The Need for COVID-19 Testing in Patients With Lung Cancer
Posted: Thursday, April 23, 2020
With the limited information currently available on the treatment of patients with cancer infected by COVID-19, a team of European oncologists published an editorial providing an update on the need to test for COVID-19 in these patients. In the Annals of Oncology, Antonio Passaro, MD, PhD, of the European Institute of Oncology IRCCS, Milan, and colleagues offer guidance on how best to test patients with lung cancer who may have or already have COVID-19.
The authors emphasized that although all types of cancers seem to be associated with a high COVID-19 prevalence, morbidity, and mortality; lung cancer represents a specific scenario of cumulative risk factors for COVID-19 complications. These risk factors include older age, significant cardiovascular and respiratory comorbidities, smoking-related lung damage, as well as the unavoidable addition of treatment-related immune impairment or suppression.
One potential conundrum for oncologists who treat patients with lung cancer is that these patients may show similar clinical symptoms, including cough, fever, and dyspnea, with severe adult respiratory syndrome coronavirus (SARS-CoV-2) infection compared with other individuals. Thus, an accurate COVID-19 screening model could allow for early detection and potentially reduce the risk of severe complications and mortality, the authors stated.
Another potential issue is that a significant proportion of patients with lung cancer require corticosteroids for prophylaxis, treatment, and symptom control related to cancer or chronic obstructive pulmonary disease. Although steroids may reduce inflammation and immune cellular activity, they may be possibly deleterious in the management of patients with COVID-19 and may mask some of the early symptoms of SARS-CoV-2 infection, arguing for routine SARS-CoV-2 testing in patients receiving steroids.
“In the era of COVID-19, the optimal management of patients with lung cancer remains unknown, and the oncology community should have increased awareness to prevent the emergence of an increase in cancer-related and infectious mortality,” the authors concluded. “While suspending or delaying cancer treatment delivery seems logical in some cases, the risks/benefits and final outcomes of these deviations remain to be measured.”
Disclosure: The authors reported no conflicts of interest.
