A narrative review of the pathophysiology of COVID‐19 infection among cancer patients: Current evidence and research perspectives

Abstract

Introduction The mechanism by which a suppressed immune system of a cancer patient makes them susceptible to COVID‐19 is still unclear. Any delay or discontinuation of cancer care due to the pandemic is expected to have a detrimental impact on the outcome of cancer. A few studies have addressed the incidence of COVID‐19 among cancer patients, but the small sample size of such studies makes it difficult to draw inference to the general population. Methods For our review, ‘Pubmed’ database and Google search engines were used for searching the relevant articles. The criterion used for review includes their relevance to the defined review question, which is the pathophysiological mechanism of COVID‐19 among cancer patients and the relevant therapeutic interventions therewith. This review includes 20 studies and other relevant literature which address the determinants of COVID‐19 among Cancer patients. Results Delay in cancer diagnosis will increase the stage progression of cancer patients and increased mortality in the future. A short delay in administering cancer related treatment to aid the odds of patient surviving the acute SARS‐CoV‐2 infection, should be at the discretion of the treating Physician. Oncologists dilemma in the current situation includes titrating the density of drug doses and intensity of treatment regimen, for the optimal management of metastatic and adjuvant cancer patients. Patients are thus subjected to suboptimal treatment and undetected disease recurrence, To circumvent the immunosuppressive effects of chemotherapy, Providers need to consider staggered regimen or alternate therapies such as biological/immunotherapy, targeted therapy, anti‐angiogenic drugs, hormone therapy and/or antibody‐based therapeutics. Conclusion This review provides insights on the pathogenesis of SARS‐CoV‐2, which could enable Physicians in formulating therapeutic strategies for the management of severe patients, more so in Oncology settings, thus reducing the mortality. The key is to balance the continuation of urgent cancer care, but rationing the elective treatment according to the circumstances.

Co-Infection Associated with SARS-CoV-2 and Their Management

“…Due to nutritional deterioration among cancer patients, those are frequently a manifestation of anemia and hypoproteinemia, which directly affects their immunological competence and makes them more susceptible to respiratory infections. Patients with COVID-19 lung cancer may have critical anoxia and develop more quickly because of poor baseline lung function and tolerance [ 205 ]. Tocilizumab, a genetically engineered monoclonal antibody that works as an anti-IL-6-receptor inhibitor, is used to cure COVID-19 individuals with cytokine release syndrome because it lowers COVID-19 morbidity and death, even in cancer patients [ 197 , 206 ].…”