Elsevier

European Journal of Cancer

Volume 132, June 2020, Pages 199-206
European Journal of Cancer

Review
The experience on coronavirus disease 2019 and cancer from an oncology hub institution in Milan, Lombardy Region

https://doi.org/10.1016/j.ejca.2020.04.017Get rights and content

Highlights

  • One percent of patients with coronavirus disease 2019 (COVID-19) in the series were reported as patients with cancer; 50% experienced a severe or fatal event.

  • In Italy, 16.5% of patients dying from COVID-19 are patients with cancer.

  • In the first Italian series of patients with cancer and COVID-19 receiving active treatment, 22% experienced severe presentation.

  • Research is emphasised to enhance knowledge on COVID-19 and cancer care, under a global response through community healthcare.

  • An intersectoral line must be pursued for this public health (PH) emergency, providing prevention and control measures to patients with cancer.

Abstract

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related disease (coronavirus disease 2019 [COVID-19]) has spread rapidly to a pandemic proportion, increasing the demands on health systems for the containment and management of COVID-19. Cancer has been reported as a major risk factor for adverse outcomes of and death from COVID-19. We extracted data from the World Health Organization's progress reports and from the Italian Council of Medicine. In addition, we retrieved clinical data on patients with cancer and with confirmed COVID-19 in our institution. As of 2nd April 2020, 110,574 COVID-19 cases and 13,157 deaths have been reported in Italy, representing a global share of 5.1% and 28.9% for incidence and mortality, respectively. In Italy, we report the analysis of the Italian Medical Council on 909 patients who died from COVID-19; of whom, 16.5% were patients with cancer. The population was enriched with subjects with multiple comorbid non-communicable diseases, with less than 1% of the population presenting no comorbid conditions. At the patient level, we identified nine patients referred to our department in the last two months who were receiving standard-of-care or experimental medications in the curative and palliative settings. The median age was 68 years (range = 42–79 years), and patients carried a median of one comorbid condition (0–2); two of nine patients presented with severe COVID-19 and were receiving inpatient care. None of the patients receiving immunotherapy experienced severe adverse outcomes, and four patients were discharged with complete reversal of the clinical syndrome and SARS-CoV-2 clearance. Learning from the experience of countries with a high burden, efforts must be made to assure the access of patients with cancer to treatments, prioritising the cancer health interventions based on their intrinsic value and limiting the exposure to an unacceptable risk of infection for both health providers and patients. Any significant work in the design and implementation of health system actions, including clinical care, must be framed as an initiative under the global response agenda and through a community approach, with the intention of pursuing common goals to tackle COVID-19 and cancer, as ‘One Community’ working for ‘One Health's.

Keywords

Cancer
COVID-19
SARS-CoV-2
Coronavirus
Hub

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