Why are cancer patients with COVID-19 more likely to develop severe events?

Many articles have reported that cancer patients are more susceptible to COVID-19 pneumonia and cancer patients with COVID-19 seem to be more often tend to develop severe events. In these studies of infected cancer patients, factors associated with a higher risk of developing severe events included age, baseline fragility, and anti-tumor treatment. However, specific reasons regarding why infected patients with cancer have a higher probability of severe events compared to non-cancer infected patients remain unclear. Thus, we sought to study one particular factor to determine a potential associative effect: differences in Computed tomography (CT) findings. In our study,we found that cancer patients represent a special population which multiple lobes of the lungs were more susceptible to infection by the SARS-CoV-2, and thus were more likely to be transferred from mild illness to severe, should be deserved more intensive attention during the SARS-CoV-2 pandemic. Why are cancer patients with COVID-19 more likely to develop severe events? Jianping Bi, Yajie Wang, Tingting Nie, Vivek Verma, Guoliang Pi, Changchun Chen, Guowu Jiang and Guang Han * Correspondence to: Guang Han, Hubei cancer Hospital, 430079, China. E-mail: 562674771@qq.com. Tel: +86 02787670275; Fax: +8602787670150; Guowu Jiang, Hubei cancer Hospital, 430079, China. E-mail: 245666126@qq.com.

To the Editor, We read with interest the recent paper by Zhang et al, who described in a retrospective case study of 28 patients, that 53.6% of cancer patients with COVID-19 developed severe events [1]. Additionally, the publication by Hirotaka described that patients with cancer were intubated significantly more frequently than those without cancer [2]. Therefore, cancer patients with COVID-19 seem to be more often tend to develop severe pneumonia. In these studies of infected cancer patients, factors associated with a higher risk of developing severe events included age, baseline fragility, and anti-tumor treatment. However, specific reasons regarding why infected patients with cancer have a higher probability of severe events compared to non-cancer infected patients remain unclear.
Thus, we sought to study one particular factor to determine a potential associative effect: differences in Computed tomography (CT) findings. According to the updated COVID-19 Diagnosis and Treatment Plan (Provisional 7th Edition) of China [3], the serum antibody test for SARS-CoV-2 may be used as a diagnostic criterion. CT images can also be used as an important complement for diagnosis of COVID-19 pneumonia.
Herein, all inpatients and their companions were required to screen for SARS-CoV-2 infection using chest CT scans and viral serum IgM and IgG antibodies by colloidal gold immunoassay in the Hubei Cancer Hospital. All subjects found to harbor antibodies to SARS-CoV-2 were further evaluated by RT-PCR for viral nucleic acid. All CT images were independently reviewed by two experienced thoracic radiologists blinded to clinical data. CT imaging features were described as previously reported by Meng et al [4].
Radiologic features upon admission are shown in Table 1. CT image features of cancer patients, the predominant feature was ground glass opacity (GGO) with peripheral distribution (90.9%), most commonly bilateral (77.3%), and mostly involving [?]3 lung lobes (72.7%). In a previous report 4 , the predominant CT findings in asymptomatic patients without cancer was GGO with peripheral distribution (75.9%), unilateral location (58.6%), and mostly involving [?]2 lung lobes (65.5%). In our study, among caregivers, three (60.0%) had unilateral disease. Only one (20.0%) patient had [?]3 lobes involved. Therefore, based on the lung distribution of CT-evident lesions, cancer patients with COVID-19 pneumonia may be more vulnerable to lung damage with the potential to develop severe evens.
The factors that led to severe illness for cancer patients with COVID-19 were comprehensive: age, nutritional status, general conditions, medical resources, etc. However, cancer patients represent a special population which multiple lobes of the lungs were more susceptible to infection by the SARS-CoV-2, and thus were more likely to be transferred from mild illness to severe, should be deserved more intensive attention during the SARS-CoV-2 pandemic.

Funding
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