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    CancerNews posted an update

    Cancer Patients at Special Risk for COVID-19?
    — Retrospective data from Wuhan point to the possibility
    by Ian Ingram, Deputy Managing Editor, MedPage Today March 26, 2020

    Cancer patients receiving care at a single center in Wuhan, China, were twice as likely to be diagnosed with COVID-19 as the general population, according to researchers there.

    Among more than 1,500 patients admitted to a tertiary cancer hospital in the early part of the year, 0.79% were ultimately diagnosed with the COVID-19 coronavirus (SARS-CoV-2), as compared with an infection rate of 0.37% in the city overall (OR 2.31, 95% CI 1.89-3.02), reported Conghua Xie, MD, of Zhongnan Hospital of Wuhan University, and colleagues.

    The results, published in JAMA Oncology, support those from another single-center study suggesting that hospital-acquired infections were a likely source of spread in Wuhan. Cancer patients are thought to be at higher risk of contracting COVID-19, as they typically require repeat visits for care, and often receive immunosuppressive treatments such as chemotherapy or radiation.

    In the study, lung cancer patients appeared to be at particular risk. Among 228 non-small cell lung cancer patients, seven (3%) were diagnosed with COVID-19 pneumonia (1.8% in those 60 or younger and 4.3% in those over 60).

    "Our findings imply that hospital admission and recurrent hospital visits are potential risk factors for SARS-CoV-2 infection," the group wrote. "We propose that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward."

    In the wake of the COVID-19 pandemic, U.S. cancer centers are already establishing protocols to address the changing landscape of patient management. During a webinar hosted by Oncology Business Review on Monday, Debra Patt, MD, MPH, MBA, of Texas Oncology in Austin, discussed some of the strategies at her clinic aimed at reducing the risk of infection.

    To preserve clinic safety for patients on active treatment, infusion chairs were placed 6 feet apart, visitors were minimized, and all routine follow-up visits were pushed back.

    "I decreased my clinic volume by about 70%," she said. "We don't want to have a packed waiting room, or a packed infusion center right now."

    Treatments deemed unlikely to adversely impact outcomes were also considered for delay (e.g., zoledronic acid for bone health), and Patt said that the risks and benefits of all interventions should be assessed before proceeding.

    "By and large, cancer does need treatment, and most of that needs to be treated in a timely way, but there are things that one can forego," she said.

    Describing a hypothetical case involving a BRCA-positive triple-negative breast cancer patient who elected bilateral mastectomy and reconstruction, and needs immediate surgery, Patt suggested a staged procedure, delaying reconstruction until a later time to minimize the patient's in-hospital time and decrease her risk for exposure to the virus.

    She also highlighted the switch to telehealth for routine visits and especially for the management of potentially infectious patients.

    "If they have an acute symptom, I really don't want to bring that patient into clinic," she said. "And I don't want to send them to the emergency room, because if I routinely send patients with acute complaints to the emergency room, I would be sending them to the highest concentration of COVID-19 in the city."

    In the study from Xie and colleagues, 12 of the 1,524 patients at the single center in Wuhan were diagnosed with the COVID-19 coronavirus from Dec. 30, 2019 to Feb. 17, 2020. Across the entire city during this time, there were 41,152 cases out of 11 million individuals.

    Median patient age of the cancer patients diagnosed with COVID-19 was 66 years (range 48-78), two-thirds of whom were over 60. Three of the 12 patients developed severe adult respiratory syndrome. By March 10, three of the patients had died, three remained in hospital, and six had been discharged.

    Disclosures

    The study was funded in part by a National Medical Research Council Clinician-Scientist Award.

    Xie and co-authors disclosed no relevant relationships with industry.

    The Oncology Business Review webinar was sponsored by GlaxoSmithKline.

    Primary Source

    JAMA Oncology

    Source Reference: Yu J, et al "SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China" JAMA Oncol 2020; DOI: 10.1001/jamaoncol.2020.0980.

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    CancerNews asked a questionCancer

    All of us on the WhatNext Team are concerned about all of our community.

    10 answers
    • centered1's Avatar
      centered1

      I searched all day Monday high and low and couldn't find it. I have officially lost my mind. But you know what? Life is easier and a lot more fun without it:)

      about 5 hours ago
    • Carool's Avatar
      Carool

      LWC and centered 1, love it!

      I’m okay. We stay home a lot anyway. I can do my artwork here on my Mac. Get free online library books to read on my phone. Watch movies. Zoom or just talk on phone. Talk more to my plush dog (he’s happy I’m home more). Listen to Gov. Cuomo. Hear the day’s Covid count and rising death toll. Be frightened. Keep dreaming about the six-foot-rule (yes, every night).

      about 3 hours ago
    • BoiseB's Avatar
      BoiseB

      Today there was very good news. The models from the University of Washington project that the epidemic will peak on Apr. 9th and begin a significant decline on April 17. Seattle might be ahead of that curve because measures were taken there (and here ) before the rest of the state. Hang in there everyone if we can do it so can you.

      about 1 hour ago
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    CancerNews asked a questionLeukemia

    Today is National Doctor's Day - Who is your favorite doctor(s)?

    8 answers
    • Created07's Avatar
      Created07

      I've been blessed with wonderful doctors. First, my OB/GYN - Oncologist - Dr. Veronica Schimp. She taught me that cancer was Not a death sentence. Second, My breast cancer and non-hodgkins oncologist - Dr. Rostorfer. He has been known to call me from his phone on his way home just to see how I was. He never had me go to the ER. He always met me in his office at the hospital and took me to my room. And third, my sweet radiologist. He was in charge of my radiation for endometrial and breast cancer. We shared jokes..some not too nice, and I learned to laugh in any situation. I spent 6 years with these wonderful doctors and their precious nurses. I still see Dr. Rostorfer. He says he will take care of my 'girls' as long as I live. I dare anyone to have a better group of doctors.

      4 days ago
    • LiveWithCancer's Avatar
      LiveWithCancer

      I call my PCP my angel doctor. I haven't seen her in years since my oncologist does everything for me, but Dr Donna Casey was and is absolutely remarkable. Everyone I know that goes to her agrees.

      My oncologist, Dr David Gerber, is fabulous. He is that doctor who won't give up on you, even when all others have. He's that doctor who will come in singing happy birthday to you like you were at a restaurant, he's that daddy who will go to sewing classes with his 8-year-old daughter and then wear the tie she made him for his birthday to work and to speaking engagements that evening. He's sought after internationally to discuss immunotherapy. He spends much of his time in the lab, researching ways to cure or slow down lung cancer. I trust him with my life.

      4 days ago
    • BoiseB's Avatar
      BoiseB

      I almost forgot about the Dr. who is responsible for saving my life. That is because I don't think of him as a Dr. because he is my nephew. He is the Dr. that gave the second opinion and referred me to the Dr.s who saved my life.

      3 days ago
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