BACKGROUND: Patients with cancer have a higher risk of coronavirus disease 2019 (COVID-19) than noncancer patients. The authors conducted a multicenter retrospective study to investigate the clinical manifestations and outcomes of patients with cancer who are diagnosed with COVID-19. METHODS: The authors reviewed the medical records of hospitalized patients who were treated at 5 hospitals in Wuhan City, China, between January 5 and March 18, 2020. Clinical parameters relating to cancer history (type and treatment) and COVID-19 were collected. The primary outcome was overall survival (OS). Secondary analyses were the association between clinical factors and severe COVID-19 and OS. RESULTS: A total of 107 patients with cancer were diagnosed with COVID-19, with a median age of 66 years (range, 37-98 years). Lung (21 patients; 19.6%), gastrointestinal (20 patients; 18.7%), and genitourinary (20 patients; 18.7%) cancers were the most common cancer diagnoses. A total of 37 patients (34.6%) were receiving active anticancer treatment when diagnosed with COVID-19, whereas 70 patients (65.4%) were on follow-up. Overall, 52.3% of patients (56 patients) developed severe COVID-19; this rate was found to be higher among patients receiving anticancer treatment than those on follow-up (64.9% vs 45.7%), which corresponded to an inferior OS in the former subgroup of patients (hazard ratio, 3.365; 95% CI, 1.455-7.782 [P = .005]). The detrimental effect of anticancer treatment on OS was found to be independent of exposure to systemic therapy (case fatality rate of 33.3% [systemic therapy] vs 43.8% [nonsystemic therapy]). CONCLUSIONS: The results of the current study demonstrated that >50.0% of infected patients with cancer are susceptible to severe COVID-19. This risk is aggravated by simultaneous anticancer treatment and portends for a worse survival, despite treatment for COVID-19. Cancer 2020;126:4023-4031.

The outbreak of 2019 novel coronavirus disease (COVID-19) caused not only extraordinary public health concerns but also tremendous psychological distress. 1 Soon after the COVID-19 outbreak, the Chinese government has activated level 1 health emergency responses and Wuhan was locked down on January 23, 2020. During the quarantine period, cancer patients represented a significant vulnerable population confronting with high risk of infection and poorer outcomes after infection. 2-4 Public emotional impacts and psychological response have drawn increasing attention of researchers during the COVID-19 epidemic. However, most studies have focused on the mental health situations of general population or medical staff. 5,6 No study has yet specifically examined the psychological influence of COVID-19 in cancer patients, particularly cancer patients in the initial epicenter of this pandemic. Therefore, we conducted a survey to study the psychological impacts of COVID-19 epidemic on cancer patients in Wuhan, the epicenter of the epidemic in China. Fear of disease progression and psychological stress were investigated by analyzing the data on selfreport questionnaires of Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) from cancer patients, and correlated factors were also explored to help us set up potential appropriate interventions. 2 | METHODS 2.1 | Procedure and data collection Cancer patients from our cancer institute were contacted by their doctors-in-charge and were asked to respond to an Internet-based survey. Demographic data (gender, age, marriage status, reproductive history, educational level, income, concern degree about COVID-19 outbreak, cancer type, co-morbidity, living style, and impact of COVID-19 outbreak on cancer treatment), scores of FoP-Q-SF, SAS, and SDS were collected from April 15 to 17, 2020. A basic description of the three questionnaires was provided in the Supplementary Information. 2.2 | Statistical analyses Mann-Whitney U test or Kruskal-Wallis H test was used to compare quantitative variables between groups. Factors with univariate P < .05 or clinical factors that may have significance were included in the multiple linear regression model. The statistical analyses were undertaken using SPSS Statistics Version 25. All tests were two-tailed, and a P < .05 was considered statistically significant. 2.3 | Ethical issues The study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University (2020089K). Informed consent was Gaili Chen, Qiuji Wu, and Huangang Jiang are co-first authors.

Putative master genes exhibiting changes in both gene expression and DNA methylation are limited to 266 genes and are mainly involved in the renin-angiotensin system (n = 3), mitochondrion metabolism (n = 18), and phospholipid homeostasis (n = 3). Most of these master genes participate in nonalcoholic fatty liver disease. The adverse effects of MDD on the metabolic process indicate the beneficial impact of folate and vitamin B12, especially during the perinatal period.