Commentary: Cancer patients are a vulnerable group during COVID-19. But that can be helped

SINGAPORE: The COVID-19 Pandemic has gravely impacted the world and has put a major strain on healthcare systems globally.

There are almost four million people infected and close to 300,000 who have succumbed to the disease.

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The zoonotic coronavirus (SARS-CoV-2) is highly infectious and spreads quickly. It is responsible for greater adverse events, including a high rate of fatalities, in the older population and specific vulnerable groups.

One of these vulnerable groups are the cancer patients. Many cancer patients frequently visit the hospital for treatment and disease surveillance.

They may have lower immunity levels due to the underlying malignancy (the presence of a malignant tumour) or anti-cancer therapy and are therefore at a higher risk of developing infections.

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CANCER PATIENTS ARE A HIGH-RISK POPULATION

Increasing evidence suggests that cancer patients have an elevated risk of COVID-19 infection and are more likely to have higher morbidity and mortality than the general population.

In a recent study published in JAMA Oncology covering a total of 1,524 patients with cancer, cancer patients had a two-fold increased risk of COVID-19 infection when compared with the general population.

A cancer treatment machine at a private Malaysian hospital. (File photo: Bernama)

The report by the World Health Organization (WHO)—China Joint Mission on COVID-19 identified significantly higher case fatality amongst patients with pre-existing malignancy at 7.6 per cent compared with patients without comorbid conditions at 1.4 per cent.

In a study that was published in Lancet Oncology and looked at the nationwide COVID-19 analysis in China, cancer was associated with higher risk of severe events such as admission to the intensive care unit, invasive ventilation.

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It also saw a higher incidence of death in seven of 18 patients with cancer – accounting for 39 per cent – when compared to only 8 per cent, or 124 of 1,572 patients, without cancer.

These findings have been corroborated internationally, as an Italian study assessing the case fatality of COVID-19 found that amongst 355 patients who died and underwent detailed chart review, 72 or 20.3 per cent of them had active cancer.

While these analyses are preliminary and require validation from larger international cohorts, several factors could account for an elevated risk for acquiring COVID-19 and consequent complications among cancer patients, including frequent hospital visits and admissions, immuno-compromised state, advanced age, and poor functional status.

HEALTHCARE SYSTEMS OVERLOADED

What makes it more complex for patients with pre-existing conditions such as cancer is that the massive rise of COVID-19 infections have caused an overload on the healthcare systems.

The available resources have been reallocated to manage the care for infected patients.

So far, 80 per cent of victims of China's coronavirus were elderly individuals aged 60 or above and 75 per cent had pre-existing health conditions. (Photo: AFP/NICOLAS ASFOURI)

This has culminated in the need to balance risks and protect patients and health care workers.

It is therefore recommended that elective surgeries & non-urgent procedures be deferred. Many oncology clinics have postponed procedures for interventional tissue biopsies such as bronchoscopies & endoscopies.

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This has resulted in delays for cancer diagnosis and time to treatment. Moreover, most hospital pathology labs have also shifted their focus towards COVID-19 testing and may not have the available resources to undertake comprehensive genomic profiling required for the cancer patients.

The diagnosis and timely treatment of cancer patients should not be compromised during an infectious disease pandemic. However, the management of such patients should be tailored according to the best available resources.

The necessity of any interventional procedure must be balanced against the increased risk during a pandemic and should be evaluated on a case-by-case basis to address the urgency of the procedure and the effect on the patients outcome if the procedure is to be deferred.

NEW TECHNOLOGIES FOR CANCER CARE

Despite that, cancer patients do not have to feel short-changed or at increased risk during this period.

First, liquid biopsies may provide a safer and more efficient alternative to invasive interventional procedures and reduce the need for cancer patients to be hospitalised or to have multiple visits to the clinic.

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The simple blood draw can be conducted using mobile phlebotomy services and can be undertaken in the comfort of the homes of cancer patients.

This minimises the risk of exposure for the cancer patients to possible COVID-19 hospital acquired infections.

The fast turnaround time of seven days also helps to reduce unnecessary waiting time due to delays in the hospital and can hasten the time to treatment for advanced cancer patients.

The results from the comprehensive genomic profiling test helps to guide oncologists with treatment selection decisions and determine the most effective treatment approach for the patient.

Second, telemedicine can also be considered to support patients remotely to reduce in-person hospital visits during an infectious pandemic.

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