Editors' ChoiceCancer

COVID-19 and cancer: The bad and the ugly

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Science Translational Medicine  13 May 2020:
Vol. 12, Issue 543, eabb7097
DOI: 10.1126/scitranslmed.abb7097

Abstract

Patients with cancer are more vulnerable to COVID-19 infection with higher risk of severe symptoms and death.

Cancer is the name for a multitude of different individual diseases that all have in common hallmarks such as inflammation, resistance to cell death, invasion, and metastasis. Coronavirus SARS-CoV-2, the cause of the COVID-19 pandemic, is estimated to have been responsible for more deaths per day than cancer in April 2020 in the United States. Although very different entities, COVID-19, a viral infection, resembles in some ways a malignancy: It invades the body and it causes inflammation. Patients with cancer are generally more prone to infections due to their malignancy, comorbidities, age, or anticancer therapies, but the effects of SARS-CoV-2 in patients with cancer are still unknown.

To begin to address this, Dai et al. conducted a study in 14 hospitals in Wuhan, China, the first epicenter of the COVID-19 pandemic, comparing 105 patients with cancer to 536 age-matched patients without cancer, all of whom were diagnosed with COVID-19. The aim of this study was to report the clinical outcomes of patients with concomitant cancer and COVID-19 infection.

Upon admission, all patients had similar signs and symptoms except for a higher prevalence of chest distress in patients with cancer. Patients with COVID-19 and cancer had higher rates of severe events including death, intensive care unit admission, and need for invasive mechanical ventilation, as well as having at least one severe or critical symptom (septic shock, acute respiratory distress syndrome, acute kidney injury, disseminated intravascular coagulation or rhabdomyolysis). In particular, those with hematological malignancies, lung cancer, or metastatic cancer had the highest frequency of severe events related to COVID-19. Patients with localized cancer experienced similar frequencies of severe events to those observed in patients without cancer. Recent surgery or immunotherapy was associated with a higher risk of severe events, while undergoing recent radiotherapy or chemotherapy was not. No association between immunosuppression due to anticancer therapy and severe outcomes was observed.

These findings highlight that patients with cancer may be particularly vulnerable to COVID-19 infection. They should be protected by encouraging social distancing and frequent handwashing, but consideration should also be given to deferral of elective surgeries during the pandemic and limiting hospital visits to avoid exposure.

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