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Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: closed (28 April 2023) | Viewed by 25666

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Dr. Alvin Lee

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The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
Interests: cancer immunology; cell therapy; drug resistance; personalised medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Coronavirus disease (COVID-19) became a global pandemic in 2020. This continues to impact upon patients with cancer. The ongoing pandemic, with its multiple variants and waves of disease, has resulted in missed or delayed cancer diagnosis, alterations to standard treatment and risk of severe outcomes including increased morbidity or death following COVID-19.

Patients with cancer appear to be at greater risk compared to those without cancer following infection with SARS-CoV-2. Vaccination offers protection; however, this protection is reduced for those who are immunocompromised such as those with cancer. The global oncology community responded to the COVID-19 pandemic with many COVID-19 and cancer registries and studies. These studies have identified potential risk factors for worse outcomes, including advanced or metastatic disease, hematological malignancies, and potentially certain classes of systemic anticancer treatments.

We hope that this Special Issue will collect and highlight the evidence needed to help shape long-term management of patients with cancer in a world where COVID-19 remains a risk. We look forward to your contributions.

Dr. Alvin J. X. Lee
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

COVID-19
SARS-CoV-2
coronavirus
cancer
malignancy
oncology
survival
mortality
outcomes
long-term sequelae

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Published Papers (10 papers)

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Research

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12 pages, 428 KiB

Open AccessArticle

Characteristics and Outcomes of COVID-19 Cancer Patients Admitted to a Portuguese Intensive Care Unit: A Case-Control Study

by Ridhi Ranchor, Nuno Pereira, Ana R. Medeiros, Manuel Magalhães, Aníbal Marinho and António Araújo

Cancers 2023, 15(12), 3264; https://doi.org/10.3390/cancers15123264 - 20 Jun 2023

Viewed by 1717

Abstract

Cancer patients appear to be a vulnerable group in the COVID-19 pandemic. This study aims to compare clinical characteristics and outcomes of cancer and non-cancer patients with COVID-19 admitted to the ICU. All COVID-19 cancer patients (cases) admitted to a Portuguese ICU between March 2020 and January 2021 were included and matched on age, sex and comorbidities with COVID-19 non-cancer patients (controls); 29 cases and 29 controls were enrolled. Initial symptoms were similar between the two groups. Anemia was significantly superior among cases (76% vs. 45%; p = 0.031). Invasive mechanical ventilation (IMV) need at ICU admission was significantly higher among cases (48% vs. 7%; odds ratio (OR) = 12.600, 95% CI: 2.517–63.063, p = 0.002), but there were no differences for global need for IMV during all-length of ICU stay and mortality rates. In a multivariate model of logistic regression, the risk of IMV need at ICU admission among cases remained statistically significant (adjusted OR = 14.036, 95% CI: 1.337–153.111, p = 0.028). Therefore, compared to critical non-cancer patients, critical cancer patients with COVID-19 had an increased risk for IMV need at the moment of ICU admission, however, not for IMV need during all-length of ICU stay or death. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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13 pages, 548 KiB

Open AccessArticle

Impact of Multiple COVID-19 Waves on Gynaecological Cancer Services in the UK

by Samuel Oxley, Ashwin Kalra, Michail Sideris, Nicole Itzkowitz, Olivia Evans, Emma Christine Atakpa, Adam R. Brentnall, Nina Dworschak, Faiza Gaba, Rhian Gabe, Sudha Sundar, Nick Wood, Shibani Nicum, Alexandra Taylor, Stephen Dobbs, W. Glenn McCluggage, Andy Nordin, Rosa Legood, Sean Kehoe, Sadaf Ghaem-Maghami and Ranjit Manchanda Show full author list Hide full author list

Cancers 2023, 15(4), 1273; https://doi.org/10.3390/cancers15041273 - 16 Feb 2023

Cited by 1 | Viewed by 3289

Abstract

Background: This study aimed to assess the impact of multiple COVID-19 waves on UK gynaecological-oncology services. Methods: An online survey was distributed to all UK-British-Gynaecological-Cancer-Society members during three COVID-19 waves from 2020 to2022. Results: In total, 51 hospitals (including 32 cancer centres) responded to Survey 1, 42 hospitals (29 centres) to Survey 2, and 39 hospitals (30 centres) to Survey 3. During the first wave, urgent referrals reportedly fell by a median of 50% (IQR = 25–70%). In total, 49% hospitals reported reduced staffing, and the greatest was noted for trainee doctors, by a median of 40%. Theatre capacity was reduced by a median of 40%. A median of 30% of planned operations was postponed. Multidisciplinary meetings were completely virtual in 39% and mixed in 65% of the total. A median of 75% of outpatient consultations were remote. By the second wave, fewer hospitals reported staffing reductions, and there was a return to pre-pandemic urgent referrals and multidisciplinary workloads. Theatre capacity was reduced by a median of 10%, with 5% of operations postponed. The third wave demonstrated worsening staff reductions similar to Wave 1, primarily from sickness. Pre-pandemic levels of urgent referrals/workload continued, with little reduction in surgical capacity. Conclusion: COVID-19 led to a significant disruption of gynaecological-cancer care across the UK, including reduced staffing, urgent referrals, theatre capacity, and working practice changes. Whilst disruption eased and referrals/workloads returned to normal, significant staff shortages remained in 2022, highlighting persistent capacity constraints. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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12 pages, 922 KiB

Open AccessArticle

Long-COVID in Patients with Cancer Previously Treated with Early Anti-SARS-CoV-2 Therapies in an Out-of-Hospital Setting: A Single-Center Experience

by Angioletta Lasagna, Giuseppe Albi, Simone Figini, Sara Basile, Paolo Sacchi, Raffaele Bruno and Paolo Pedrazzoli

Cancers 2023, 15(4), 1269; https://doi.org/10.3390/cancers15041269 - 16 Feb 2023

Cited by 6 | Viewed by 2261

Abstract

The incidence of long COVID in a cohort of patients with cancer with or without previous treatment with early therapies anti-SARS-CoV-2 in an out-of-hospital setting have to be elucidated. We prospectively enrolled all patients treated for a solid tumor at the department of Medical Oncology of the Fondazione IRCCS Policlinico San Matteo with a positive SARS-CoV-2 antigen or polymerase chain reaction test from January to September 2022 (Omicron surge). Ninety-seven patients answered the survey questions by telephone at least 12 weeks after COVID-19 diagnosis in order to evaluate the incidence of long COVID symptoms. Only twelve patients (12.4%) reported long COVID. No significant difference between early therapies anti-SARS-CoV-2 31 and long COVID (p = 0.443) was seen. The female sex (p = 0.024) and diabetes mellitus (p = 0.014) are significantly associated with long COVID. No statistically significant difference between the two groups (Long COVID vs. No Long COVID) according to the time to nasal swab viral clearance (p = 0.078). The overlap between the symptoms related to the oncological disease/oncological treatment and the symptoms of long COVID is one of the main future challenges that oncologists will have to manage. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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15 pages, 1170 KiB

Open AccessArticle

The Mental Health Burden of Patients with Colorectal Cancer Receiving Care during the COVID-19 Pandemic: Results of the PICO-SM Study

by Kok Haw Jonathan Lim, Panagiotis Ntellas, Daniel Anderson, Lilly Simpson, Michael Braun, Marios Adamou, Jorge Barriuso, Katerina Dadouli, Jacqueline Connell, Joseph Williams, Theodora Germetaki, Deirdre Lehwald, Niall Fitzpatrick, Mark Cutting, Danielle McCool, Jurjees Hasan, Saifee Mullamitha, Kalena Marti, Mark Saunders and Konstantinos Kamposioras

Cancers 2023, 15(4), 1226; https://doi.org/10.3390/cancers15041226 - 15 Feb 2023

Cited by 2 | Viewed by 2435

Abstract

The COVID-19 pandemic has resulted in unprecedented changes to the lives of patients with cancer. To evaluate the impact of the COVID-19 pandemic on the mental health and well-being of patients with colorectal cancer, we conducted a prospective longitudinal questionnaire study at a UK tertiary cancer centre. In total, 216 participants were included: mean age 65 years, 57% (n = 122) male, 92% (n = 198) of white ethnicity. Amongst participants who completed the screening psychometric questionnaire, 24% (n = 48/203) reported anxiety (GAD-7 ≥ 5), 15% (n = 31/204) depressive symptoms (PHQ-9 ≥ 10), 3% (n = 5/190) probable post-traumatic stress disorder (PC-PTSD-5 ≥ 4), and 31% (n = 66/213) poor well-being (WHO-5 < 50). In the subgroup (n = 95/216, 44%) who consented to and completed a follow-up survey 6 months later, there was a significant increase in the number of participants at risk of depression (4% vs. 13%, p = 0.021). Self-reported concern about the COVID-19 pandemic impacting one’s mental health is associated with increased likelihood of anxiety, depression, and poor well-being, in respective multivariate analyses. In conclusion, screening for the mental health impact of the COVID-19 pandemic is essential to ensure timely action from all key stakeholders and to avoid potentially longer-term detrimental consequences. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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21 pages, 7003 KiB

Open AccessArticle

Pan-Cancer Analysis of Pentraxin 3: A Potential Biomarker of COVID-19

by Zijian Zhou, Xuan Zhou, Yuanyuan Yang, Lujia Wang and Zhong Wu

Cancers 2022, 14(18), 4438; https://doi.org/10.3390/cancers14184438 - 13 Sep 2022

Cited by 1 | Viewed by 1969

Abstract

Pentraxin 3 (PTX3), a potential biomarker of the severity and mortality of COVID-19 patients, is aberrantly expressed in human tumors. However, a comprehensive pan-cancer analysis of PTX3 remains to be elucidated. PTX3 data profiles and clinical information in TCGA cancers were obtained from different public databases to clarify the expression levels, genetic alterations, prognostic significance, underlying mechanisms, and the predicted role in immunotherapy of PTX3 across TCGA cancers. Our analyses showed that PTX3 was aberrantly expressed in most tumors and was significantly related to prognosis and tumor stage. Interaction network and enrichment analyses revealed that PTX3 participated in tumor immuno-related progression. In addition, PTX3 levels were critically associated with immune cell components and immune scores, and PTX3 strongly coexpressed with immune-related genes in TCGA cancers. Meanwhile, PTX3 expression was associated with immune checkpoint genes, and immunotherapy potential biomarkers in multiple cancers, predicting special immunotherapy responses in different tumor types. In kidney renal clear cell carcinoma (KIRC), PTX3 emerged as an independent prognostic factor through multivariable Cox regression analyses. Blocking PTX3 with siRNA could suppress the growth of KIRC cells and invasion. Conclusively, our study shows a comprehensive bioinformatic analysis of PTX3, which might serve as a pan-cancer prognostic biomarker. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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11 pages, 685 KiB

Open AccessArticle

Impact of COVID-19 Pandemic on Thyroid Surgery in a University Hospital in South Korea

by Seong Hoon Kim, Euna Min, Young Mi Hwang, Yun Suk Choi and Jin Wook Yi

Cancers 2022, 14(17), 4338; https://doi.org/10.3390/cancers14174338 - 5 Sep 2022

Cited by 9 | Viewed by 2488

Abstract

The COVID-19 pandemic has changed healthcare systems around the world. Medical personnel concentrated on infectious disease management and treatments for non-emergency diseases and scheduled surgeries were delayed. We aimed to investigate the change in the severity of thyroid cancer before and after the outbreak of COVID-19 in Korea. We collected three years of data (2019, 2020, and 2021) on patients who received thyroid surgery in a university hospital in South Korea and grouped them as “Before COVID-19”, “After COVID-19 1-year” and “After COVID-19 2-years”. The total number of annual outpatients declined significantly after the outbreak of COVID-19 in both new (1303, 939, and 1098 patients) and follow-up patients (5584, 4609, and 4739 patients). Clinical characteristics, including age, sex, BMI, preoperative cytology results, surgical extent, and final pathologic diagnosis, were not significantly changed after the outbreak of COVID-19. However, the number of days from the first visit to surgery was significantly increased (38.3 ± 32.2, 58.3 ± 105.2, 47.8 ± 124.7 days, p = 0.027). Papillary thyroid carcinoma (PTC) patients showed increased proportions of extrathyroidal extension, lymphatic invasion, vascular invasion, and cervical lymph node metastasis. Increased tumor size was observed in patients with follicular tumor (3.5 ± 2.2, 4.0 ± 1.9, 4.3 ± 2.3 cm, p = 0.019). After the COVID-19 outbreak, poor prognostic factors for thyroid cancer increased, and an increase in the size of follicular tumors was observed. Due to our study being confined to a single tertiary institution in Incheon city, Korea, nationwide studies that include primary clinics should be required to identify the actual impact of COVID-19 on thyroid disease treatment. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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10 pages, 2477 KiB

Open AccessCommunication

The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy

by Seamus O’Reilly, Verena Murphy, Eibhlin Mulroe, Lisa Tucker, Fiona Carragher, Jacinta Marron, Aoife M. Shannon, Ken Rogan, Roisin M. Connolly, Bryan T. Hennessy and Ray S. McDermott

Cancers 2022, 14(9), 2247; https://doi.org/10.3390/cancers14092247 - 30 Apr 2022

Cited by 7 | Viewed by 2169

Abstract

Background: Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. Methods: A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. Results: In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. Conclusion: The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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16 pages, 1050 KiB

Open AccessArticle

Longitudinal Humoral and Cellular Immune Responses Following SARS-CoV-2 Vaccination in Patients with Myeloid and Lymphoid Neoplasms Compared to a Reference Cohort: Results of a Prospective Trial of the East German Study Group for Hematology and Oncology (OSHO)

by Sabrina Jotschke, Susann Schulze, Nadja Jaekel, Beatrice Ludwig-Kraus, Robby Engelmann, Frank Bernhard Kraus, Christina Zahn, Nicole Nedlitz, Gabriele Prange-Krex, Johannes Mohm, Bettina Peuser, Maik Schwarz, Claudia Spohn, Timo Behlendorf, Mascha Binder, Christian Junghanss, Sebastian Böttcher and Haifa Kathrin Al-Ali

Cancers 2022, 14(6), 1544; https://doi.org/10.3390/cancers14061544 - 17 Mar 2022

Cited by 4 | Viewed by 2918

Abstract

Purpose: To assess humoral responses longitudinally and cellular immunogenicity following SARS-CoV-2-vaccination in patients with hematologic and oncologic malignancies receiving checkpoint-inhibitors. Methods: This prospective multicenter trial of the East-German-Study-Group-for-Hematology-and-Oncology, enrolled 398 adults in a two (patients; n = 262) to one (controls; n = 136) ratio. Pre-vaccination, day 35 (d35), and day 120 (d120) blood samples were analyzed for anti-spike antibodies and d120 IL-2⁺IFNγ⁺TNFα⁺-CD4⁺- and CD8⁺-cells. Laboratories were blinded for patients and controls. Results: Patients belonged to the myeloid (n = 131), lymphoid (n = 104), and checkpoint-inhibitor (n = 17) cohorts. While d35 seroconversion was higher in controls (98%) compared to patients (68%) (p < 0.001), d120 seroconversion improved across all patient cohorts [checkpoint-inhibitors (81% to 100%), myeloid (82% to 97%), lymphoid (48% to 66%)]. CD4⁺- and CovCD8⁺-cells in the lymphoid (71%/31%) and control (74%/42%) cohorts were comparable but fewer in the myeloid cohort (53%, p = 0.003 /24%, p = 0.03). In patients with hematologic malignancies, no correlation between d120 humoral and cellular responses was found. A sizeable fraction of lymphoid patients demonstrated T-cell responses without detectable spike-specific-IgGs. Conclusions: Evidence of vaccine-elicited humoral and/or cellular immunogenicity in most patients is provided. Both humoral and cellular responses are crucial to determine which patients will generate/maintain immunity. The findings have implications on public health policy regarding recommendations for SARS-CoV-2 booster doses. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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Review

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29 pages, 437 KiB

Open AccessReview

Interactions between COVID-19 and Lung Cancer: Lessons Learned during the Pandemic

by David J. H. Bian, Siham Sabri and Bassam S. Abdulkarim

Cancers 2022, 14(15), 3598; https://doi.org/10.3390/cancers14153598 - 23 Jul 2022

Cited by 10 | Viewed by 3004

Abstract

Cancer patients, specifically lung cancer patients, show heightened vulnerability to severe COVID-19 outcomes. The immunological and inflammatory pathophysiological similarities between lung cancer and COVID-19-related ARDS might explain the predisposition of cancer patients to severe COVID-19, while multiple risk factors in lung cancer patients have been associated with worse COVID-19 outcomes, including smoking status, older age, etc. Recent cancer treatments have also been urgently evaluated during the pandemic as potential risk factors for severe COVID-19, with conflicting findings regarding systemic chemotherapy and radiation therapy, while other therapies were not associated with altered outcomes. Given this vulnerability of lung cancer patients for severe COVID-19, the delivery of cancer care was significantly modified during the pandemic to both proceed with cancer care and minimize SARS-CoV-2 infection risk. However, COVID-19-related delays and patients’ aversion to clinical settings have led to increased diagnosis of more advanced tumors, with an expected increase in cancer mortality. Waning immunity and vaccine breakthroughs related to novel variants of concern threaten to further impede the delivery of cancer services. Cancer patients have a high risk of severe COVID-19, despite being fully vaccinated. Numerous treatments for early COVID-19 have been developed to prevent disease progression and are crucial for infected cancer patients to minimize severe COVID-19 outcomes and resume cancer care. In this literature review, we will explore the lessons learned during the COVID-19 pandemic to specifically mitigate COVID-19 treatment decisions and the clinical management of lung cancer patients. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

Other

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24 pages, 1348 KiB

Open AccessSystematic Review

Antiandrogens as Therapies for COVID-19: A Systematic Review

by Massimiliano Cani, Samantha Epistolio, Giulia Dazio, Mikol Modesti, Giuseppe Salfi, Martino Pedrani, Luca Isella, Silke Gillessen, Ursula Maria Vogl, Luigi Tortola, Giorgio Treglia, Consuelo Buttigliero, Milo Frattini and Ricardo Pereira Mestre

Cancers 2024, 16(2), 298; https://doi.org/10.3390/cancers16020298 - 10 Jan 2024

Cited by 2 | Viewed by 2162

Abstract

Background: In 2019, the breakthrough of the coronavirus 2 disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represented one of the major issues of our recent history. Different drugs have been tested to rapidly find effective anti-viral treatments and, among these, antiandrogens have been suggested to play a role in mediating SARS-CoV-2 infection. Considering the high heterogeneity of studies on this topic, we decided to review the current literature. Methods: We performed a systematic review according to PRISMA guidelines. A search strategy was conducted on PUBMED and Medline. Only original articles published from March 2020 to 31 August 2023 investigating the possible protective role of antiandrogens were included. In vitro or preclinical studies and reports not in the English language were excluded. The main objective was to investigate how antiandrogens may interfere with COVID-19 outcomes. Results: Among 1755 records, we selected 31 studies, the majority of which consisted of retrospective clinical data collections and of randomized clinical trials during the first and second wave of the COVID-19 pandemic. Conclusions: In conclusion, we can state that antiandrogens do not seem to protect individuals from SARS-CoV-2 infection and COVID-19 severity and, thus, their use should not be encouraged in this field. Full article

(This article belongs to the Special Issue Coronavirus Disease (COVID-19) and Its Impact on Patients with Cancer)

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