Narrative Review of Lung Cancer Treatment at the Time of COVID-19 Pandemia

Pitfall and Issues

Francesca Casaluce; Cesare Gridelli

Disclosures

Transl Lung Cancer Res. 2021;10(1):475-482. 

In This Article

Abstract and Introduction

Abstract

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for coronavirus disease 2019 (COVID-19) pandemic, has caused disruption in cancer care and research, changing daily management approach of cancer patients, above all for those affected by lung cancer disease. Unfortunately, its length and severity beyond today is still uncertain. This emerged viral pandemic has produced severe illness to overwhelm healthcare infrastructure, with worse impact on public health system and on providers of essential community services, and needing to ration medical equipment and interventions. Several data from across the world highlighted the susceptibility of patients affected by tumors to high severe infection and mortality from COVID-19. Lung cancer patients emerged as "frail" subgroup, mainly attributable to their immunosuppression, co-existing medical conditions and underlying pulmonary compromise. So, the lung cancer care was confounded by urgent need for intervention for most patients and the competing risk of life-threatening COVID-19 infection, and also influenced by competing needs for personnel, beds and equipment for urgent COVID-19 care. Clearly, no one model of care is possible during all pandemic phases or in all medical environments. In this review we will discuss on available data and their impact on prioritizing the individual management for lung cancer patients, with aim to protect them from COVID-19.

Introduction

Identified in late 2019 as a cluster of pneumonia cases, the coronavirus disease 2019 (COVID-19) pandemic has no true precedent in modern times and is a rapidly evolving crisis worldwide, affecting more than 3 million people and forcing the medical community to reexamine every aspect of healthcare delivery.[1] Given the systemic immunosuppressive state caused by malignancy and anticancer treatments, cancer patients face the double ordeals of disease and epidemic situation, appearing more likely vulnerable than general population. Up to date, data on clinical characteristics and outcomes of oncologic patients with COVID-19 infection are not detailed and still poor, representing a minority in all series reported. As suggested from early retrospective Chinese reports, cancer patients who are infected with COVID-19 are also associated to poor outcomes and higher occurrence of severe complications, and consequently higher mortality.[2–5] About cancer care strategies, contrasting and limited data are available, but some series have shown higher risk of clinically severe events (HR: 4.079) for those patients who underwent treatment administration within 2 weeks,[3] with chemotherapy as the worse ongoing treatment, followed by immunotherapy and at last by targeted therapy.[5] Similarly, higher mortality and higher chances of having critical symptoms have reported after cancer surgery.[6] A recent meta-analysis from 11 series revealed an overall pooled prevalence of COVID-19 cases in cancer patients of 2–3%, more high than previously published results.[7] Despite several limits—small series and selected population, above all—this value confirms cancer patients and cancer survivors as an important vulnerable population for the COVID-19 contamination. We present the following article in accordance with the Narrative Review reporting checklist (available at http://dx.doi.org/10.21037/tlcr-20-640).

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