Wenhua Liang and colleagues were the first to focus on COVID-19 infection in patients with cancer (DOI:https://doi.org/10.1016/S1470-2045(20)30096-6). They reported that 18 (1%; 95% CI 0·61–1·65) of 1590 COVID-19 cases had a history of cancer and they showed that patients with cancer had poorer outcomes from COVID-19 than those without cancers. Furthermore, they showed that patients who underwent chemotherapy or surgery in the past month had a numerically higher risk of clinically severe events than did those not receiving chemotherapy or surgery also after adjustment for major prognostic factors. Based on these results, they proposed an intentional postponing of adjuvant chemo therapy or elective surgery for stable cancer in endemic areas.
Italy is currently among the most affected countries and major questions oncologists are confronted with follows:
what you have chosen to do with new patients or patients on treatment who are infected?
What are you doing with patients planned for surgery?
In what circumstances do you continue or hold therapy?
In what circumstances do you restart therapy?
Particularly those on cytotoxic chemotherapy or immunotherapy?
What is the decision we are trying to inform?
decision about whether to treat (in case how) or not to treat a cancer patients with CPVID-19
Who is the decision-maker?
health care professionals dealing with cancer patients
What type of real-world data is needed to generate reliable evidence?
prevalence of cancer patients among patients COVID-19 positive ?
description of cancer treatments in the last 3 months before COVID-19 infection (chemotherapy, surgery, radiotherapy, concomitant chemo-radiotherapy, immuno check point inhibitors)
major clinical features of cancer patients (age, type of comorbidities, cancer stage etc.)
|cancer patients experiences a severe events or death in active treatment (admission to Intensive care unit, requiring ventilation, death. specifically, how many of those experiencing severe event or dying had received surgery, had received cytotoxic chemotherapy or immunotherap,had received concomitant chemo-radio therapy in the last month? to what extend treatment impacted on the outcomes considering also prognostic factors?
How will reliable real-world evidence inform the decision?
(we’ll presume we know the answer to ‘When is the evidence needed?’ = as soon as possible!)
there are no data about COVID-19 impact on cancer patients but 18 cases described in China. The oncological community is taken decision based on expert opinion and are in great need of data to support their choice