Given that hospital visits are likely a substantial risk factor for transmission of coronavirus, a group of Chinese researchers is calling for “aggressive measures” to reduce the frequency of such visits among people with cancer. People with cancer who must be hospitalized should be isolated to lower their risk of infection.
Conghua Xie, MD, PhD, of the department of radiation and medical oncology at Zhongnan Hospital of Wuhan University in Wuhan, China, and colleagues assessed the coronavirus incidence among cancer patients admitted to the department between December 30 and February 17. They reported their findings in a letter published March 25 in JAMA Oncology.
The coronavirus pandemic originated in Wuhan.
As background, the researchers referred to a report published in February 7 regarding 138 people hospitalized with coronavirus-related pneumonia at Zhongnan Hospital. This report indicated that 41.3% of those patients had acquired the infection in the hospital. This finding, the authors of the new report state, implicated “the hospital environment as a source of spread of the virus.”
People with cancer, they noted, often make repeated visits to the hospital for treatment and monitoring. Therefore, they may be at risk at those visits of contracting coronavirus, which can cause the disease COVID-19. Furthermore, cancer therapies including chemotherapy and radiotherapy suppress the immune system; immunosuppression is itself a risk factor for developing COVID-19.
The new report’s authors reviewed the medical records of 1,524 people with cancer, looking at demographic, clinical and treatment data. They estimated that 0.79% (12 people) of the cancer patients at their hospital had coronavirus. By comparison, some 0.37% (41,152 of 11.1 million) people in all of Wuhan were diagnosed with COVID-19 during the same study period.
The median age of the 12 cancer patients with coronavirus was 66 years old; the ages ranged between 48 and 78 years old.
Eight (66.7%) of these 12 individuals were older than 60 years old. Seven (58.3%) had non-small-cell lung carcinoma (NSCLC), a form of lung cancer. Five (41.7%) were receiving either chemotherapy with or without immunotherapy (three people) or radiotherapy (two people).
Three people developed severe adult respiratory syndrome (SARS), one of whom required intensive care.
As of March 10, six (50.0%) of the cancer patients with coronavirus had been discharged from the hospital, and three (25.0%) had died.
Of the 1,524 people with cancer, 22 had NSCLC. The investigators found that people with this form of lung cancer who were older than 60 had a higher rate of COVID-19 diagnosis (4.3%) than those who were 60 or younger (1.8%).
The investigators concluded that people with cancer in the Wuhan hospital had a 2.31-fold higher risk of coronavirus infection than the hard-hit city’s general population. Less than half of those individuals with cancer were undergoing treatment for their malignancies.
People older than 60, they further concluded, and those with NSCLC may be at greater risk of developing COVID-19, according to the findings from the analysis. While this analysis was not able to detect advanced age as a risk factor for COVID-19, the authors suggested that a larger sample size would have revealed such an association in the data.
Other recently released scientific papers, including those coming out of China, have analyzed large cohorts of people with coronavirus and have quite solidly concluded that people older than 60 are indeed at greater risk for complications from the infection than younger individuals.
The new report’s authors stated that hospital admission and recurrent hospital visits “are potential risk factors” for coronavirus infection.
“We propose,” the authors concluded, “that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward. For patients who require treatment, proper isolation protocols must be in place to mitigate the risk of [coronavirus] infection.”
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To read the research letter, click here.