Another study from China evaluating all cancer patients admitted to Zhongnan Hospital of Wuhan University determined that cancer patients had a 0.79% infection rate compared with the overall city’s 0.37% infection rate. A total of 12 patients were affected, 58.3% had non-small cell lung carcinoma (NSCLC) with approximately 41.7% were undergoing treatment with chemotherapy and resulting mortality rate as of March 10, 2020, being 25%. Additionally, NSCLC patients that were greater than age 60 had a higher incidence of COVID-19 compared with younger patients with NSCLC [43•]. These findings are further corroborated by a study that examined all 28 cancer patients admitted to 3 hospitals in China. Lung cancer was the most common cancer type among these patients (25%). Diabetes (14.3%) and chronic cardiovascular and cerebrovascular disease (14.3%) were the most common comorbidities listed. Clinical factors that significantly predicted worse outcomes in this group of patients included age, patchy consolidation on imaging, and receipt of anti-tumor treatment in the last 14 days [44]. These studies suggest that patients with cancer are at higher risk for COVID-19, and those with older age and cancer are at an even higher risk for poor outcomes. Lung cancer has been reported to be more common in these studies, but the total sample size of cancer patients remains too low to draw any meaningful conclusions on which malignancy may be most associated with severity of COVID-19 infections. Lastly, although having recent anti-cancer treatment increases the risk for severe outcomes, it is unclear which anti-cancer agents are associated with higher risk for acquiring COVID-19 infection, severity of infection, and/or mortality. Table 1 demonstrates a literature review of studies published until April 26, 2020 that identify the prevalence of cancer among COVID-19 infected patients.
Table 1 COVID-19 Studies with cancer and cardiovascular disease epidemiology (through April 22, 2020)
Author Country Clinical setting Number of institutions Date of publication Number of patients in study with COVID-19 Canceran (%) Predominant cancer n (%) HTN n (%) CVDbn (%) Mortality in cancer patients n (%)
Wu C, et al. China Hospitalized 1 March 13,2020 201 1(0.5) Not specified 39 (19.4) 8 (4.0) Not reported
Guo T, et al. China Hospitalized 1 March 27, 2020 187 13(7) Not specified 61 (32.6) 29 (15.5) Not reported
Zhou F, et al. China Hospitalized 2 March 9, 2020 191 2(1) Not specified 58 (30.4) 15 (8) 0
Shi S, et al. China Hospitalized 1 March 25, 2020 416 9(2.2) Not specified 127 (30.5) 61 (14.7) Not reported
Liang W, et al. China Hospitalized 575 February 14, 2020 1590 18(1.1) Lung - 5 (28) Not reported Not reported Not reported
Onder G, et al. Italy Not specified Not specified March 23, 2020 355 72 (20.3) Not specified Not specified 117 (33) 100 (Study only reviewed cases that died)
Grasselli G, et al.c Italy Intensive care units 72 April 6, 2020 1043 81(8) Not specified 509 (49) 223 (21) Not reported
McMichael T, et al. USA Long-term care facility 1 March 27, 2020 167 15(9) Not specified 74 (44.3) 68 (40.7) Not reported
Goyal P, et al. USA Hospitalized 2 April 17, 2020 393 23(5.9) Not specified 197 (50.1) 82 (21) Not reported
Richardson, et al. USA Hospitalized 17 April 22, 2020 5700 320(6) Not specified 3026 (56.6)c 966 (18)d Not reported
aCancer was defined in studies as either cancer, tumor, malignant neoplasm, or carcinoma. There was variability in whether cancer was active or in remission
bThere were various definitions utilized for cardiovascular disease across all studies not limited to cardiomyopathy, coronary artery disease, and ischemic heart disease
c,dHistory regarding these comorbidities may not have been available for all patients enrolled in the study; hence, percentage does not correlate the with total number of patients in the study
HTN hypertension, CVD cardiovascular disease