Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8441
Peer-review started: February 18, 2021
First decision: April 6, 2021
Revised: April 7, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 6, 2021
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 has led to an unprecedented global public health crisis. Patients with cancers are particularly suspectable to morbidity and mortality from COVID-19 infection due to their medical risk factors, immune dysfunction, and frequent health care visits for their underlying disease.
To analyze the characteristics of COVID-19 infection among cancer patients which would help treating physicians in optimal management of COVID-19 cancer patients.
In this review article, authors intend to describe the role of critical care in COVID-19 cancer patients and to analyze the various factors which determine the outcome in patients with malignancy and COVID-19.
Authors searched the PubMed and, Medline database for “COVID-19” and “Cancer”, “Malignancy”. Studies published in English, including adults with malignancy and COVID-19 infection, were eligible to be included in this review. We identified two thousand one hundred eighty-six articles, among which eighteen studies were eligible and were included in this review.
A total of 5199 cancer patients were reported. Male predominance was noted in 12 studies. Most reported malignancies with COVID-19 infection were hematological in 44% of patients, followed by thoracic malignancy in 11% of patients. The mean number of cancer patients with COVID-19 requiring critical care was 16%. The mean mortality reported was 27.4%. 72% of COVID-19 cancer patients required hospitalization across all the studies. Majority of the cancer patients required intensive care due to respiratory failure and the need for mechanical ventilation. Male gender, age ≥ 65 years, presence of higher comorbidity burden and smoking history are associated with the worse outcome from COVID-19 infections among the cancer patients. These factors are significantly associated with the patient’s worse outcome independent of oncological features such as tumor stage, disease status, or current provision of active anticancer therapy.
Among symptomatic COVID-19 cancer patients, approximately one in six patients required intensive level of care, and one in four patients had a fatal outcome. It is crucial to identify factors associated with the worse outcome as it helps to provide prognostic enrichment while discussing the goals of care in this specific patient population. Appropriate contingency planning for these patients in terms of goals of care and judicious resource allocation in the resource-poor regions is the key.
In this review, we identified that in the setting of active malignancy cytotoxic treatments can be continued with caution. Cancer patients treated with tyrosine kinase inhibitors were less likely to develop severe forms of COVID-19 infection. Two randomized control trials are ongoing to provide more definitive evidence.