Challenges posed by COVID-19 in cancer patients: A narrative review

Abstract

A novel coronavirus, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the causative agent of coronavirus disease 2019 (COVID-19). In early 2020, the World Health Organization declared COVID-19 the sixth public health emergency of international concern. The COVID-19 pandemic has substantially affected many groups within the general population, but particularly those with extant clinical conditions, such as having or being treated for cancer. Cancer patients are at a higher risk of developing severe COVID-19 since the malignancy and chemotherapy may negatively affect the immune system, and their immunocompromised condition also increases the risk of infection. Substantial international efforts are currently underway to develop specific methods for diagnosing and treating COVID-19. However, cancer patients' risk profiles, management, and outcomes are not well understood. Thus, the main objective of this review is to discuss the relevant evidence to understand the prognosis of COVID-19 infections in cancer patients more clearly, as well as helping to improve the clinical management of these patients.

Keywords: COVID-19; SARS-CoV-2; cancer; immunodeficiency.

FIGURE 1

The risk factors influencing infection severity in cancer patients. Several factors can increase the risk of COVID‐19 in cancer patients. These risk factors are delayed admission, low sensitivity, or wrong interpretation of the SARS‐CoV‐2 RT‐PCR tests. In some cases, the initial diagnosis may not be correct due to the similarity of cancer symptoms and COVID‐19. There are also risk factors for cancer treatment, including chemotherapy, targeted therapy, radiotherapy, immunotherapy, and treatment regimens containing JAKi or BTKi. Treatment with high‐dose corticosteroids and ICIs can also increase the chance of infection. Observing patchy consolidation in the first CT scan of the lungs on admission is also a risk factor for increasing the severity of infection. Also, patients with some cancers are more susceptible to infection than others. Abbreviations: BTKi, Bruton tyrosine kinase inhibitors; CT, computed tomography; ICIs, Immune checkpoint inhibitors; JAKi, Janus kinase inhibitors. ^*Gastrointestinal, thoracic (particularly non‐small cell lung carcinoma), and head and neck cancers

FIGURE 2

Challenges of oncologists in the face of COVID‐19. Due to the COVID‐19 pandemic, oncologists face many challenges in treating cancer patients. One of these challenges is using shared staff and beds for cancer patients with COVID‐19 due to a lack of human resources and hospital equipment. Other challenges include the fear of developing COVID‐19. Many patients delay seeing a doctor because of this fear, which delays diagnosis, treatment, or even radiation therapy. Lack of appropriate guidelines for their condition also worsens the condition of patients with cancer. Interactions between antineoplastic regimens and anti‐SARS‐CoV‐2 treatment are a major challenge for physicians. One of the most important challenges was accurately detecting COVID‐19 from the so‐called neoplasms. Reducing or delaying any routine cancer care activity is also a challenge. ^*Including the visits, reduction in the number of cancer surgeries, delay in radiotherapy, and delay, reschedule, or cancellation of outpatient visits