- Regarding baseline risk of infection and death:
- Smoking history, is correlated with a higher incidence of respiratory infections and a 2.4 times higher risk of ICU admission, mechanical ventilation or death from COVID-19 infection. This may be due to structural and immunologic-induced modifications from tobacco;
- Alteration in the lung architecture from tumor mechanical obstruction (or surgery) may also predispose to infection;
- Patients with lung cancer tend to be older and have significant comorbidities (cardiovascular and respiratory);
- Peri-tumoral microenvironment with presence of macrophage infiltration in lung tissue may pose a higher risk for cytokine release and therefore ARDS.
- Regarding treatment related risk of infection and death:
- Treatment-related immune impairment or suppression increases the risk of death, particularly for cytotoxic chemotherapy. Data regarding ICI (immune checkpoint inhibitors) or tyrosine kinase inhibitors is still lacking;
- Some patients with lung cancer may receive corticosteroids as a prophylaxis, treatment or symptom relief strategy of cancer or COPD. Reports suggest that steroids are possibly deleterious in the management of ARDS and mask early symptoms of infection related to COVID-19.
- Regarding diagnosis challenges of SARS-CoV-2 in lung cancer patients:
- Lung cancer patients may chronically have cough and dyspnea, leading to a more difficult threshold for clinical suspicion of infection;
- Distinguishing radiological features of lung cancer or related to these treatments from SARS-CoV-2 infection may be a challenge;
- As cancer patients undergo periodic CT of the lung, suspicious ground-glass images may be seen in otherwise asymptomatic patients.
- Possible Screening Strategies for lung cancer patients:
- Baseline SARS-CoV-2 testing of all lung cancer patients rather than symptomatic testing strategies may improve early detection and management. No statement was made regarding the screening method. Interestingly, lung CT may be more sensitive than naso-oropharyngeal swabs, but it needs more medical resources;
- Bronchoscopy may be considered for patient with negative swab test, but new symptoms and ground-glass opacities detected on imaging studies.
These statements were made by a group on thoracic oncology expert from Switzerland, Hong Kong, China, Italy and Japan.
Passaro A., Peters S., Mok T.S.K., Attili I., Mitsudomi T., Marinis F. (April 03, 2020). Testing for COVID-19 in lung cancer patients. Annals of oncology. https://doi.org/10.1016/j.annonc.2020.04.002