This page was last updated on 07/02/2020. Please check back frequently for updates.
What are the current data on care of patients with cancer and COVID-19? Are patients with cancer more likely to be infected? Do they have more complications?
The CDC is frequently updating its information on COVID-19. For the most up to date general information on the virus and the epidemic, the CDC is best source of information.
Mortality of patients with cancer and COVID-19
The best available evidence available at this time suggests that patients with cancer are at increased risk of death compared to patients without cancer. Two meta-analyses of studies of mortality in patients with cancer and COVID-19 have been reported. These meta-analyses had differing inclusion criteria and search windows, but the results were consistent. Giannakoulis et al, JCO Glob Oncol found a statistically significant increase in all-cause mortality [risk ratio (RR) 1.66 (95% CI 1.33-2.07)] in an analysis of 8 studies including 1,428 patients with cancer and 36,379 patients without. Venkatesulu et al, medRxiv similarly found a statistically significant increase in all-cause mortality [odds ratio (OR) 2.54 (95% CI 1.47-4.42) in an analysis of 10 studies including 22,166 patients with cancer and 143,814 patients without.
Severity and complications in patients with cancer and COVID-19
Several meta-analyses have been published (Wang et al, Aging (Albany NY); Ofori-Asenso et al, ecancermedicine; Singh et al, Diabetes Obs Metab) that have analyzed the risk of severe complications from COVID-19 in patients who have cancer compared to those who do not. The most comprehensive of these to date, Singh et al, reports a relative risk (RR) of 2.48 (95% CI 1.46-4.19) from an analysis of 18 studies.
Several reports from China (Dai et al, Cancer Discov; Zhang et al, Cancer), as well as the United States (Myashita et al, Ann Oncol; Kuderer et al, Lancet), provide similar results. Difficulties in interpreting these data have also been expressed by the Editors of the Journal of Clinical Oncology (Cannistra et al, JCO).
Incidence of COVID-19 among patients with cancer
Yu et al, JAMA Oncol reported on 1524 patients with cancer admitted from December 30, 2019 to February 17, 2020 to an oncology department of a hospital in Wuhan, China. The authors found that the infection rate among the patients with cancer (0.79% (12 of 1524 patients; 95% CI, 0.3%-1.2%) was higher than the cumulative incidence in the community served by the hospital (0.37%). Five of the 12 patients were undergoing anti-cancer therapy at the time of hospital admission. In a similar study, Rogado et al, Clin Transl Oncol reported a cumulative incidence of COVID-19 among 1069 patients with cancer admitted to a hospital in Madrid, Spain of 4.2% (45/1069), as compared to a cumulative incidence rate of 0.63% for Madrid as a whole.
Prevalence of cancer in patients with COVID-19
Several systematic reviews have been published (Desai et al, JCO Glob Oncol; Emami et al, Arch Acad Emerg Med; Ofori-Asenso et al, ecancermedicine) that include estimates of the prevalence of cancer in patients with COVID-19. These estimates range from 0.92% to 3.4%.
However, higher prevalence of cancer in patients with COVID-19 has been seen in studies not included in the systematic reviews due to publication date. Montopoli et al, Ann Oncol reported that among 9,280 patients with COVID-19 treated in 68 hospitals in Veneto, Italy, 8.5% had a diagnosis of cancer.
Data related to specific cancer types
He et al, Leukemia reported on a cohort study of 128 patients with hematological cancers with COVID-19 infection compared with a contemporaneous set of 226 health care providers with COVID-19 infection as a comparison group. There was no significant difference in the proportion of patients with hematological cancers vs. health care providers (10% vs. 7%, p=0.322), but there was a significant difference in case fatality rate (62% vs. 0%, p=0.002). Most of the patients had either acute myeloid (39%) or acute lymphoblastic leukemia (20%); 59% had received chemotherapy, with a median interval from the end of the last cycle of chemotherapy of 9 days (range 7-19 days).
Cook et al, Br J Haematol have reported a high rate of mortality among patients with multiple myeloma with confirmed COVID-19 infection in the United Kingdom. Out of 70 patients identified via clinical audit at multiple institutions, 41 (54.6%) died, with a median time from onset of symptoms to death of 8.5 days.
Robilotti et al, Nature Med have reported a strong association (OR of 2.49, 95% CI 1.35-4.67) between hematological malignancy and risk of hospitalization in an analysis of 423 patients with COVID-19 treated at a single institution in New York City.
Luo et al, Ann Oncol reported a high rate of mortality among patients with lung cancer and confirmed COVID-19 at an institution in New York City. Out of 102 patients, 25 (25%) died and 63 (62%) required hospitalization.
As further evidence becomes available, ASCO will update this page.
General Care: What are the recommendations for general care of patients with cancer?
ASCO encourages anyone caring for patients with cancer to follow the existing CDC guidance where possible:
- General health care facility and health care professional guidance
- Clinical care guidance
- Home care guidance
- High-risk subpopulation guidance
In addition to the general CDC guidance, the following practice points may be considered:
- Patients should be informed regarding the symptoms of COVID-19, and trained in proper handwashing, hygiene, and minimizing exposure to sick contacts and large crowds.
- At this time, no specific evidence on mask use by patients with cancer has been published. Patients and clinicians are urged to follow the CDC’s general guidance on mask wear — which now recommends that everyone should wear a cloth face cover when they go out in public — as well as guidance from local health authorities. There is no evidence to suggest that N95 masks are required.
- For cancer patients with fever or other symptoms of infection, a comprehensive evaluation should be performed, as per usual medical practice.
Testing for COVID-19: What information is available on testing for COVID-19?
ASCO has prepared a special report, A Guide to Cancer Care Delivery During the COVID-19 Pandemic. This report provides guidance on testing for COVID-19 in both patients with cancer and in care providers.