Risk of COVID-19 in Patients With Cancer | JAMA Oncology | JAMA Network
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Comment & Response
July 2, 2020

Risk of COVID-19 in Patients With Cancer

Author Affiliations
  • 1Department of Radiotherapy, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
  • 2Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
  • 3Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
JAMA Oncol. 2020;6(9):1469-1470. doi:10.1001/jamaoncol.2020.2577

To the Editor We read the article by Yu and colleagues1 published in JAMA Oncology with great interest. In this article, Yu et al reported that patients with cancer have a notably higher risk of coronavirus disease 2019 (COVID-19) compared with that of overall population in Wuhan, China, which shares a similar conclusion with a recent report by Liang et al.2 Also, the authors found that age older than 60 years is an independent risk factor of COVID-19 in individuals with lung cancer.

COVID-19 has been officially declared a global pandemic, and the needs of patients with particular vulnerabilities require particular attention. To date, a number of comorbidities have evidently contributed to the incidence of COVID-19.3 However, it has been well documented that diseases such as chronic obstructive pulmonary disease, hypertension, and cancer are closely related to age. In China Statistical Yearbook 2019,4 people older than 50 years accounted for 32% of the total population. In a report by Guan et al5 among 1011 patients with COVID-19, 44% were older than 50 years, suggesting that the risk of COVID-19 in older adult patients may be higher. Thus, before probing the underlying diseases associated with higher susceptibility to COVID-19, we must stratify the patients in terms of age. Hence, to determine the role of cancer in COVID-19, a comparison of incidence of COVID-19 between patients in the same age group with and without cancer will be of great importance.

Second, the incidence of COVID-19 in patients who periodically visit hospitals for cancer care is higher than that in the community does not necessarily lead to the conclusion that cancer is a risk factor of COVID-19. Medical visit–related exposure should not be neglected, especially in an epidemic region. Of note, this could be the general potential explanation for higher incidence of COVID-19 in patients having underlying diseases.

Third, by reviewing the data derived from the study by Yu et al,1 we found that cancer-related interventions seemed to be correlated with neither severe events nor death caused by COVID-19. These observations further raise the concern that whether the disease of cancer indeed contributes to the susceptibility and/or prognosis of COVID-19.

Fourth, a P value of .486 was shown for the incidences of COVID-19 in patients with lung cancer older than 60 years compared with patients younger than 60 years. This was a numeric but not statistically significant difference.

Collectively, the question regarding the specific susceptibility of patients with cancer to COVID-19 remains to be resolved. Further investigations with larger sample sizes and rigorous study designs are warranted.

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Article Information

Corresponding Author: Yang Xia, MD, PhD, Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China (yxia@zju.edu.cn).

Published Online: July 2, 2020. doi:10.1001/jamaoncol.2020.2577

Conflict of Interest Disclosures: None reported.

References
1.
Yu  J, Ouyang  W, Chua  MLK, Xie  C.  SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China.   JAMA Oncol. Published online March 25, 2020. doi:10.1001/jamaoncol.2020.0980PubMedGoogle Scholar
2.
Liang  W, Guan  W, Chen  R,  et al.  Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.   Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6PubMedGoogle Scholar
3.
Team  NCPERE; Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention.  The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China.  Article in Chinese.  Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-151.PubMedGoogle Scholar
4.
Population Census Office of the State Council of China. Tabulation of the 2010 population census of the People's Republic of China. Accessed May 28, 2020. http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm
5.
Guan  WJ, Ni  ZY, Hu  Y,  et al; China Medical Treatment Expert Group for Covid-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle Scholar
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