Cancer patients – especially those with blood or lung malignancies, or tumours that have spread throughout the body – have a higher risk of death or other severe complications from Covid-19 compared with those without cancer, according to a study published on Tuesday.

The study, which involved 14 hospitals in Hubei province in central China, where the pandemic emerged, included 105 cancer patients and 536 non-cancer patients of the same age – all of whom had Covid-19, the disease caused by the novel coronavirus.

The co-authors, from China, Singapore and the United States, found that cancer patients who developed Covid-19 had nearly a threefold higher death rate from the virus than the 2 to 3 per cent rate estimated for the general population. Cancer patients also were more likely to experience “severe events”, such as being admitted to intensive care units and needing mechanical ventilation, than people without cancer. Risk factors included not just age, but also the kind of cancer, the stage and the treatment.

“These findings suggest that patients with cancer are a much more vulnerable population in the current Covid-19 outbreak,” the authors concluded.

The study was released at the American Association for Cancer Research’s virtual annual meeting and published in the organisation’s peer-reviewed journal, Cancer Discovery. The only previous study of cancer patients and Covid-19 included just 18 patients.

Inside US hospital: A day fighting the coronavirus Show all 13 1 /13 Inside US hospital: A day fighting the coronavirus Inside US hospital: A day fighting the coronavirus Cheryll Mack, 46, a registered nurse in the emergency department, poses for a photograph after a 12-hour shift outside the hospital where she works. "The Covid-19 spread has affected a lot of livelihood, a lot of people's lives. It has created a crisis, death in general. So I would like to ask not one single person, but all people worldwide, to converge and join the platform that this is something that nobody can fight individually," said Mack. Reuters Inside US hospital: A day fighting the coronavirus Dr Laura Bontempo, 50, an emergency medicine doctor wears her personal protective equipment she uses when she sees patients, while posing for a photograph after a nine-hour shift, outside the hospital. "The hardest moments have actually been separating families from patients, there is a no-visitor policy now and taking people away from their loved ones is very challenging," Bontempo said. "I'm used to treating sick patients. I treat sick patients all the time. It's very different knowing that the patient you are treating, is actually a risk to you as well. That's the main difference here. No one who works in hospitals is afraid of treating sick people. Just want to keep staff safe and the patients safe at the same time." Reuters Inside US hospital: A day fighting the coronavirus Ernest Capadngan, 29, a registered nurse who works at a biocontainment unit poses for a photograph after a 12-hour shift, outside the hospital. "The hardest moment during the shift was just seeing Covid patients die helpless and without their family members beside them," Capadngan said. Reuters Inside US hospital: A day fighting the coronavirus Martine Bell, 41, a nurse practitioner in an emergency department, poses for a photograph after a six-hour shift outside the hospital where she works. "The hardest thing in all of this, has been taking care of fellow healthcare providers. It really hits home and it's really scary when you see someone that could be you coming in and now you're taking care of them. It's also hitting home that once healthcare providers start getting sick, who is going to be taking care of the public," Bell said. "It's very stressful, everyone is on edge. We don't know who's coming in next, or how sick they're going to be, or if we are going to get a whole bunch of people or if we're not going to get no one. It's a really stressful and just a completely unusual time for all of us." Reuters Inside US hospital: A day fighting the coronavirus Kaitlyn Martiniano, 25, a registered nurse who works at a biocontainment poses for a photograph after a 12.5-hour shift, outside the hospital. "We have a lot of patients and they are pretty sick right now but we have not yet been hit as hard as New York or Seattle, so I feel like we are very lucky with that so far. Every day you have to just be optimistic." Said Martiniano. "I think the reason that we are not being hit as hard right now is because so many things are closed, and because so many people are staying at home." Reuters Inside US hospital: A day fighting the coronavirus Tracey Wilson, 53, a nurse practitioner in an intensive care unit (ICU), poses for a photograph after a 12-hour shift, outside the hospital where she works. "I had a patient fall out of bed today and I had to call his wife and tell her and she couldn't come see him, even though she pleaded and begged to come see him," Wilson said. "There is a lot of unknowns and with that unknown is a lot of anxiety and stress that we're not used to dealing with." Reuters Inside US hospital: A day fighting the coronavirus Meghan Sheehan, 27, a nurse practitioner in an emergency department, poses for a photograph after a 12-hour shift, outside the hospital where she works. "I think the hardest moment has been the fear that lives within all of us. There is a lot of unknown right now. We fear what's going to happen tomorrow, how the emergency department will look next week when we come in. We have fears about our own colleagues, whether they will fall ill. We also fear that we could be asymptomatic carriers and bring this virus home to our families and our loved ones. There has been a lot of fear over our supplies and whether we'll run out. And then obviously there is the fear that we will see patients and not be able to do everything we normally can to help save patients' lives," Sheehan said. Reuters Inside US hospital: A day fighting the coronavirus Kimberly Bowers, 44, a nurse practitioner in an ICU, poses for a photograph after a 13-hour shift, outside the hospital. "The hardest moment was a young woman who died and her family wasn't able to be here with her," Bowers said. "I think right now, it's just frustrating and scary just not knowing what comes next." Reuters Inside US hospital: A day fighting the coronavirus Tiffany Fare, 25, a registered nurse who works at a biocontainment unit poses for a photograph after a 13-hour shift, outside the hospital where she works. "One of the hardest moments was having to see a family member of a Covid patient, say goodbye over an iPad, rooms away. That was a tough one, I can't imagine how hard it would be to be saying goodbye, you can't see your loved one and then they're gone," Fare said. "My team has been really great to me. We've worked really well together and we've really come together in this crisis. We don't really know each other, we all come from different units within the same hospital, so for us to come together and work so well as a team, it's been a journey but I think that's what is giving me hope." Reuters Inside US hospital: A day fighting the coronavirus Dr Kyle Fischer, 35, an emergency medicine doctor, poses for a photograph after a 12-hour shift, outside the hospital where he works. "Since it's a new virus, we don't have any experience with it. For most diseases I am used to seeing it and taking care of it and this, I don't have any starting place. I know what I'm hearing from New York, I've read all of the papers it seems like, but no one knows what the correct answers are, so there's a huge amount of uncertainty and people are really, really sick. So it's hard to second guess whether or not you are doing the right thing when you think you are but you never quite know," said Fischer. Reuters Inside US hospital: A day fighting the coronavirus Julia Trainor, 23, a registered nurse at a surgical ICU, poses for a photograph after a 14-hour shift, outside the hospital. "The hardest moment was having to put a breathing tube in my patient who could no longer breathe for herself and after the breathing tube went in, we called her family and the husband, of course, couldn't visit her because of visitor restrictions at the hospital. So I had to put him on the phone and hold the phone to her ear, as he told her that he loved her so much and then I had to wipe away her tears as she was crying," said Trainor. "I'm used to seeing very sick patients and I'm used to patients dying but nothing quite like this. In the flip of a switch, without the support, they're completely isolated. They're very sick. Some of them recover and some of them don't. But the hardest part, I would think, is them having to go through this feeling like they are alone." Reuters Inside US hospital: A day fighting the coronavirus Lisa Mehring, 45, a registered nurse who works in a biocontainment unit with Covid-19 patients, poses for a photograph after a 12.5-hour shift, outside the hospital where she works in Maryland. "Seeing these new moms have babies has been the hardest moment along with having do their pumping for the new moms and them not being able to be with their newborn children, it's hard to think of the family that they are missing," Mehring said. Photos Reuters Inside US hospital: A day fighting the coronavirus Jacqueline Hamil, 30, a registered nurse in an emergency department, poses for a photograph after a 12-hour shift outside the hospital. "The hardest moment of my shift today, I was in charge, and we had a really sick patient that was in a really, really small room and usually, when we have sick crashing patients, we can have a ton of resources and a ton of staff go in and help with the nurse and the doctors that are taking care of that patient. But due to the patient being ruled out for the coronavirus, we could only have five or six people in the room at a time and putting on all the gowns and gloves and masks and face shields to protect us in case the patient does have coronavirus, it takes a while, so the nurse that was in there, ended up being in the room for you know 6, 7 hours with minimal breaks and it was hard being in charge and knowing that she was stuck in the room and really nothing I could do to help her," Hamil said. Reuters

J Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society, which was not involved in the study, called it “important”, adding that it “reflects what we had heard previously – that cancer patients are more susceptible to the virus, and that the course of the infection is worse and the outcomes are worse”. He said that the study was still relatively small and that thousands more patients need to be scrutinised.

The apparent higher risk of death and other serious complications from the virus are among the dangers facing cancer patients as they try to navigate a pandemic that has forced the delays of some treatments, the closing of many clinical trials to new patients and shortages of critical pain medications, said Howard Burris, chief medical officer and executive director of the Sarah Cannon Research Institute in Nashville, Tennessee and president of the American Society of Clinical Oncology (Asco).

“We face daunting challenges to optimal patient care,” he said at an Asco media briefing last week. He noted that some hospitals “have effectively deemed all cancer surgeries elective”, requiring them to be postponed. While such delays make sense for some patients with early-stage disease, they can be devastating for “patients with fast-moving or hard-to-treat cancers”, he warned.

More than 1.8m new cancer cases are expected to be diagnosed in the United States in 2020, according to the American Cancer Society, and more than 606,000 people are expected to die of the disease.

Mr Lichtenfeld said he expects some healthcare systems to begin treating more non-Covid-19 patients in coming weeks and months. “It won’t be the same in every part of the country,” he said. “But we are starting to move through. That doesn’t mean we are not still at a difficult place, but health systems are trying to figure out the best way to loosen the reins on some elective surgeries.”

The newly published study on cancer patients and Covid-19 showed that patients with leukemia, lymphoma and myeloma – all diseases in which cancer attacks the immune system – were among those with the highest rates of severe problems. Patients with lung and gastrointestinal cancers also were at higher risk for poor outcomes.

In addition, cancer patients who underwent surgery as part of their treatment were likely to have worse outcomes than those without cancer, while those who got radiotherapy had similar outcomes. People with early-stage disease – localised malignancies – had results similar to those of non-cancer patients.

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For Deborah Silverman, an MD/PhD candidate at MD Anderson Cancer Centre in Houston, Texas, the outbreak has had a direct impact on her treatment. Diagnosed last year with triple negative breast cancer, one of the most aggressive breast cancers, she has had chemotherapy, surgery and radiation and now is getting chemotherapy again. Even so, Ms Silverman has some residual disease and a 50 to 60 per cent chance of recurrence, she said.

To reduce her risk, she planned to enter a clinical trial for immunotherapy, which unleashes the immune system to attack cancer.

But the trial, like many across the country, is not enrolling new patients as a result of the pandemic, so she is extending her chemotherapy regimen. One side effect has been blisters on her feet and toes, making it painful to do yoga or even to walk.

Ms Silverman is hoping she can switch soon to immunotherapy, which has fewer side effects than chemotherapy. “This is the only trial available right now for someone in my position,” she said. “We want to have all the shots on goal we can.”