From the WebMD Archives

May 28, 2020 -- Cancer patients diagnosed with COVID-19 who are otherwise generally healthy can and do survive the coronavirus, according to a new study that evaluated 928 patients with both conditions. But there was much bleaker news for cancer patients with COVID-19 who also had other medical issues, such as high blood pressure and diabetes.

Overall, the death rate from COVID-19 for cancer patients over the study's 3-week follow-up was 13%, says study lead author Jeremy Warner, MD, an associate professor of medicine and biomedical informatics at Vanderbilt University, Nashville.

That’s higher than the estimated 5.9% case-fatality rate for the U.S.

When Warner looked at a small group of 86 patients who had no other medical problems in addition to the cancer and the coronavirus and had been functioning normally despite the cancer, he found that all of them survived.

Those at higher risk of dying included:

  • Older patients
  • Men
  • Smokers or former smokers
  • Patients with two other conditions
  • Those with active cancer
  • Patients who had taken the drug combination of hydroxychloroquine and azithromycin

Warner says 270 patients received the drug combination. At the time the study began, in mid-March, ''those were the most used drugs in the treatment of patients with COVID," he says.

Module: video
Leonard Lichtenfeld
 
Coronavirus in Context: Why Delaying Cancer Care Puts You At RiskWebMD's Chief Medical Officer, John Whyte, speaks with J. Leonard Lichtenfeld, Deputy Chief Medical Officer, American Cancer Society to discuss why delaying cancer care and treatment puts you at higher risk.647

[MUSIC PLAYING]

JOHN WHYTE: You're watching

Coronavirus in Context.

I'm Dr. John Whyte, Chief

Medical Officer at WebMD.

I'm joined today by Dr. Len

Lichtenfeld.

He's the Deputy Chief Medical

Officer of the American Cancer

Society.

Doctor Lichtenfeld, thanks

for joining me.



LEONARD LICHTENFELD:

My pleasure.



JOHN WHYTE: You know,

we've been telling patients

to stay away from the hospital,

don't come in.

And they have been staying away.

I saw a report, um,

late last week that says

87% of mammograms are down,

90% of colonoscopies,

nearly 60% of PSA tests.

And there's the belief

that this decrease in screening

can lead to 80,000 fewer cancer

diagnoses.

How concerned should we

be about this?



LEONARD LICHTENFELD: Obviously,

John, whenever there's a change

in a typical pattern,

we all become very concerned.

So, uh, that-- that's a given.

Quite honestly,

I am not surprised, personally,

that we've seen those declines.

The American Cancer Society,

among other organizations,

told people not to get-- people

at average risk, I should add,

not to get routine cancer

screenings during this period

of time.

That the risk of going

into a medical setting

was higher than--

than the benefit

of the screening.

And again emphasizing people

of average risk.

And there's also no question

in my mind that as we come out

of this,

as we begin to not get--

we won't get back to normal,

but whatever that new normal is,

we're going to see a backlog

of people who will go get

screened.

And we will have an increase,

consequently, of patients who

are diagnosed with cancer.



My biggest concern is--

is really twofold.

Number one, the people

at highest risk

get screened as appropriate.

So let's say someone

with the BRCA test.

That people with a sign

or symptoms that suggest they

may have cancer, whether they

have rectal bleeding,

for example, or a breast lump,

that they make sure they

don't wait.

That-- that's not screening.

That's-- that's diagnosis.

I think we'll work our way

through this.

But yes, there will be a delay.

And we-- we will find out

how much of an impact

it actually has had.



JOHN WHYTE: American Cancer

Society put out a report

recently that talked

about clinical trials

in-- in cancer care.

And the FDA has put out

some guidances about how

to minimize the number of, uh,

blood draws that people need,

tissue samples, et cetera.

But it's hard enough to get

people to enroll in--

in clinical trials.

Are-- do you think we're going

to be moving to clinical trials

in home?

Should patients just say, you

know what, I'm not going

to worry about it right now?

But then-- then it becomes

six months, a year,

and then all of a sudden,

we're not reaching recruitment,

even to a worst degree

than before.



LEONARD LICHTENFELD: There,

again, is no question

that clinical trials have been

impacted.

Some that were supposed to start

didn't start, and some that did

start, there have been problems

getting the drugs to patients

or continuing the treatment.

So it's a major issue.

We aren't really

great in this country getting

people on clinical trials

in the first place.

And so this disruption

from the pandemic is not going

to make that circumstance

any better.



The research enterprise

in general

has been significantly impacted

by COVID-19.

And on the clinical side,

as we're talking about here

with clinical trials,

but also on the basic research

side.

You know, we-- we did a survey.

50%, about 50%

of the investigators can't-- you

know, at the time we did

the survey, couldn't get

into their labs.

The other 50% were severely

restricted.

And the same goes

on the clinical side as well.

So it will have an impact.

And I know that--

that organizations are trying

to do workarounds to make sure

that impact is limited.



You mentioned clinical trials

at home.

Yes, they're trying to get

the drugs to patients where they

are, wherever that may be.

And also, let's not forget

the people who used to travel

to some

of these major institutions

for a particular drug can't get

there.



So, um, the story,

unfortunately, I wish we had

a better handle on the pulse

of what's actually happening.

We hear anecdotes, but we don't

have much organized information.

But I-- I sincerely hope, along

with you, I'm sure, that we get

this-- this-- this back on track

as soon as we possibly can.



JOHN WHYTE: And how concerned

should patients be when

their protocols are adjusted?

So maybe they were receiving

an infusion and now they're

receiving an oral medicine,

you know, a pill.

And you and I know that can

cause a lot of anxiety

on the part of patients.

So what can we tell them?

How-- how can we help them?



LEONARD LICHTENFELD: So I think

that there's, you know,

in every bad situation is always

some good news that comes out

of it.

And medical organizations,

first-- first off,

physicians, oncologists,

and surgeons, or radiation

oncologists at local levels,

have gotten together to try

to figure out what's best

for patients

under these circumstances.

But on a national level,

we've

seen

reputable medical organizations

come together and say what they

think has to be done today

and what they--

where the modifications can

occur.

So it's no longer happening

in a vacuum.



When we first started, a lot

of what we call ad hoc,

a lot of decisions

were made on the fly.

But now it's getting back

into an organization,

and it's actually been

fascinating to hear the experts

on webinars who say, you know,

we've taken a good look at this,

and we think we can do it

this way instead of that way,

and there won't be any harm.



And by the way, there's research

that suggests that what we're

doing,

these changes won't be

a problem.

But yes, when you're a patient

and you have cancer

and you want to be treated

and you want to get the best

treatment possible, any changes

is a problem.

One thing that I would

want to point out.

It's going to be the health care

we need, and it may not

be the health care we want.



But I know

that every oncologist,

particularly those involved

in cancer care,

are doing their utmost, doing

their best to make sure

the patients, uh, have

the least--

least inconvenience,

and frankly, the least

harm from any of the adjustments

that have to be made.



JOHN WHYTE: What do cancer

centers and hospitals need

to start doing to help patients

recognize,

depending upon what's happened

in their local community,

that it's safe to come back

into the hospital?

To your point at the beginning,

we told them it's-- it's not

safe.

It was also, we didn't have

enough equipment in terms

of, you know,

personal protection.



But how do they know that, you

know, maybe it's safe

to consider that colonoscopy,

even at average risk?

Because we know those are often

delayed, that we know it's time,

you know, to get some blood

draws.

Blood draws our 90% down.

You know, who's getting any type

of blood test

that's not COVID-related?



So there is a communication

issue, I think, in terms of,

you know, we told them it's not

safe to come in.

Now we're starting to say

it might be.

Soon we'll be saying,

you know,

under these circumstances,

you can come in.

Let's be honest.

That can be

confusing to patients,

and in patients

with cancer who are very

anxious.



LEONARD LICHTENFELD: John,

there's no question.

I mean, first off,

let's understand,

all of the communications

surrounding this pandemic

has been confusing.

Uh, and, you know,

for-- for the general public,

they've gotten so many

mixed messages.

And one-- one place does one

thing, another place does

another thing.

Maybe there's equipment, maybe

there's testing, no, there

isn't.

So-- so all-- everyone

is confronted.

Including me, and you, and all

the medical community,

are confronted

by mixed messaging.

Um, you know, I--

this is really going to put

a responsibility

on the shoulders

of the medical community

in particular, when we're

talking about health care.



The medical community,

the medical facilities,

the medical institutions,

the universities, the cancer

centers, whatever it may be.

It's going to put

a major responsibility

on their shoulders to show

the patients, the public,

that-- that, in fact, they're

taking

every step possible to keep

everyone

safe in a difficult situation.

We're not going to go back

to normal.

There's not going to be a day,

uh-- there was-- there actually

were some predictions about what

that day may be,

literally for different parts

of the country.

That's gone.

I mean, we're now-- each--

each day is another day.



So medical facilities, doctors,

patients, nurses, health

professionals of every type,

have to make sure they put

patient safety as a priority,

and that they prioritize who has

to come in earliest, who does

need that blood draw now,

and frankly, who can wait.

You know, sometimes, instead

of a colonoscopy, maybe

this year it can be a stool test

for blood.

Maybe that's what we do.



JOHN WHYTE: [INAUDIBLE]



LEONARD LICHTENFELD: Maybe you

don't need a-- a mammogram

every year.

Maybe if you're 60 years

old at average risk,

you can get it every two years.

That's-- the American Cancer

size says that's OK, as do other

organizations.

So, you know--



JOHN WHYTE: But as you know,

patients often don't know

whether they're at average risk

or not.

There's a lot

of misunderstanding about that.

And certainly to your point

early on, if-- if people are

having symptoms,

they feel a lump,

they have bleeding, they have

a mole that, you know,

is rapidly changing,

that's not screening.

And in some ways, that requires

something different.

So we have to make sure we give

patients good information too.

What advice would you

and American Cancer Society

give for-- for cancer patients,

their families, who are often

part of, you know,

the entire treatment process,

during this pandemic?



LEONARD LICHTENFELD: So cancer

patients, unfortunately, are

at a special risk, higher risk

of getting complications

of COVID-19

or getting it if they get

the infection

in the first place.

So we have been sharing

that it's really

important for cancer patients

and their families

to take this seriously,

to protect themselves

as much as possible,

especially if they're

on treatment or recently been

in treatment.

And even some studies suggest

as far out as three years

they've had chemotherapy,

there may be some problems.

And there may be

some disagreement about that.

But the-- the point is,

is important.



Take care of yourself,

shelter in place,

follow the recommendations,

be around people who use masks,

wash your hands, socially

distance.

And families can have

a huge role in making sure

that their loved ones stay safe.

It may be a matter of doing

the grocery shopping

and making sure that a parent

is--

is-- is cared for properly.

But extra special caution.

When we say wash your hands,

wash your hands.

Use hand-- you know,

hand sanitizer.

Use hand sanitizer.



All those things,

all those messages are--

are what's most

important to keep yourself safe.

That's actually

true for everyone-- everyone,

but especially for patients

with cancer.



JOHN WHYTE: Well, Dr.

Lichtenfeld, I want to thank you

for taking time today.



LEONARD LICHTENFELD: And Thank

you.

It was a pleasure.



JOHN WHYTE: And I want to thank

you for watching Coronavirus

in Context.

I'm Dr. John Whyte.

John Whyte, MD, MPH. Chief Medical Officer, WebMD, J. Leonard Lichtenfeld, MD, MACP, Deputy Chief Medical Officer, American Cancer Society/delivery/aws/69/e0/69e0cbd5-00a1-361c-8be5-85fa67d6dc8b/Lichtenfeld_051120_,4500k,2500k,1000k,750k,400k,.mp405/18/2020 11:20:0018001200Leonard Lichtenfeld/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Lichtenfeld_051120_1800x1200.jpg091e9c5e81eff4f9

"What we did find was a three-fold risk of death in the patients who got the combination," Warner says, but the researcher can't explain the finding with certainty. "Whether it means the drugs themselves are causing harm, or that the patients were sicker, or maybe a combination, we just don't know."

The drug combination, popular when the study began, has been discredited since. In a recent analysis of hydroxychloroquine with or without an antibiotic such as azithromycin that looked at data from 671 hospitals and six continents, researchers could not confirm a benefit and found an association with decreased survival in the hospital and an increased risk of abnormal heart rhythms.

"These drugs should not be given outside a clinical trial, and clinical trials are needed to determine whether they help or hurt," Warner says. Out of the 270 in this study who received the drug combination, Warner says that only two received them as part of a clinical trial.

Study Details

Researchers collected information on COVID-19 patients with cancer from 104 institutions as part of a clinical trial. The median age was 66, and breast cancer was the most common type, affecting 21% of patients, followed by prostate, gastrointestinal, and thoracic, including lung cancers. And 39% were on active cancer treatment when diagnosed with COVID-19. Cancer type was not linked to mortality.

Warner's team is continuing to study the effects of COVID-19 on cancer patients. The data base is now over 2,200 patients. The use of the antiviral drug remdesivir is up dramatically, he says. The FDA granted remdesivir emergency use authorization to treat COVID-19 on May 1.

The data suggests that in some instances, COVID-19 patients who are doing well on cancer treatments might be able to continue them, but that others might consider changing to palliative care, Warner says.

“Patients with progressing cancer or impaired performance are at a higher risk of a bad outcome,” he says. “It's pretty clear they shouldn't continue aggressive therapies for the cancer if diagnosed with COVID-19."

Second Cancer Study

A separate study found that patients with thoracic cancers, including of the lung, who also have COVID-19 are less likely to survive the coronavirus if they are over 65, are on chemotherapy, on steroids of more than 10 milligrams daily, or on anti-blood clot medicines.

The data base includes 428 patients: 141 who died, 169 who recovered, and 118 with ongoing data.

The two studies help shed understanding on the impact of the virus on cancer patients, says Howard A. Burris III, MD, president of the American Society of Clinical Oncology, who reviewed both presentations.

"With the virus causing pneumonia and lung damage in the infected patients who became ill, it is not surprising that our cancer patients with lung and other thoracic cancers are more vulnerable," he says. The adverse outcomes with the azithromycin and hydroxychloroquine are being reported by others as well, he says.

He would encourage COVID-19 patients with cancer to seek out clinical trials for COVID-19 treatments, with guidance from their cancer specialists, infectious disease specialists, and lung doctors.

WebMD Health News

Sources

Jeremy Warner, MD, associate professor of medicine and biomedical informatics, Vanderbilt University, Nashville.

Howard A. Burris III, MD, president, American Society of Clinical Oncology.

American Society of Clinical Oncology annual meeting, May 30, 2020.

FDA: "Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment," May 1, 2020.

The Lancet: "Hydroxychloroquine or chloroquine with or without a macrolide for the treatment of COVID-19: A multinational registry analysis."

Johns Hopkins Coronavirus Resource Center.

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