wuhan, China -- the original epicenter of the COVID-19 pandemic -- suggest that many contracted the coronavirus while undergoing treatment in the hospital.
That could mean that this vulnerable population might need to discuss delaying cancer care to help minimize their odds of infection, the study authors said.
"We propose that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward," wrote a team led by Dr. Conghua Xie, of the department of radiation and medical oncology at Zhongnan Hospital of Wuhan University.
The research, which focused on 12 cancer patients treated at the hospital in January and February, was published March 25 in the journal JAMA Oncology.
It's long been understood that cancer, as well as its therapies, have the unfortunate side effect of weakening a patient's immune system. That can leave a patient more vulnerable to infectious illness, including COVID-19.
In the new study, Xie's team tracked infection incidence among more than 1,500 patients with cancer admitted to Zhongnan Hospital.
Twelve of those patients were later diagnosed with COVID-19, and the infection rate of the cancer patients was more than double that of the general population of Wuhan.
That's probably because people with cancer are often "immunocompromised," Xie's group wrote, and many may contract the new coronavirus during visits to the hospital for cancer care.
As seen in the general population, the risk of developing COVID-19 among cancer patients tended to rise with age: eight of 12 patients were over 60. Seven patients had lung cancer.
Three of the patients -- two with lung cancer, another with pancreatic cancer -- went on to develop severe COVID-19 requiring ICU care. All three died.
Of the remaining nine patients, six have recovered and have been discharged from the hospital, the team said.
According to the researchers, the take-home message from this small, early study is that during the COVID-19 pandemic, decisions may need to be made on curtailing cancer care. And if patients do require in-hospital treatment, "proper isolation protocols must be in place to mitigate the risk of [viral] infection," they said.
Three cancer specialists in the United States who reviewed the report agreed that cancer treatment may require patient-doctor discussions at this time.
Amy Moore directs science and research at the GO2 Foundation for Lung Cancer in Washington, D.C. She believes that lung cancer patients, especially, "may have elevated risk [of coronavirus infection] compared to other cancer types."
Also, Moore said, "hospital admissions and recurrent visits increase risk, reinforcing the importance of patients talking to their physicians regarding their own personal treatment plan."
Dr. Wasif Saif is medical director at the Northwell Health Cancer Institute in Lake Success, N.Y. He stressed that the study population was very small, so the findings must be considered preliminary. But certain patterns emerged.
"Cancer patients were deemed to be at highest risk for severe complications, including admission to the intensive care unit requiring invasive ventilation, or death," Saif noted. "Additionally, diagnosis of cancer was associated with a shorter time to development of severe events when compared to non-cancer patients."
Because hospitals are especially potent venues for coronavirus infection, Saif believes that "tough decisions have to be made during this COVID-19 crisis whether to delay [cancer] treatment or simplify the treatment."
But Dr. Adil Akhtar, director of inpatient clinical operations at Karmanos Cancer Institute at McLaren Oakland in Pontiac, Mich., took a slightly different view.
He agreed that cancer patients appear to be at higher odds of coronavirus infection, but added that "cancer programs across the U.S. have already implemented robust infection and environmental controls, as per the [U.S. Centers for Disease Control and Prevention] guidelines."
Akhtar added that, as per guidelines from the American Society of Clinical Oncology, at this time "there is no direct evidence to support changing or withholding chemotherapy or immunotherapy in patients with cancer."
He believes it's tough to determine, on an individual patient basis, whether the risk of contracting COVID-19 outweighs the benefit to be gained from continued cancer care.
So "clinical decisions should be individualized that consider factors such as the risk of cancer recurrence if therapy is delayed, modified or interrupted; the number of cycles of therapy already completed, and the patient's tolerance of treatment," Akhtar said.
The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.
SOURCES: Amy Moore, Ph.D., director, science and research, GO2 Foundation for Lung Cancer, Washington, D.C.; Wasif Saif, M.D., deputy physician-in-chief and medical director, Northwell Health Cancer Institute, Lake Success, N.Y.; Adil Akhtar, M.D., associate professor, Department of Medical Oncology and Hematology, Oakland University-William Beaumont School of Medicine, and director, Inpatient Clinical Operations, Karmanos Cancer Institute at McLaren Oakland, Pontiac, Mich., and chief, Division of Palliative and End of Life Care, Michigan Health Professionals; March 25, 2020, JAMA Oncology