In ASCO Daily News, March 25,2020, Kinberley Morgan interviewed Dr Abdul-Rahman Jazieh of Cancer Care Commission, who relayed his personal experience in dealing with MERS-coronavirus in 2015.
“Outcome of Oncology Patients Infected with Coronavirus”
Journal: JCO Global Oncology
Purpose: This study investigated the features of oncology patients with confirmed Middle East respiratory syndrome (MERS) at the Ministry of National Guard Health Affairs-Riyadh during the outbreak of June 2015 to determine the clinical course and outcome of affected patients.
Methods: The patients’ demographic information, cancer history, treatment pattern, information about MERS-coronavirus (CoV) infection, history of travel, clinical symptoms, test results, and outcome were collected and analyzed as part of a quality improvement project to improve the care and safety of our patients. Only patients with confirmed infection were included.
Results: A total of 19 patients were identified, with a median age of 66 (range, 16-88), and 12 patients (63%) were males. The most common underlying disease was hematologic malignancies (47.4%), followed by colorectal cancer (21.0%) and lung cancer (15.8%). Hypertension and diabetes mellitus were the most common comorbidities (57.9% and 52.6%, respectively). Infection was diagnosed by nasopharyngeal swab in all patients. All patients contracted the infection during their hospitalization for other reasons. Sixteen patients (80%) were admitted to the intensive care unit; 13 patients (81%) had acute respiratory distress syndrome, 11 were intubated (68.75%), 9 had acute renal injury (56.25%), and 3 required dialysis (18.75%). Only 3 patients (15.8%) with early-stage cancers survived. Patients with hematologic malignancies and advanced solid tumors had a 100% case fatality rate. The majority of the causes of death were due to multi-organ failure and septic shock.
Conclusion: MERS-CoV infection resulted in a high case fatality rate in patients with malignancy. Therefore, it is critical to implement effective primary preventive measures to avoid exposure of patients with cancer to the virus.
Abdul-Rahman Jazieh, MD, MPH, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, in Riyadh, Saudi Arabia
Q: Univariable analysis showed significant association between survival status and stage of cancer, was this expected? Did anything about the study’s results surprise you?
Dr. Jazieh: When we planned the analysis, we expected that patients with cancer would have poorer outcomes [when exposed to the virus] based on our clinical experience, but we did not know the specific relation with different variables, such as stage. However, it is a standard approach whenever you are looking for outcomes of patients with cancer to factor in the type of cancer and the stage of the disease. Although we did expect poor outcomes, the magnitude of difference compared to other case fatality was surprising. It was more than double the total case fatality and reaching 100% in metastatic cancers and hematologic malignancies.
Q: Has anything from your past experiences with coronavirus/the study itself prepared you or impacted your practice during the current acute respiratory syndrome coronavirus-2 (SARS-CoV-2 [COVID-19]) pandemic?
Dr. Jazieh: In 2015, we implemented a stringent and structured plan to control that outbreak and avoid further harms to our patients. The plan was part of wider institutional transformation approach to control the outbreak and be ready for any future outbreak. The plan was quickly adapted and implemented for this pandemic.
Q: The study stressed the importance of implementing extra precautionary measures to ensure vulnerable patients, such as those with cancer, are not exposed to the virus. What precautionary measures can be implemented to better support these patients during the current, as well as potential future, outbreak(s) of coronavirus?
Dr. Jazieh: The most important step is to prevent our patients from getting exposed to suspected cases by all measures. Patients and visitors are screened before coming into oncology areas and suspected cases triaged properly. The other measure is to categorize patients into different priorities in terms of need to come to the hospital and the treatment administration. Basically, we should minimize our patient visits to the center and delay, safely, any treatment that can postponed, especially, in the early phase of outbreak to get better handle of the situation.
The most important step is to prevent our patients from getting exposed to suspected cases by all measures.
Q: What are the key lessons from this study for oncologists that can be applied to the present COVID-19 pandemic being experienced globally?
Dr. Jazieh: Deal with every person (patient and caregivers) as a suspected case. You need to protect other patients from getting infected. Protecting yourself and your staff from getting exposed is as critical as protecting patients because, in addition to the personal risks, infected health care professional can transmit disease to other patients and other health care professionals, which will be compounded by shortage of staff in a critical period and put other staff at risk.
It is also advised to screen patients by phone before their appointment and before they walk into your center.
Q: Based upon the study, what would you recommend to an oncologist who is treating patients during the present COVID-19 pandemic?
Dr. Jazieh: Due to the lack of clear evidence-based guidelines, a simple approach will be to categorize patients with cancer into three categories:
- Patients we must see soon, as delay will put their lives at risk: Screen for infection and treat them as necessary. Give hematopoietic growth factors more liberally if neutropenia is a risk.
- Patients we can postpone treatment for 2 weeks or more: Postpone treatment as far as you judge it safe. Communicate with them clearly and schedule virtual or phone visits, if needed.
- Patients seeking routine follow-up care: Reschedule 2 or 3 months in the future and schedule virtual or phone visit, if needed.
The risk is dependent on the prevalence of COVID-19 in the community at large and the hospital specifically. Hospitals with intensive care units filled with patients who have COVID-19 will certainly not do cancer surgery or even give chemotherapy for longer periods of time. We are still learning, and nothing is written in stone. Therefore, oncologists should get information from reliable sources like the ASCO Coronavirus Resources Center.
— Kimberly Morgan