Cancer patients — especially those with blood or lung malignancies, or tumors that have spread throughout the body — have a higher risk of death or other severe complications from covid-19 compared with those without cancer, according to a study published Tuesday.
The study, which involved 14 hospitals in Hubei province in central China, where the pandemic emerged, included 105 cancer patients and 536 non-cancer patients of the same age — all of whom had covid-19, the disease caused by the novel coronavirus.
The co-authors, from China, Singapore and the United States, found that cancer patients who developed covid-19 had nearly a threefold higher death rate from the virus than the 2 to 3 percent rate estimated for the general population. Cancer patients also were more likely to experience “severe events,” such as being admitted to intensive care units and needing mechanical ventilation, than people without cancer. Risk factors included not just age, but also the kind of cancer, the stage and the treatment.
“These findings suggest that patients with cancer are a much more vulnerable population in the current covid-19 outbreak,” the authors concluded.
Cancer patients are more vulnerable for several reasons, according to the paper’s authors and other experts. Cancer itself depresses the immune system, and cancer patients tend to be older, which is itself a risk factor for serious complications from covid-19. Blood cancers such as leukemia, lymphoma and myeloma attack the immune system, reducing patients’ natural defenses and making them prone to dangerous infections.
Another high-risk group — patients with lung cancer — are likely more vulnerable because of reduced lung function, the authors of the study said. In addition, some treatments, such as chemotherapy and surgery also suppress the immune system. The paper found that even cancer patients who had completed treatment had higher risks of serious covid-19 complications than those who had never had cancer. But those with early-stage disease — localized malignancies — had results similar to those of non-cancer patients.
The study was released at the American Association for Cancer Research’s virtual annual meeting and published in the organization’s peer-reviewed journal, Cancer Discovery. The only previous study of cancer patients and covid-19 included just 18 patients.
J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society, which was not involved in the study, called it “important,” adding that it “reflects what we had heard previously — that cancer patients are more susceptible to the virus, and that the course of the infection is worse and the outcomes are worse.” He said that the study was still relatively small and that thousands more patients need to be scrutinized.
The apparent higher risk of death and other serious complications from the virus are among the dangers facing cancer patients as they try to navigate a pandemic that has forced the delays of some treatments, the closing of many clinical trials to new patients and shortages of critical pain medications, said Howard Burris, chief medical officer and executive director of the Sarah Cannon Research Institute in Nashville and president of the American Society of Clinical Oncology.
“We face daunting challenges to optimal patient care,” he said at an ASCO media briefing last week. He noted that some hospitals “have effectively deemed all cancer surgeries elective,” requiring them to be postponed. While such delays make sense for some patients with early-stage disease, they can be devastating for “patients with fast-moving or hard-to-treat cancers,” he warned.
Oncologists also are concerned about delays in cancer tests and screenings, which are crucial for finding and monitoring the disease and include mammograms and colonoscopies. Tests and screenings plunged in the United States since mid-March, according to a new report by Komodo Health, a health data firm, Reuters reported.
More than 1.8 million new cancer cases are expected to be diagnosed in the United States in 2020, according to the American Cancer Society, and more than 606,000 people are expected to die of the disease.
Lichtenfeld said he expects some health-care systems to begin treating more non-covid-19 patients in coming weeks and months. “It won’t be the same in every part of the country,” he said, “but we are starting to move through. That doesn’t mean we are not still at a difficult place, but health systems are trying to figure out the best way to loosen the reins on some elective surgeries.”
For Deborah Silverman, 29, an MD/PhD candidate at MD Anderson Cancer Center in Houston, the outbreak has had a direct impact on her treatment. Diagnosed last year with triple negative breast cancer, one of the most aggressive breast cancers, she has had chemotherapy, surgery and radiation and now is getting chemotherapy again. Even so, Silverman has some residual disease and a 50 to 60 percent chance of recurrence, she said.
To reduce her risk, she planned to enter a clinical trial for immunotherapy, which unleashes the immune system to attack cancer.
But the trial, like many across the country, is not enrolling new patients as a result of the pandemic, so she is extending her chemotherapy regimen. One side effect has been blisters on her feet and toes, making it painful to do yoga or even to walk.
Silverman is hoping she can switch soon to immunotherapy, which has fewer side effects than chemotherapy. “This is the only trial available right now for someone in my position,” she said. “We want to have all the shots on goal we can.”
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