Hospital Visits Increase Risk of Infection During COVID-19 Pandemic for Patients With Cancer

A single-institution study from Wuhan, Hubei, showed that admission or recurrent visits to the hospital put patients with cancer at risk for severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and patients with non—small cell lung cancer (NSCLC) over the age of 60 had a higher incidence of coronavirus disease 2019 (COVID-19), which has been linked to SARS-CoV-2.¹

“We propose that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward,” Jing Yu, MD, Zhongnan Hospital of Wuhan University, et al wrote. “For patients who require treatment, proper isolation protocols must be in place to mitigate the risk of SARS-COV-2 infection.”

The infection rate of SARS-CoV-2 was 0.78% (95% CI, 0.3-1.2) in patients with cancer from the single institution. The infection rate was higher than the cumulative incidence of all diagnosed cases of COVID-19 reported in the city of Wuhan over the same period of time, which was 0.37 as of the data cutoff date, February 17, 2020.

Among 12 patients with cancer included in the single-institution study, 3 patients (25%) developed SARS-CoV-2, and 1 patient required intensive-level care. Six patients (50%) were discharged as of March 10, 2020, and 3 deaths (25%) were recorded.

Investigators evaluated the association of SARS-CoV-2 with age and concurrent diagnosis of NSCLC. Out of the 228 patients with NSCLC, 7 patients had COVID-19. However, patients who were over the age of 60 years had a higher incidence of COVID-19 (4.3%) than the younger group (1.8%), whereas 2 of 111 patients ≤ 60 years had COVID-19 compared with 5 of 117 patients > 60 years.

Medical records for 1,524 patients with cancer, including demographic, clinical, and treatment data, were used for the retrospective study. This included patients who were admitted to the Department of Radiation and Medical Oncology at the Zhongnan Hospital of Wuhan University. The COVID-19 pneumonia was diagnosed by updated COVID-19 Diagnostic Criteria, 5^thEdition.

The median age of patients was 66 years old (range, 48-78). Eight of 12 patients were over the age of 60 years, and 7 of 12 patients had NSCLC. Three patients had pancreatic cancer, 2 had rectal cancer, 2 had urothelial carcinoma, 1 had breast cancer and 1 had colorectal cancer. Investigators also noted that 5 patients (41.7%) received chemotherapy with either immunotherapy (n = 3) or radiotherapy (n = 2).

In December 2019, the COVID-19 outbreak occurred in Wuhan, Hubei. Investigators reported the incidences and outcomes of SARS-CoV-2 infection in patients with cancer-based on the hypothesis that they may be more susceptible to infection during a viral epidemic, such as the COVID-19 pandemic.

In a separate analysis of 138 patients who were hospitalized at the Zhongnan Hospital of Wuhan University, 57 patients (41.3%) were presumed to have contracted the novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) in the hospital setting, including 17 patients (12.3%) who were already hospitalized for other reasons and 40 healthcare workers (29%). Of the infected patients, 7 were from the surgical department, 5 from internal medicine, and 5 from the oncology department.²

This analysis also found that the virus could be spread patient-to-patient in the hospital, and at least 4 patients were infected in the same ward of the hospital. One patient was initially diagnosed after presenting with symptoms and a fever. The patient was isolated, but subsequently, the 3 other patients in the same ward presented with fever and similar symptoms and were later diagnosed with 2019-nCoV infection.

The median age of patients in this study was 56 years (range, 22-92), and more than half of the patients were men (54.3%). All patients enrolled had a confirmed diagnosis of NCIP and were monitored up to February 3, 2020. Hospital-associated transmission was presumed as the suspected mechanism of infection among hospitalized patients, as well as healthcare professionals, included in the study.²This analysis supported the rationale for the single-institution study from Yu et al.¹

In conclusion, Yu et al wrote,¹“our findings imply that hospital admission and recurrent hospital visits are potential risk factors for SARS-CoV-2 infection.”

Due to the frequent visitation of patients with cancer to the hospital for either treatment or monitoring, patients with cancer are at greater risk of contracting COVID-19, according to these findings. The study authors suggest that a larger sample size of patients with cancer is needed to verify the findings from this single-institution analysis.

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Reference:

1. Yu J, Ouyang W, Chua MLK, et al. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China [Published Online March 25, 2020].Jama Oncology. DOI:10.1001/jamaoncol.2020.0980.
2. Wang D, Hu B, Hu C, et al. Clinical characteristics if 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China [Published Online February 7, 2020].Jama Oncology. doi:10.1001/jama.2020.1585.