Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak

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Abstract

In a study of 105 patients with cancer and 536 without, all with confirmed COVID-19, cancer was predictive of more severe disease, with stage IV cancer, hematologic cancer, and lung cancer being associated with worse outcomes.

Abstract

The novel COVID-19 outbreak has affected more than 200 countries and territories as of March 2020. Given that patients with cancer are generally more vulnerable to infections, systematic analysis of diverse cohorts of patients with cancer affected by COVID-19 is needed. We performed a multicenter study including 105 patients with cancer and 536 age-matched noncancer patients confirmed with COVID-19. Our results showed COVID-19 patients with cancer had higher risks in all severe outcomes. Patients with hematologic cancer, lung cancer, or with metastatic cancer (stage IV) had the highest frequency of severe events. Patients with nonmetastatic cancer experienced similar frequencies of severe conditions to those observed in patients without cancer. Patients who received surgery had higher risks of having severe events, whereas patients who underwent only radiotherapy did not demonstrate significant differences in severe events when compared with patients without cancer. These findings indicate that patients with cancer appear more vulnerable to SARS-CoV-2 outbreak.

Significance:

Because this is the first large cohort study on this topic, our report will provide much-needed information that will benefit patients with cancer globally. As such, we believe it is extremely important that our study be disseminated widely to alert clinicians and patients.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Nanshan Chen, Min Zhou, Xuan Dong … (2022)

Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Author and article information

Journal

Journal ID (nlm-ta): Cancer Discov

Journal ID (iso-abbrev): Cancer Discov

Journal ID (hwp): candisc

Title: Cancer Discovery

Publisher: American Association for Cancer Research

ISSN (Print): 2159-8274

ISSN (Electronic): 2159-8290

Publication date (Print): June 2020

Publication date (Electronic): 28 April 2020

Publication date PMC-release: 28 April 2020

Volume: 10

Issue: 6

Pages: 783-791

Affiliations

[1 ]Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.

[2 ]Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China.

[3 ]Hubei Cancer Clinical Study Center, Wuhan, China.

[4 ]Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts.

[5 ]Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.

[6 ]Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

[7 ]Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.

[8 ]Cancer Center, Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.

[9 ]Department of Emergency, The Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.

[10 ]Department of Gynecology, The Central Hospital of Huanggang, Huanggang, Hubei, China

[11 ]Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China.

[12 ]Department of Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, China.

[13 ]Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China.

[14 ]Cancer Center, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.

[15 ]Department of Oncology, The Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.

[16 ]Department of Radiology, Hubei Cancer Hospital, Wuhan, Hubei, China.

[17 ]Department of Thoracic Surgery, Hubei Cancer Hospital, Wuhan, Hubei, China.

[18 ]Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China.

[19 ]Department of Oncology, Wuhan Puren Hospital, Wuhan, Hubei, China.

[20 ]Department of Obstetrics and Gynecology, The Central Hospital of Xianning, Xianning, Hubei, China.

[21 ]Department of Oncology, The Central Hospital of Xiaogan, Xiaogan, China.

[22 ]Department of Obstetrics and Gynecology, The People's Hospital of Huangmei, Huangmei, Hubei, China.

[23 ]Department of Obstetrics and Gynecology, Xiangyang First People's Hospital affiliated to Hubei University of Medicine, Xiangyang, Hubei, China.

[24 ]Department of Obstetrics and Gynecology, The People's Hospital of Shiyan, Shiyan, Hubei, China.

[25 ]Harvard Stem Cell Institute, Harvard Medical School, Boston, Massachusetts.

[26 ]Cancer Science Institute of Singapore, National University of Singapore, Singapore.

[27 ]Harvard T.H. Chan School of Public Health, Dana-Farber, Harvard Cancer Center, Boston, Massachusetts.

Author notes

[* ] Corresponding Authors: Hongbing Cai, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China. Phone: 86-1-339-716-8990; Fax: 027-6781-2648; E-mail: chb21051@ 123456163.com ; Mauricio Santillana, Boston Children's Hospital, Harvard Medical School, Boston, MA. Phone: 617-919-1795; E-mail: msantill@ 123456g.harvard.edu ; and Miao Liu, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115. Phone: 857-350-7065; E-mail: mliu0@ 123456bwh.harvard.edu

Article

Publisher ID: CD-20-0422

DOI: 10.1158/2159-8290.CD-20-0422

PMC ID: 7309152

PubMed ID: 32345594

SO-VID: e1c8a872-5e50-444b-a409-cd195b7d8d88

License:

This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

History

Date received : 02 April 2020

Date revision received : 16 April 2020

Date accepted : 23 April 2020

Page count

Figures: 2, Tables: 2, Equations: 0, References: 23, Pages: 9

Funding

Funded by: National Natural Science Foundation of China, https://doi.org/10.13039/501100001809;

Award ID: 8197103302/H16

Award Recipient : H. Cai

Funded by: Singapore Ministry of Health's National Medical Research Council, ;

Award ID: MOH-STaR18nov-0002

Award Recipient : H. Cai

Funded by: NIH, http://dx.doi.org/10.13039/100000002, NHLBI, https://doi.org/10.13039/100000050;

Award ID: P01HL095489

Funded by: Xiu Research Fund, ;

Award Recipient : L. Chai

Funded by: Institutional Ethics Board of Zhongnan Hospital of Wuhan University, ;

Award ID: 2020029

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