The impact of the COVID-19 pandemic on cancer patients

Abstract

COVID-19 infection in patients with cancer is associated with a significantly increased risk of case fatality. Strategies to reduce the likelihood of infection and improve early identification in this immunocompromised patient population is crucial. Clinicians must balance the risks of delaying cancer treatments versus the risks for SARS-CoV-2 exposure and the potential increased adverse outcomes of COVID-19 infection in cancer patients. Physical distancing rules and contact limitations should be essential components of cancer care delivery. Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities such as diabetes and obesity. Likelihood of severe illness from COVID-19 is higher among patients with lung cancer and hematologic malignancies. There is no identified evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment. Anti-CD20 monoclonal antibodies causing B cell depletion and lymphopenia may contribute to the severity of COVID-19 infection. Treatment with immune checkpoint inhibitors may have the potential to alleviate inflammation in COVID-19 infection. In retrospective cohort studies there are conflicting results but there is no clear data for increasing the severity of the infection. The management of COVID-19 infection in cancer patients is generally the same as in the general population. Mild cases and asymptomatic infections can be managed conservatively at home Agents used specifically for COVID-19 are reserved for patients with severe disease. Clinicians delivering cancer care should have discussions with their patients about goals of care and future care planings.