Delaying Cancer Treatment During Pandemic Likely Unnecessary

By Marilynn Larkin

December 22, 2020

NEW YORK (Reuters Health) — Delaying active cancer treatment to avoid SARS-CoV-2 infection should not be routinely recommended, new findings from Italy suggest.

"We are reassured by these results, (which) allow oncologists and patients to make informed decisions regarding antitumor treatment during this pandemic," said Dr. Carlo Aschele of Ospedale Sant'Andrea in La Spezia.

"At the time the study was (conceptualized) and designed, early reports from China indicated a much higher risk of COVID-19 among oncologic patients compared to the general population," he told Reuters Health by email. "In Italy, oncologists, and patients as well, were terrified, expecting to face a huge amount of infections and death, particularly among patients receiving chemo or immunotherapy."

To investigate, the team analyzed data on close to 60,000 patients treated between January and May in 118 medical-oncology units throughout Italy.

Overall, 406 patients (0.68%) developed COVID-19, as confirmed by a positive nasopharyngeal PCR test, a rate 42% higher than that of the general population. The median age of the infected patients was 68 and about half were women.

"From a clinical point of view, the low probability of SARS CoV-2 infection among these patients (<1%) supports the continuation of most oncologic treatments in the adjuvant and metastatic setting," the researchers write in JAMA Oncology. "Based on the present data, delaying active antitumor treatment to avoid SARS-CoV-2 transmission should not be routinely recommended."

Most of the infected patients (83%) were symptomatic and 77% were hospitalized. Lung cancer was the most common tumor (22%), followed by breast cancer (18.5%). Chemotherapy with or without biologics was the most common treatment (60%).

The infection rate was higher compared with the general Italian population during the same time period and varied among geographical areas. For example, in Northern Italy, the rate was 0.96 versus 0.68 among the general population (rate ratio, 1.40); in Southern Italy and the islands, the rate was 0.13 versus 0.08 (RR, 1.65).

"The lower risk increment observed in our study - i.e., 1.4-fold compared the general Italian population - may (be due to) the much larger sample size, but most likely also reflects reorganization measures implemented in medical oncology day hospitals in Italy at the beginning of the pandemic outbreak," Dr. Aschele said. "Similar measures were implemented, I think, in European and U.S. oncologic units, and our results may thus hold true elsewhere."

"An additional measure now implemented during the second wave is periodic screening of patients receiving antineoplastic treatment. This could further minimize the risk of COVID 19 spread among the patients," he added.

Dr. Daniel Geynisman, associate professor in the department of hematology/oncology at Fox Chase Cancer Center in Philadelphia, told Reuters Health by email, "Previous reports . . . have been somewhat conflicting, but in general concluded that the rate and severity of SARS-CoV-2 infection in cancer patients is higher than in the general population."

"However, aside from those with lung cancer and hematologic malignancies, it appears that comorbidities and age are the major drivers of (COVID-19) disease severity, rather than the cancer itself or its treatment," said Dr. Geynisman, who was not involved in the new research.

"As such, the key is to individualize care by carefully screening, testing and risk stratifying cancer patients, while continuing to provide the standard-of-care oncologic treatments," he said. If a patient is infected with the virus, "withholding most therapies until the resolution of symptoms and repeat negative testing is also prudent."

"For some very low-risk malignancies or those in which the benefit of systemic therapy is questionable, withholding therapy until immunization may be appropriate," he said. "For most malignancies where timing of treatment is important, continuing systemic therapy is appropriate.

"Finally," he added, "most cancer patients should receive the COVID-19 vaccine, and this should help make these decisions easier."

SOURCE: https://bit.ly/3nFhRvF JAMA Oncology, online December 17, 2020.

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