Outcomes in Radiotherapy-Treated Patients With Cancer During the COVID-19 Outbreak in Wuhan, China

This case series evaluated the delivery of radiotherapy in 209 patients with cancer during the COVID-19 outbreak in Wuhan, China.

Several health care services have been affected by the novel coronavirus disease 2019 (COVID-19) pandemic. A delay in diagnosis and treatment can be detrimental to patients with cancer. 1,2 However, patients with cancer are also at risk for COVID-19 because of immunosuppressive treatments and recurrent visits to the hospital. 3 In this article, we report preliminary outcomes in 209 patients who underwent radiotherapy at the Zhongnan Hospital of Wuhan University (ZHWU) during the COVID-19 outbreak in the city of Wuhan, China.
Methods | All patients who were treated at the Department of Medical and Radiation Oncology, ZHWU, from January 20 to March 5, 2020, were included. Public health measures implemented during the study period included city lockdown (January 23, 2020), cordon sanitaire, traffic restriction, social distancing, and home confinement. We analyzed patient demographics as well as clinical and treatment parameters. Survival status of all patients was updated as of March 12, 2020. This study was approved by the ZHWU institutional review board (No. 2020041) with waiver of informed consent for the use of aggregated, anonymized patient data. Unfortunately, 112 patients (53.6%) were unable to return for radiotherapy after the lockdown. Among the 67 patients receiving chemoradiotherapy, 3 (4.5%) had completed treatment and 62 (92.5%) discontinued treatment (58 could not return, and 4 discontinued by the physician's choice); only 2 patients (3.0%) resumed chemoradiotherapy. Before the lockdown, the mean (range) number of patients per day was 188 (160-209). However, these numbers dropped sharply after the date of lockdown and declined with each subsequent week (mean [range] number of patients per day, 12 [2-66]) ( Figure).

Results | The
We recorded only 1 case (0.5%) of confirmed severe acute respiratory syndrome coronavirus 2 infection during the study period. Although 70 patients (33.5%) had a history of contact with this patient, none of them developed clinical symptoms of COVID-19. Of these 70 patients, 52 (74.2%) were unable to resume radiotherapy after the lockdown, while 18 (25.8%) continued radiotherapy without delay. All patients were alive as of March 12, 2020.
Discussion | To date, more than 10 000 000 humans have been diagnosed as having COVID-19. This disease is highly infectious, since both asymptomatic and symptomatic individuals can transmit the virus. 4,5 Extensive public health measures that are focused on physical distancing and tight In this article, we share our experience with the COVID-19 lockdown and the delivery of radiotherapy in patients with cancer at ZHWU in Wuhan, China. Caseloads were substantially reduced (a 10-fold drop after lockdown). More than half of the patients in this case series were unable to return to the city for treatment, which is a consequence of the massive human migration (Chunyun) for the Spring Festival that preceded the lockdown. Additionally, physicians were conservative in resuming chemoradiotherapy. Long-term follow-up data may reveal detrimental ramifications of treatment interruption on the survival of these patients with cancer.

COVID-19 in Children With Cancer in New York City
Data on the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children, 1-4 and in children with cancer specifically have been limited. Less than 1% of cases reported from China were in children younger than 10 years. 3 The MSK Kids pediatric program at Memorial Sloan Kettering Cancer Center (MSK) is one of the largest pediatric cancer programs in the US. Starting in mid-March, 2020, we instituted a screening and testing plan to mitigate risk associated with coronavirus disease 2019 (COVID-19).
Methods | On presentation for outpatient or inpatient care, patients were screened for the presence of symptoms of COVID-19 or exposure to contacts with known SARS-CoV-2 infection. We also instituted testing for SARS-CoV-2 using a RT-PCR assay for 3 cohorts of individuals: (1) patients exposed to COVID-19 (screen positive) or with symptoms of infection (symptom positive); (2) asymptomatic patients (symptom negative) prior to deep sedation, myelosuppressive chemotherapy, or admission to the hospital; and (3) caregivers accompanying patients for admission or multiday outpatient chemotherapy. Data for this report were gathered a retrospective research protocol approved by the MSK institutional review board with waiver of informed consent owing to the retrospective and deidentified nature of the data used. Groups were compared using a 2-tailed Fisher exact test.
Only 1 patient with COVID-19 illness required noncritical care hospitalization for COVID-19 symptoms. Three other patients without significant COVID-19 symptoms were admitted for concomitant fever and neutropenia, cancer morbidity, or planned chemotherapy. All other pediatric patients had mild symptoms and were managed at home.
We also instituted testing of adult caregivers of patients (Table 1). Of the 74 individuals tested, 13 caregivers (17.6%) of 10 patients tested positive for SARS-CoV-2. Notably among 68 asymptomatic and unexposed caregivers (screen negative and symptom negative), 10 tested positive for SARS-CoV-2 (14.7%). Simultaneous detection of virus in patient and caregiver was found in 5 patient/caregiver dyads, whereas 5 patients were negative for virus despite close exposure to caregivers with COVID-19.
Discussion | Although this report is limited by small numbers, the data show that (1) the overall morbidity of COVID-19 in pediatric patients with cancer is low with only 5% requiring hospitalization for symptoms of COVID-19; (2) that the rate of SARS-CoV-2 infection among asymptomatic pediatric patients is very low; (3) that unrecognized SARS-CoV-2 infection in asymptomatic caregivers is a major infection control consideration; and (4) that consistent with the sex difference previously seen in adults with critical disease, 5 there is a male bias in SARS-CoV-2 infections in children, suggesting a biological basis in skewed infectivity. This report suggests that pediatric patients with cancer may not be more vulnerable than other children 2-4 to infection or