Do Patients With Cancer Need Disease-Specific Precautions to Prevent COVID-19 Infection?

Coronavirus disease 2019 (COVID-19) is a disease caused by SARS-CoV-2, a novel coronavirus first detected in China.¹ COVID-19 has the United States and many other countries coping with a major public health emergency in the form a potential coronavirus pandemic.

The US Centers for Disease Control and Prevention (CDC) is advising all healthcare providers to be suspicious if people who recently traveled from certain countries — China, Iran, Italy — present with fever and respiratory symptoms. It also recommends that healthcare providers protect themselves by diligently following recommended infection control procedures. COVID-19 has caused illness and death, and its sustained person-to-person spread is concerning, especially for patients undergoing treatment for cancer.

In general, patients with cancer are likely to be at higher risk of severe disease than patients who do not have cancer. Additionally, the more extensive the cancer and the more immunosuppressive their treatment, the more likely they are to experience complications, Peter Axelrod, MD, chair of infection control committees at Temple University Hospital and Fox Chase Cancer Center, Philadelphia, Pennsylvania, explained [email communication, February 27, 2020]. “There will likely be more detailed studies of [COVID-19] infection in cancer patients, but we don’t think they exist yet,” he added.

Currently, a lot is still unknown about this disease and how it is spreading. In addition, there has not been any specific information regarding patients with cancer and COVID-19. However, one study suggested a small percentage of patients had preexisting conditions including diabetes (6.4%), hypertension (12.8%), cardiovascular disease (3.7%), liver diseases (2.7%), malignancy (1.4%), and others (3.7%).² “It does seem that more severe underlying illness, in general, increases the risk of severe disease,” Dr Axelrod explained.

A univariate analysis showing that comorbidity, age older than 50, lymphocyte counts <1500/μL, and serum ferritin >400 ng/mL at presentation were predictive of progression to severe disease. In this study, 73% of patients (11/15) with 3 or all 4 risk factors progressed to severe disease that required intubation or intensive care unit (ICU) admission compared with 11.8% (4/34) of patients with 0 to 2 risk factors (odds ratio [OR] 6.2; 95% CI, 1.7 to 22.8; P =.006).³ “None of the [patients] with absence of all 4 risk factors progressed to more severe diseases,” Dr Axelrod said. “But the low lymphocytes and high ferritin might just reflect the severity of the infection, not the underlying health of the patient.”

Another study showed that patients were more likely to die from COVID-19 if they were older (OR 26.0), had any comorbidity (OR 4.7), hypertension (OR 3.5), cardiovascular disease (OR 5.1), endocrine system disease (OR 3.5), and respiratory system disease (OR 18.1). These patients exhibited shortness of breath (OR 11.8), confusion (OR 3.3), chest pain (OR 29.1), and fever plus cough plus shortness of breath (OR 4.4).⁴

If COVID-19 becomes more widespread, Dr Axelrod warned, patients should be advised to avoid crowded areas as much as possible and avoid having visitors or visiting people with respiratory infection symptoms. “If the number of cases becomes large, facemasks when going out in public may be helpful. The best ones are very close fitting, such as N-95 respirators, but they may be hard to find and breathing is often uncomfortable with them, especially for people with breathing issues,” he said.