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Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multi-Center Study During the COVID-19 Outbreak


Background: The novel COVID-19 outbreak, caused by the SARS-CoV-2 virus and originally detected in December 2019 in Wuhan, China, has affected more than 140 countries and territories as of March 2020. Given that patients with cancer are generally more vulnerable to infections, systematic analysis of diverse cohorts of patients with cancer affected by COVID-19 are needed.Methods: Clinical information from 105 hospitalized patients with cancer and 233 hospitalized patients without cancer, all infected by the SARS-CoV-2 virus, were collected from 14 hospitals in Hubei province, China, from January 1, 2020, to February 24, 2020. Standard statistical methodologies were used to compare four different outcomes: death, admission into an intensive care unit (ICU), development of severe/critical symptoms, and utilization of invasive mechanical ventilation; between patients with cancer (of different types, stages, and treatments of cancer) and patients without cancer.Findings: Compared with COVID-19 patients without cancer, COVID-19 patients with cancer had higher risks in all four severe outcomes. Patients with blood cancers, lung cancers, or with metastatic cancer (stage IV) had the highest frequency of severe events. Non-metastatic cancer (stage I-III) patients experienced similar frequencies of severe conditions to those observed in patients without cancer. Patients who received immunotherapy and surgery had higher risks of having severe events, while patients with only radiotherapy and targeted therapy did not demonstrate significant differences in severe events when compared to patients without cancer.Interpretations: Patients with blood cancer, lung cancer, and metastatic cancer demonstrated a higher incidence of severe events compared to patients without cancer. In addition, patients who underwent immunotherapy or cancer surgery had higher death rates and higher chances of having critical symptoms.Funding Statement: National Natural Science Foundation of China; Singapore Ministry of Health's National Medical Research Council under its Singapore Translational Research (STaR) Investigator Award; National Institutes of Health; Xiu Research Fund.Declaration of Interests: HBC declares funding from the NSCI. DLT declares funding from Ministry of Health's National Medical Research Council under its Singapore Translational Research (STaR) Investigator Award. ML and LC declares funding from National Institutes of Health and Xiu Research Fund. All other authors declare no competing interests.Ethics Approval Statement: This case series was approved by the institutional ethics board of Zhongnan Hospital of Wuhan University (No. 2020029) and the board waived the need for informed consent.

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