When a lung cancer patient meets a novel coronavirus…

The overall cancer burden in China continues to rise, and the cancer spectrum in developed countries coexists with that in developing countries. The situation of cancer prevention and control is still grim [1].
It is well known that cancer patients are more susceptible to infection than non-cancer patients because the malignancy itself and anti-cancer treatments can suppress the immune system.
Since the beginning of 2020, the ravages of novel coronavirus not only brought huge influence to the healthy crowd all over the world, undoubtedly also deeply affects the body and mental health of cancer patients.

Among all malignant tumor types, lung cancer ranks the first in China. In 2015, there were about 787,000 new cases of lung cancer in China, with a incidence rate of 57.26/100,000 cases, and it is also the top cancer killer that seriously threatens the life and health of Chinese people [1].
The unprecedented spread of novel coronavirus has also helped this “life fanatic”, increasing the disease burden of lung cancer patients.


Effects of novel coronavirus on the diagnosis and treatment of lung cancer patients

Early stage of epidemic situation, the department of tumor of many hospitals receives the patient that the tumor amalgamates without symptom infection inadvertently, the result causes the collective infection of medical staff of novel coronavirus, bring about the phenomenon that many departments of tumor stop to check or refuse to receive the patient then.
In April this year, the Respiratory Society of Chinese Medical Association and the Chinese Respiratory Oncology Collaborative Group released the Expert Guidelines for Advanced Non-Small Cell Lung Cancer Patients during the Covid-19 Epidemiology (Trial), and the recommendations put forward in the guidelines include [2] :

The patients with no obvious symptoms and stable condition should be postponed according to the situation, and the patients with obvious symptoms and unstable condition should be returned to hospital for treatment as scheduled.
Patients with lung cancer who do not need to be hospitalized should try their best to receive outpatient treatment. Patients who really need to be hospitalized should be excluded from Novel Coronavirus infection before they can be hospitalized.

Patients with advanced lung cancer complicated with Novel Coronavirus infection should first be actively isolated for treatment according to the guidelines of Covid-19. Patients with mild disease can continue to use targeted drugs or suspend observation. Chemotherapy and immunotherapy are not recommended, and patients with severe disease should stop all antitumor therapy.

For patients with lung cancer in the recovery stage of viral infection, the time of tumor treatment should be moderately delayed. It is recommended to receive targeted therapy at least 2 weeks after pneumonia cure and discharge, and chemotherapy, immunotherapy and intravenous antivascular therapy at least 4 weeks after pneumonia cure.

Some foreign studies have provided data support for the influence of novel coronavirus epidemic on the diagnosis and treatment of lung cancer patients.
Immune checkpoint inhibitors (ICIs) in lung cancer patients in Italy do not appear to be affected by regional epidemics [3].

However, a study in Japan showed that 9.1% of patients with lung cancer during the Novel Coronavirus pandemic needed to delay treatment for lung cancer, with anxiety by patients or their families (86.7%) the main reason for the delay, and the remaining 13.3% being requested by doctors.
No delay in treatment was observed in lung cancer patients receiving molecularly targeted drugs.
Compared with lung cancer patients without delayed treatment, a higher proportion of patients with delayed treatment require ICIS monotherapy [4].


Lung cancer patients are at high risk of contracting new corons

Although Novel Coronavirus can infect anyone, cancer patients are more likely to be at high risk for Covid-19 infection, a conclusion that has been supported by many studies.
Among 1524 cancer patients admitted to the Department of Oncology, Radiotherapy and Chemotherapy of Central South Hospital of Wuhan University, 0.79% were infected with Novel coronavirus, compared with only 0.37% in the general population during the same period.
In the same study, the infection rate of lung cancer patients with non-small cell patients was higher, especially people over 60 years old [5].


Clinical outcomes in patients infected with neocrown lung cancer

Patients over 65 years old or with multiple comorbiditions, moderate to severe asthma, heart disease, immunosuppression, severe obesity (BMI ≥ 40 kg/m2), diabetes, dialysis, liver disease and inpatients living in nursing homes are more likely to develop severe disease after infection with novel coronavirus [6].

Luo J, etc, according to the study, which appeared in the patients with lung infection will be seriously ill after coronavirus (hospitalization rate was 62%, the death rate 25%), but the outbreak during a pandemic will be caused by a coronavirus infection of lung cancer deaths accounted for only a small part of the total deaths (11%), in a critical condition is the most important determinants of smoking status (independent risk factors), the individual characteristics of patients with chronic obstructive pulmonary disease (copd), and the patient’s history of thoracic surgery or radiation therapy, and the recent history of systemic treatment had no significant effect of illness severity [7].
Older than 65 years and male appear to be risk factors for severe disease and poor prognosis (requiring intensive care, invasive ventilation, or death) in patients [8].

In another multicenter retrospective cohort study of 45 lung cancer patients infected with Novel coronavirus from 12 hospitals in Hubei, 11 patients (24.4%) died during hospitalization, which was similar to the mortality rate obtained by Luo J et al.
At the same time, this study found that prolonged PT and elevated high-sensitivity troponin I were also independent risk factors for increased mortality during hospitalization in these patients [9].

In addition, according to a systematic review and meta-analysis of 3019 cancer patients (1628 male and 1391 female) from 15 studies published in November 2020, novel coronavirus-infected patients with cancer had a higher case fatality rate (22.4% overall) compared to non-cancer patients with novel coronavirus-infected patients [8].
Although there was no significant difference in the risk of serious events in patients with lung cancer infected with Novel Coronavirus compared to patients with other solid or hematologic malignancies, the latter had a higher case fatality rate (32.9%) than the overall case fatality rate (17.2%) for solid cancer types other than lung cancer.
This suggests that once the disease progresses to the severe stage, the recovery process of lung cancer patients infected with novel coronavirus may be more difficult [8].

To sum up, novel coronavirus caused this world epidemic to the diagnosis and treatment of lung cancer patients can not be ignored.
As a high-risk group of novel coronavirus infection, the incidence of serious complications and mortality of lung cancer patients infected with the virus increased significantly.

Now CoviD-19 seems to be making a comeback. The above conclusions remind medical workers that it is still necessary to start from the source of infection, transmission route and susceptible population, three key links to control infectious diseases, so as to avoid encounters between novel coronavirus and lung cancer patients who have a double disaster as much as possible.

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