Researchers from Harvard, Lausanne University Hospital in Switzerland, Vanderbilt University Medical Center, and Columbia University Medical Center authored a review compiling over 160 references to analyze the relationship between COVID-19 and cancer.
Published online in earlier this month, the review summarizes five facets of cancer care that have been affected by the pandemic: the biological link between COVID-19 and cancer; testing for COVID-19 in cancer patients; changes to therapeutic, surgical, and medical cancer care delivery; clinical risk factors for COVID-19 in cancer patients; and COVID-19’s impact on cancer researchers and clinicians.
Jessica Hawley, a first author on the study and assistant professor of medicine at Columbia University, said the review was inspired by a desire to create a concise and readable of information for cancer centers and community clinics to use as a “strategic framework” for treatment and risk mitigation in cancer and COVID-19 patients.
“The amount of publications out there on COVID is just very overwhelming,” Hawley said. “We wanted to pull together as much as we could.”
The pandemic has had significant negative effects on certain patient populations such as those with cancer, according to the paper: Evidence shows cancer patients are more likely to be infected by SARS-CoV-2, develop a COVID-19 infection, and die as a result of COVID-19. A recent meta-analysis estimates that patients with active malignancy experience higher observed death rates from COVID-19 by approximately 25 percent. Previous estimates of the observed death increase ranged from 5 to 61 percent.
Despite potential adverse outcomes caused by COVID-19, cancer research has offered several promising approaches to treating the disease.
One of the most notable approaches involves cytokines — proteins secreted by the immune system that regulate inflammation — according to Ziad Bakouny, another first author of the paper and a postdoctoral research fellow at the Harvard-affiliated Dana Farber Cancer Institute.
“We've been able to use all things that we have learned from the biology of cancer, and now we've tried to implement that to improve the care of patients with COVID-19,” Bakouny said. “Cytokine release syndrome is a syndrome that is a complication of some of the immune therapies used in the treatment of cancer.”
“These therapies are now being tried in the cytokine storm of COVID-19, which is very similar in terms of its pathophysiology,” Bakouny added.
The pandemic has also led to changes in patient care that could improve cancer care experiences, including increased flexibility and access to medical advice remotely via telemedicine, according to Hawley.
“One of the big takeaways for me personally is that in compiling all of these different references and papers and things, that we actually have learned some positive things in dealing with cancer care delivery during a pandemic,” Hawley said. “Cancer centers have, and community clinics also, have really taken different measures to help improve care and make things more flexible for patients and the lessons that we've learned in taking care of patients during the pandemic should be perpetuated forward.”
Jeremy L. Warner, another author of the paper and an associate professor of medicine and biomedical informatics at Vanderbilt University, said the review lays the groundwork for future discussions of how COVID-19 may change patients’ treatments and outcomes.
“There's still a lot to understand about the survivors of COVID-19,” Warner said. “The question of whether the virus itself might affect their cancer trajectory, whether long term symptoms might alter their prognosis — those are the types of questions that we're going to be asking over the next months and years, really, and I think our review article sets the stage for that.”