Thrombosis and Hemostasis Issues in Cancer Patients with COVID-19
Coronavirus disease 2019 (COVID-19) is an infectious pandemic disorder caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), a single-stranded RNA β-coronavirus. Virus particles that can be inhaled through the respiratory system and invade lung alveolar cells may cause a limited viral disease. However, in some patients, severe complications, including systemic inflammatory response syndrome, acute respiratory disease syndrome, multiple organ failure, and shock may develop. These presentations are particularly frequent among several risk groups, including older patients, those with hypertension, obesity, cardiovascular, pulmonary and renal diseases, autoimmunity disturbances, and cancer. COVID-19 is associated with severe thrombotic complications, both micro- and macrovascular, substantially including deep vein thrombosis (DVT), pulmonary embolism (PE), primary pulmonary arterial thrombosis, up to disseminate intravascular coagulation (DIC)-like syndrome.   
Cancer patients are more vulnerable to COVID-19 infection and their disease course is likely to be more aggressive. A recent report evaluated 1,524 patients, admitted to the Department of Radiation and Medical Oncology of Zhongnan Hospital of Wuhan University. While the rate of COVID-19 was 0.79% among cancer patients, it was 0.37% in the general population of Wuhan during the same time period (odds ratio [OR]: 2.31, 95% confidence interval [CI]: 1.89–3.02). Patients with non-small-cell lung cancer (NSCLC) displayed higher incidence of COVID-19, especially those > 60 years of age (4.3 vs. 1.8% in those aged ≤ 60 years with NSCLC). In another study from China, cancer patients were found to have higher risk of severe events (i.e., death or admission to the intensive care unit [ICU] for invasive ventilation) (7/18 [39%] vs. 124/1,572 [8%] patients; p = 0.0003).
The COVID-19 and Cancer Consortium (CCC19) registry recently reported a large cohort study of 928 patients from the United States, Canada, and Spain. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. The median age was 66 years (57–76), and 50% of patients were males. The leading malignancies were breast (21%) and prostate (16%). The ratio of active anticancer treatment or active (measurable) cancer was high, 39 and 43%, respectively. As per analysis dated May 7, 2020, 121 (13%) patients died. The independent risk factors associated with 30-day mortality included age (per 10 years; partially adjusted OR: 1.84, 95% CI: 1.53–2.21), smoking status (1.60, 1.03–2.47), male sex (OR: 1.63, 95% CI: 1.07–2.48), number of comorbidities (2 vs. none: OR: 4.50, 95% CI: 1.33–15.28), the Eastern Cooperative Oncology Group performance status of 2 or higher (OR: 3.89, 95% CI: 2.11–7.18), active cancer (5.20, 2.77–9.77), and use of azithromycin plus hydroxychloroquine (OR: 2.93, 95% CI: 1.79–4.79). Of note, ethnicity, obesity, tumor type, and the anticancer therapy applied had no impact on mortality. As for environmental factors, residence in Canada or the U.S.-Midwest were associated with decreased 30-day all-cause mortality compared with residence in the U.S.-Northeast (OR: 0.24, 95% CI: 0.07–0.84 and OR: 0.50, 95% CI: 0.28–0.90, respectively).
12 August 2020 (online)
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