GENERAL COMMENTARY published: 10 July 2020 doi: 10.3389/fonc.2020.01223 Commentary: SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China Serena Di Cosimo 1 , Luca Porcu 2 , Andrea Malfettone 3 , Javier Cortés 3,4,5,6,7† and Rosalba Miceli 8*† 1 Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy, 2 Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy, 3 Medica Scientia Innovation Research (MedSIR), New Jersey, United States, 4 Medica Scientia Innovation Research (MedSIR), Barcelona, Spain, 5 IOB Institute of Oncology, Quiron Group, Madrid, Spain, 6 IOB Institute of Oncology, Quiron Group, Barcelona, Spain, 7 Vall d’Hebron Insititute of Oncology (VHIO), Barcelona, Spain, 8 Clinical Epidemiology and Trial Organization Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy Keywords: COVID-19, SARS-CoV-2 infection, cancer care, patient guidance, risk factors A Commentary on SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Edited by: Wuhan, China Nicola Silvestris, University of Bari Aldo Moro, Italy by Yu, J., Ouyang, W., Chua, M. L. K., and Xie, C. (2020). JAMA Oncol. doi: 10.1001/jamaoncol.2020.0980 Reviewed by: Giulia Accardi, University of Palermo, Italy INTRODUCTION Francesca Gorini, National Research Council Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome (CNR), Italy coronavirus 2 (SARS-CoV-2), has rapidly escalated to a global pandemic, triggering countries *Correspondence: to implement lockdowns and stringent border controls. Under increasing pressures, healthcare Rosalba Miceli institutions worldwide have taken precautions to attenuate the negative effects of the COVID-19 rosalba.miceli@istitutotumori.mi.it pandemic and continue to deliver optimal care to patients with cancer. † These authors share Thus, far, systematic reports about the incidence of asymptomatic COVID-19 in patients with senior authorship cancer are very scarce. The most comprehensive data available at this time originates from a joint mission report indicating that in China the case fatality rate for patients with cancer was Specialty section: 7.6% compared with 1.4% for those with no comorbidities (1). Despite limited data, people with This article was submitted to hematological and other cancers and who are undergoing active treatment with chemotherapy or Cancer Epidemiology and Prevention, radiotherapy seem to be at greater risk than others because their immune systems are compromised, a section of the journal they are of greater age, or they have multiple comorbidities. Moreover, patients with cancer Frontiers in Oncology often make frequent visits to the hospital for treatment and monitoring, presenting them with a Received: 29 April 2020 heightened risk for exposure to SARS-CoV-2, possibly resulting in severe illness with COVID-19. Accepted: 15 June 2020 Published: 10 July 2020 SUMMARY OF THE REPORT Citation: Di Cosimo S, Porcu L, Malfettone A, We read with great interest the report in JAMA Oncology by Jing Yu and colleagues (2). Moving Cortés J and Miceli R (2020) from recently reported results of a large epidemiologic study (3), the authors focused on the effect Commentary: SARS-CoV-2 Transmission in Patients With Cancer of the COVID-19 pandemic on hospitalized cancer patients at a single institution in Wuhan, China. at a Tertiary Care Hospital in Wuhan, A retrospective analysis of 1,524 patients with cancer revealed a higher incidence of SARS-CoV-2 China. Front. Oncol. 10:1223. infection compared with the community at large, though <50% were undergoing active anticancer doi: 10.3389/fonc.2020.01223 treatments. Potential risk factors for COVID-19 transmission to patients attending hospitals for Frontiers in Oncology | www.frontiersin.org 1 July 2020 | Volume 10 | Article 1223 Di Cosimo et al. Cancer Care for COVID-19 Patients cancer care were also considered. In elderly patients (>60 years) While it is true that almost half the patients with both COVID-19 with non-small cell lung cancer (NSCLC), the risk of contracting and cancer were actively treated for the cancer, the distribution COVID-19 was 2.4 times higher than for younger patients (4.3 vs. of various treatments among those with COVID-19 is not known 1.8%) even though no association with susceptibility to infection to be comparable to that among those without it. was found in a prior multicenter study of 1,099 patients with Last, Table 2 of the report by Jing Yu and colleagues (2) shows laboratory-confirmed COVID-19 (4). the association between age and comorbid COVID-19 in patients The authors deserve credit and their effort is worth with NSCLC. It is likely that 60 years of age was chosen as mentioning because establishing the extent of COVID-19 in the cutoff because it was convenient. This choice raises certain a very vulnerable population could help guide formulation concerns, however. For example, the usual point at which elder of policies to optimally reduce the spread of disease amid a age begins is 65 years. Also, advanced age is largely recognized pandemic. However, some of the methodology is not solid, giving as a risk factor for symptomatic COVID-19 regardless of cancer rise to a lack of confidence in the results. status (5). Finally, the reported association between age and the presence of COVID-19 was not significant (p = 0.447 using the DISCUSSION Fisher exact test [unreported]) and, even so, association does not imply causation. Because this stated study limitation, that “older First, Jing Yu, and colleagues concluded that patients with cancer patients and patients with NSCLC may be at risk of COVID-19,” were at greater risk for SARS-CoV-2 infection compared with Table 2 data must be interpreted with caution. the Wuhan community at large. However, it appears that tests for systematic errors (i.e., selection bias [symptomatic people CONCLUSION visit the hospital more often than uninfected/paucisymptomatic people], assessment bias [inconsistency between the two Overall, conclusive associations between contracting COVID- populations in the application of COVID-19 diagnostic 19 and receiving cancer care cannot yet be determined. methods], and sampling methods) were not conducted. In Additional detailed and unbiased data describing how addition, the method for obtaining the odds ratio (OR) was patients with cancer differ in susceptibility to COVID-19 not disclosed. By arranging the data in a 2x2 table, the OR and complications related directly to SARS-CoV-2 infection is 2.13 (95% confidence interval [CI], 1.21–3.76).The authors represent an unmet need of the oncologic community. Further reported that the OR was 2.31 (95% CI, 1.89–3.02). Perhaps studies are required to elucidate the clinical characteristics of this was calculated using a multivariable analysis with an SARS-CoV-2-infected patients before making statements or adjustment for heterogeneity in demographics and COVID-19 recommendations that might preclude or delay treatments of risk factors between the two populations. By omitting an life-threatening diseases. adequate description, the data do not provide repeatable results, presenting difficulties in interpretation. AUTHOR CONTRIBUTIONS Second, while Jing Yu et al. stated that cancer treatment is reportedly associated with immunosuppression, data showing a SDC, AM, and RM did the literature search and drafted relationship between the use of chemotherapy, immunotherapy, the manuscript. SDC, LP, AM, JC, and RM put forward the or radiotherapy and SARS-CoV-2 infection are not provided. hypothesis, revised the paper, and approved it for publication. REFERENCES Medica Scientia Innovation Research (MedSIR); is a consultant/advisory board member for Roche, Celgene, Cellestia, AstraZeneca, Biothera Pharmaceutical, 1. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID- Merus, Seattle Genetics, Daiichi Sankyo, Erytech, Athenex, Polyphor, Lilly, Servier, 19). Available online at: https://www.who.int/publications-detail/report- Merck Sharp & Dohme, GSK, Leuko, Bioasis, and Clovis Oncology; has received of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19) honoraria from Roche, Novartis, Celgene, Eisai, Pfizer, Samsung Bioepis, Lilly, (accessed April 27, 2020). Merck Sharp & Dohme, and Daiichi Sankyo. Research funding was provided to 2. Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 transmission Vall d’Hebron Insititute of Oncology (VHIO) from Roche, Ariad pharmaceuticals, in patients with cancer at a tertiary care hospital in Wuhan, AstraZeneca, Baxalta GMBH/Servier Affaires, Bayer healthcare, Eisai, F. 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Characteristics of COVID-19 Patients Dying in Italy Report Based on available Copyright © 2020 Di Cosimo, Porcu, Malfettone, Cortés and Miceli. This is an data on March 20th, 2020. Available online at: https://www.epicentro.iss. open-access article distributed under the terms of the Creative Commons Attribution it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf (accessed License (CC BY). The use, distribution or reproduction in other forums is permitted, April 25, 2020). provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic Conflict of Interest: SDC is a member of a speakers bureau for Novartis and is practice. No use, distribution or reproduction is permitted which does not comply an advisory board member for Pierre Fabre. JC has stock or other ownership in with these terms. Frontiers in Oncology | www.frontiersin.org 2 July 2020 | Volume 10 | Article 1223