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Patients with cancer face unique challenges in the midst of the COVID-19 pandemic: not only do they have an increased risk of contracting COVID-19 in hospital settings, but they also experience more severe clinical outcomes from the disease compared with patients without cancer. In this interview with i3 Health, Miao Liu, MD, PhD, one of the investigators who recently reported these findings in Cancer Discovery, discusses the difficult challenges that patients with cancer face as they continue to receive treatment. In addition, he shares strategies that members of the cancer care team can utilize to ensure that their patients receive optimal care during the COVID-19 pandemic.
Can you comment on the significance of your findings regarding COVID-19 outcomes in patients with cancer?
Miao Liu, MD, PhD: Generally, patients with cancer showed a vulnerable trend in COVID-19 risk and outcomes. However, their different stages and subtypes of cancer also played a role. While our research found that cancer patients with early-stage disease did not show more risk compared with individuals without cancer, our results also showed that patients with metastatic cancer, as well as patients who had received surgery, have increased risk during the COVID-19 outbreak.
How should members of the cancer care team manage the treatment of COVID-19 patients with cancer who are receiving immunotherapy?
Dr. Liu: Some new anticancer immunotherapy treatments are more popular in the United States than in China, including chimeric antigen receptor (CAR) T-cell therapy and programmed death ligand 1 (PD-L1) inhibitors. While the conclusion may not be representative because of the small population size, outcomes were unfortunately very bad in patients who received these treatments. Patients with cancer who have received or are currently receiving immunotherapy should be monitored more closely if they are infected with COVID-19.
What are some of the possible reasons for COVID-19 patients with hematological cancers experiencing more severe clinical outcomes compared with other types of cancer?
Dr. Liu: Patients with hematological cancers frequently experience immunosuppression due to their disease and treatment, which results in increased susceptibility to COVID-19 and poorer outcomes. The latest publication led by researchers from Albert Einstein College of Medicine has come to the same conclusion.
Do you have any words of advice for community oncologists and other members of the cancer care team as they continue to treat their patients during the COVID-19 pandemic?
Dr. Liu: Most patients with cancer who receive treatment while their disease is in the early stages can experience a good outcome from COVID-19. Therefore, we do not recommend that these patients postpone their cancer treatment schedule because of COVID-19, given that social distancing and protective measures are fully implemented. However, because patients with metastatic cancer exhibited an increased risk of contracting COVID-19 in our study, I strongly recommend that these patients be equipped with stronger personal protective equipment (PPE), such as gowns and N95 masks, as they continue to receive treatment. Facilities should also increase their in-hospital infection control and offer appropriate online medical services to minimize risk to cancer patients during the COVID-19 outbreak.
About Dr. Liu
Miao Liu, MD, PhD, is a senior research associate in the Department of Pathology at Brigham and Women's Hospital of Harvard Medical School in Boston, Massachusetts. Dr. Liu's research focuses on the development of novel therapeutics for cancer treatment, with a particular interest in the study of stem cell biology.
For More Information
Dai M, Liu D, Liu M, et al (2020). Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak. Cancer Discov. [Epub ahead of print] DOI:10.1158/2159-8290.CD-20-0422
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of i3 Health.