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Increased COVID-19 Risk in Patients With Cancer

SARS-CoV-2, which causes COVID-19.

Patients with cancer are at increased risk of infection with severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, according to a medical records review of patients with cancer at a hospital in Wuhan, China.

"Patients with cancer from the epicenter of a viral epidemic harbored a higher risk of SARS-CoV-2 infection… compared with the community. However, fewer than half of these infected patients were undergoing active treatment for their cancers," note the investigators, led by first author Jing Yu, MD, of the Department of Radiation and Medical Oncology at Zhongnan Hospital of Wuhan University, in their research letter now published in JAMA Oncology.

Among 1,524 patients with cancer admitted to the Department of Radiation and Medical Oncology of Zhongnan Hospital from December 30, 2019, through February 17, 2020, the infection rate of SARS-CoV-2 was higher than the cumulative incidence rate of all diagnosed COVID-19 cases reported in the city of Wuhan over the same time period (0.79% vs 0.37%), with an odds ratio of 2.31.

The median age of the 12 infected patients with cancer was 66 years, and 8 of the patients (66.7%) were over the age of 60. Seven patients (58.3%) had non-small cell lung carcinoma (NSCLC); among all patients with NSCLC, COVID-19 incidence was higher in those over the age of 60 (4.3% vs 1.8% for patients aged 60 years or younger). Five of the patients with SARS-CoV-2 (41.7%) were undergoing active cancer treatment; 3 (25.0%) were being treated with chemotherapy, with or without immunotherapy, while 2 (16.7%) were being treated with radiotherapy. Three patients (25.0%) developed SARS, with one patient requiring intensive care. As of March 10, 2020, 6 patients (50.0%) had been discharged, while 3 (25.0%) had died.

Regarding their finding of increased COVID-19 risk among patients older than 60 with NSCLC, the researchers note that a population study of 1,099 patients with COVID-19 did not indicate an association between age and infection susceptibility.

"A larger sample size in patients with cancer will resolve these potential associations," state Dr. Yu and colleagues.

The researchers make note of a separate report of 138 hospitalized patients from Zhongnan Hospital, in which hospital-acquired transmission accounted for 41.3% of admitted patients.

"Patients with cancer are often recalled to the hospital for treatment and monitoring, and hence, they may be at risk of contracting COVID-19," comment the investigators. "Moreover, cancer treatments such as chemotherapy and radiotherapy are immunosuppressive."

"We propose that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward," conclude Dr. Yu and colleagues. "For patients who require treatment, proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection."

For More Information

Yu J, Ouyang W, Chua MLK & Xie C (2020). SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2020.0980

Image credit: Alissa Eckert and Dan Higgins, Centers for Disease Control and Prevention

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