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Cancer-Specific Risks
The patients with cancer with the highest risk of contracting the disease may be bone marrow transplant recipients; patients with chronic lymphocytic leukemia (CLL), non-Hodgkin lymphoma (NHL), and acute lymphoblastic leukemia (ALL); as well as those who are older than 65 and who have comorbid illnesses, John Green MD, section chief, Division of Infectious Diseases and Tropical Medicine and senior member of the Internal Medicine Department at Moffitt Cancer Center, Tampa, Florida explained in an email [February 28, 2020]. “The highest risk patients are those who have immunodeficiency from defective T lymphocytes,” said Dr Green.
Amanda F. Cashen, MD, from the Washington University School of Medicine Division of Oncology, Section of Stem Cell Transplantation, St Louis, Missouri, agreed that patients with leukemia and stem cell transplant recipients are at greater risk of developing severe disease if they are infected with coronavirus because their immune systems are impaired [email communication, March 1, 2020].
“Many other respiratory viruses, including influenza and RSV, are common threats to my patients, and I always advise them to avoid contact with people who are sick, stay out of crowds, and use hand sanitizer,” explained Dr Cashen. If COVID-19 becomes more prevalent in the United States, these precautions will become more critical. I will then advise my patients to stay at home as much as possible and to wear a mask when going out. “I don’t think that guidelines specific to cancer patients are necessary,” she added. “Cancer patients can follow guidelines issued for all patients who are at increased risk of severe disease from [coronavirus].”
Unless an otherwise healthy patient with cancer is on immunosuppressive therapy (eg, steroids) as part of their cancer treatment, Anthony V. D’Amico, MD, PhD, chief of the Division of Genitourinary Radiation Oncology at Dana Farber Cancer Institute, Boston, Massachusetts, said, there is no reason to believe they would be more susceptible to the coronavirus compared with any other virus [email communication, March 1, 2020].
“Standard precautions do exist for patients on immunosuppressive therapy for cancer. In addition other reasons for immunosuppression, such as stress, poor health habits, autoimmune disorders, should be considered when counseling a patient regarding precautions,” noted Dr D’Amico.
Taking Action
COVID-19 was first detected in Wuhan City, Hubei Province, China, and on January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the outbreak a public health emergency of international concern (PHEIC). Global efforts at this time are focused concurrently on containing spread of the virus and mitigating its impact. An abundance of pandemic guidance developed in anticipation of an influenza pandemic is being repurposed and adapted for a COVID-19 pandemic.
The CDC has taken steps of its own to enhance the response in the United States, establishing a COVID-19 Incident Management System on January 7, 2020, and activated its Emergency Operations Center on January 21, 2020, to better provide ongoing support to the COVID-19 response. A public health emergency (PHE) was declared on January 31, 2020, by US Health and Human Services Secretary Alex M. Azar II.1
But should oncology organizations develop their own guidelines specific to patients with cancer? David J. Prelutsky, MD, from the Washington University School of Medicine and the medical director and founder of Southampton Healthcare, both in St. Louis, Missouri, does not believe this is necessary [email communication, DJ Prelutsky, March 1, 2020]. People with all the risk factors should be especially vigilant and follow a few basic guidelines, he noted. “I am telling my patients to practice good hygiene, such as handwashing, not touching mouth or eyes without washing hands. Cover their own coughs and sneezes. I am also recommending avoiding crowds, if possible. Patients should get a flu shot, if they have not already.
“I think following CDC guidelines is enough. No reason for all the societies, such as the American Society of Clinical Oncology (ASCO), to weigh in,” Dr Prelutsky said. “Most important is to let the physicians with public health expertise run the show.”
References
1. Coronavirus disease 2019 (COVID-19) situation summary. Updated March 7, 2020. Accessed March 7, 2020. https://www.cdc.gov/coronavirus/2019-ncov/summary.html
2. Cai X, Huang D, Ou P, et al. COVID-19 in a designated infectious diseases hospital outside Hubei Province, China. Preprint. Posted online February 19, 2020. medRxiv 20024018. Accessed March 9, 2020. https://www.medrxiv.org/content/10.1101/2020.02.17.20024018v1
3. Ji D, Zhang D, Chen Z, et al. Clinical characteristics predicting progression of COVID-19. Preprint. Posted on February 20, 2020. Lancet. Accessed March 9, 2020. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3539674
4. Su VYF, Yang YH, Yang KY, et al. The risk of death in 2019 novel coronavirus disease (COVID-19) in Hubei Province. Preprint. Posted online February 19, 2020. Lancet. Accessed March 9, 2020. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3539655
