COVID-19 in the Cancer Patient

Abstract

GI = gastrointestinal; HMEF = heat and moisture exchanging filter; HSCT = hematopoietic stem cell transplant; ICU = intensive care unit; IL-6 = Interleukin 6; JAKi = Janus kinase inhibitors; LFTs = liver function tests; MERS-CoV = Middle East respiratory syndrome coronavirus; OR = operating rooms; PACU = postanesthesia care unit; PAPR = powered air-purifying respirator; PPE = personal protective equipment; RSV = human respiratory syncytial virus; SARS = severe acute respiratory syndrome; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; TIL = tumor-infiltrating lymphocytes; VEGF = vascular endothelial growth factor The novel Coronavirus Disease 2019 (COVID-19) was first reported in China in December 2019. Since then, it has spread across the world to become one of the most serious life-threatening pandemics since the influenza pandemic of 1918. This review article will focus on the specific risks and nuanced considerations of COVID-19 in the cancer patient. Important perioperative management recommendations during this outbreak are emphasized, in addition to discussion of current treatment techniques and strategies available in the battle against COVID-19.

Fears, feelings and findings about COVID-19 disease in hospitalized cancer patients in a tertiary Hospital in Spain.

“…Another study showed that among patients infected with SARS-CoV-2, those with malignant tumors progress to severe disease more rapidly than noncancer patients (13 vs. 43 days, p < 0.0001) and severe cases were approximately ve times higher in cancer patients than in the general population (39% vs. 8%, p=0.0003) [15]. Williams et al [16] concluded that cancer patients have >5% mortality compared to cancer-free patients. However, when our patients were asked about their risk of COVID-19 disease due to its cancer condition, no statistical signi cance was found.…”

SARS-CoV-2 S Protein Binding hACE2: Viral Entry, Pathogenesis, Prognosis, and Potential Therapeutic Targets

“…Cancer patients are more susceptible to infections due to their poor health condition and immunosuppressive status caused by cancer and its therapies [170]. Consequently, active cancer patients infected with SARS-CoV-2 are more susceptible to severe clinical events compared to COVID-19 patients without cancer [171]. Therefore, COVID-19 patients with cancer had higher rates of suffering from at least one critical symptom, higher chances to be admitted to the ICU, higher possibility to utilize invasive mechanical ventilation, and increased death rates compared to non-cancer patients [170].…”

“…Acute inflammation is resolved as soon as the pathogen is cleared, however, if the pathogen persist then inflammation becomes chronic [174]. It is noteworthy that COVID-19 patients with cancer tend to have prolonged viral shedding and possible persisting infection sites which provoke chronic inflammation [171,174]. Chronic inflammation within a tissue can generate a pro-tumorigenic environment of immune cells and their secreted cytokines.…”

“…Furthermore, bone marrow transplant exerts the highest morbidity and mortality for the reason that this therapeutic approach eliminates the host immune system and replace it with that of his donor. On the other hand, conventional external beam radiation therapy might cause radiation-induced lymphopenia [171]. As to immunotherapies which include non-specific immunotherapies, cancer vaccines, chimeric antigen receptor T cell therapy, and immune-checkpoint inhibitors, that might exert their side effects via nonspecific T cell activation against normal tissues [178].…”

Psychological distress among cancer survivors during implementation of a&nbsp;nationwide Movement Control Order&nbsp;over the COVID-19 pandemic

“…For most patients, whose immune systems may already be compromised, psychological distress associated with the pandemic may further weaken their immune system [4]. Secondly, people who are immunocompromised, whether caused by the disease itself or the treatment, have increased risk of SARS-CoV-2 infection compared with the general population [5,6]. Further, there is also evidence showing that cancer history confers the highest risk of severe complications and is correlated with poorer outcomes from SARS-CoV-2 infections [7].…”