COVID Cancer Evidence Updates

Two useful sources of uptodate information are the Association of Cancer Physicians and Royal Collage of Radiologist websites respectively.

A plethora of tests are in development. These will be critical in helping us to understand how immunity develops in immunosupressed cancer patients, in whom the development of immunity may well be very different the general population. A group of researchers based atUCSF, UC Berkeley, Chan Zuckerberg Biohub, and Innovative Genomics Institute are publishing their rapid comparisons of emerging ELISA test.

The ICNARC reported on data on 3883 patients admitted to critical care units in England Wales and Northern Ireland. Outcomes were available for 1689 patients. Approximately 50% (871 (52%) patients died, 818 (48%) discharged alive from critical care). The data suggest the outcome is particularly poor if advanced respiratory support (i.e. invasive ventilation) is required. Those who received advanced respiratory support, 66.3% of patients died, whereas 80.6% of those receiving basic respiratory support (high-flow oxygen, CPAP, NIV) survived critical care. As is widely reported, age was associated with a worse outcome in critical care. In summary, significant consideration should be given in identifying patients who should be considered for critical care support in advance, and at the time of respiratory deterioration.

In guiding our approach in oncology, more evidence is needed, noting that evidence from Italy and China have suggested that mortality rates were higher in patients with cancer (see the WHO-China Joint Mission Report, and the Case Fatality Rate Italy papers).

Of relevance to the cancer community, the largest available study of hospitalised patients comprises 105 patients with cancer and 233 non-cancer patients. The title of the study – ‘Patients with Cancer Appear More Vulnerable to SARS-CoV-2..’ – requires further interrogation. Comparing the cancer and non-cancer groups, the patients with cancer were older and had a greater proportion of those with cardiovascular diseases. The conclusion that more cancer patients had a severe outcome (mortality, ICU admission, critical symptom or invasive ventilation) must be considered with this in mind. Further, when they looked at patients with Stage I-III disease, the outcomes were the same as patients without cancer. The statistical analyses performed based on treatment status are too limited by patient number to be meaningful. For example, conclusions about certain treatment modalities conferring a greater or lesser likelihood of a poor outcome are based on patient groups of 13 or less per treatment type.

As such, it is difficult for oncologists to establish the risk posed by cancer itself, anti-cancer treatment or the social contact required for cancer care.

COVID-19 updates

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