Indian Journal of Respiratory Care

REVIEW ARTICLE
Year
: 2021  |  Volume : 10  |  Issue : 3  |  Page : 276--279

COVID-19 and lung cancer: Strengthening the prevention component and improving the prognosis


Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2,  
1 Department of Community Medicine, Medical Education Unit, Institute Research Council, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Chengalpattu, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Chengalpattu, Tamil Nadu, India

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India

Abstract

The coronavirus disease-2019 (COVID-19) pandemic overwhelmed health-care delivery systems owing to the significant morbidity and mortality. Lung cancer in the year 2020 alone has accounted for more than 2.2 million new cases and 1.8 million deaths across the globe. The purpose of the current review is to explore the impact of COVID-19 on lung cancer and to identify measures that can improve the prognosis of cancer patients during the ongoing COVID-19 pandemic. An extensive search related to the topic was carried out in the PubMed and World Health Organization website. Relevant research articles focusing on COVID-19 and lung cancer published between April 2020 and June 2021 were included in the review. Forty-five studies similar to the current study objectives were identified initially. Among them, five were excluded due to unavailability of the complete version of the articles. Overall, forty articles were selected based on the suitability with current review objectives. Keywords used in the search include COVID-19 and Lung cancer in the title alone only. It has been estimated that patients with lung cancer will have a significantly higher risk of an adverse outcome, if they acquire COVID-19 infection. National bodies across multiple nations have released recommendations for both prevention and optimal management of COVID-19 infection among known lung cancer patients. To conclude, the COVID-19 pandemic has significantly affected patients with lung cancer. Owing to the emergence of evidence of poor prognosis of infection among lung cancer patients, there is an indispensable need to adopt a multidisciplinary treatment approach.



How to cite this article:
Shrivastava SR, Shrivastava PS. COVID-19 and lung cancer: Strengthening the prevention component and improving the prognosis.Indian J Respir Care 2021;10:276-279


How to cite this URL:
Shrivastava SR, Shrivastava PS. COVID-19 and lung cancer: Strengthening the prevention component and improving the prognosis. Indian J Respir Care [serial online] 2021 [cited 2021 Dec 2 ];10:276-279
Available from: http://www.ijrc.in/text.asp?2021/10/3/276/325876


Full Text



 Introduction



The coronavirus disease-2019 (COVID-19) pandemic overwhelmed health-care delivery systems owing to the significant morbidity and mortality. In fact, since the start of the outbreak, more than 175 million cases and 3.79 million deaths have been attributed to the infection.[1] It is quite an alarming fact that the infection has been reported in 222 nations and territories.[1] On the other hand, lung cancer continues to remain the second most common cancer in terms of incidence, accounting for more than 2.2 million cases, while it is the leading cancer in terms of death (1.8 million) in the year 2020 alone, and has been acknowledged as an important public health concern.[2] The purpose of the current review is to explore the impact of COVID-19 on lung cancer and to identify measures that can improve the prognosis of cancer patients during the ongoing COVID-19 pandemic.

 Methods



An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website. Relevant research articles focusing on COVID-19 and lung cancer published from April 2020 to June 2021 were included in the review.

A total of 45 studies similar to the current study's objectives were identified initially, of which, five were excluded due to unavailability of the complete version of the articles. Overall, forty articles were selected based on the suitability with the current review objectives and analyzed. Keywords used in the search include COVID-19 and Lung cancer in the title alone only (viz. COVID-19 [ti] AND lung cancer [ti]). Articles published in English language only were included for the review. The collected information has been presented in the following sub-headings, namely COVID-19 and patients with lung cancer, what makes lung cancer patients vulnerable, proposed recommendations, management of COVID-19-infected lung cancer patients, implications for practice, and implications for research.

 Coronavirus Disease-2019 and Patients with Lung Cancer



It has been estimated that patients with lung cancer will have a significantly higher risk of an adverse outcome, if they acquire COVID-19 infection.[3],[4],[5] Patients with lung cancer are usually prone to adverse outcomes attributed to COVID-19 infection because of old age, presence of different co-morbidities, positive history of smoking, and potential damage induced due to lung cancer.[3],[4],[5],[6],[7] Further, the immunosuppression produced by the anticancer drugs also increases the propensity of development of COVID-19-associated complications.[4],[5],[6],[7],[8],[9] Moreover, it has been reported that among all types of cancers, patients with lung cancers have the highest rate of COVID-19 infection.[6],[10] The findings of a study done among lung cancer patients who were subsequently infected with COVID-19 revealed that 78% of the lung cancer patients required hospitalization, whereas almost 36% of the patients succumbed to the complications of the infection.[11]

 What Makes Lung Cancer Patients Vulnerable?



We must take into account the fact that due to the imposition of lockdown and restriction on the movement of people, the well being of lung cancer patients is clearly affected, if they acquire the COVID 19 infection.[11],[12],[13],[14] Owing to the COVID-19 pandemic, regular screening activities for the detection of lung cancer have been interrupted, as most of the hospitals are taking care of COVID-19 patients and are often overwhelmed.[15],[16],[17] There is an immense need to initiate screening activities at the earliest, else we will soon find ourselves managing large number of patients with advanced stages of lung cancer.[16],[18]

Owing to the imposed lockdown and interruption in the delivery of routine health-care services, the services aimed for diagnosis, treatment, and follow-up of lung cancer patients have been severely affected.[19],[20],[21],[22],[23] In fact, the findings of a study have identified specific delays in terms of extension in the time span between intravenous treatments which require hospitalization, decrease in the number of treatment cycles, shifting to oral treatment as intravenous therapy is not possible, etc.[24],[25],[26],[27],[28] All these interruptions and delay have significantly impacted the prognosis of lung cancer patients and have even accounted for an impairment in the quality of life of the patients.[19],[20],[21],[22],[23],[24],[25],[26],[27],[28]

The ongoing COVID-19 pandemic has compelled hospital authorities to reorganize their hospital wards and patient care-related activities, in order to accommodate the increasing number of people infected with the novel viral infection.[20],[21],[23],[24] This reallocation of the available logistics and resources has significantly affected the nature of care offered to people with chronic diseases, including patients with lung cancer.[24],[25],[26],[27],[29] In fact, oncologists have had to prioritize patients that need immediate attention and those whose care can be delayed till COVID-19 situation improves in the local region.[26],[27],[28],[29] In other words, COVID-19 infection has started to influence even the decision-making among health-care professionals and has complicated the overall picture.[29]

The findings of a study done in Italy among lung cancer patients revealed that owing to the sudden exacerbation of cases and increasing number of deaths among COVID-19-infected patients, there was a sense of immense fear among people living with lung cancer.[30] On a similar note, a significant amount of stress was reported among another cohort of lung cancer patients as they were extremely worried about the acquisition of infection and that they would not be able to receive the treatment for their malignancy as the health-care delivery system was overwhelmed.[31]

 Proposed Recommendations



The national bodies across multiple nations have released a set of recommendations for both prevention and optimal management of COVID-19 infection among known lung cancer patients.[32],[33],[34],[35],[36] The most important strategy is to minimize the exposure of lung cancer patients to hospitals so that the risk of acquiring the infection can be significantly minimized. This essentially calls for the need to strengthen tele-consultation in health-care facilities. However, patients who definitely require follow-up should be managed in those settings, which do not entertain COVID-19 patients.[16],[28],[33] The opportunity of clinical interaction should also be utilized to screen lung cancer patients for the potential presence of clinical features suggestive of COVID-19 infection and to assess the presence of therapy-induced adverse reactions.[13],[16],[28],[35],[36]

 Management of coronavirus disease-2019-Infected Lung Cancer Patients



From the management perspective, it has been advocated to not administer immunosuppressive chemotherapeutic drugs and that even if administered, it should be done in a health-care facility with close monitoring for adverse effects.[33],[37] The COVID-19-infected lung cancer patients who need treatment for lung cancer should be isolated for a period of 2 weeks before the start of treatment either at home or in hospital settings.[14],[33] The recommendations remain same for even surgical interventions. Health professionals should exercise all precautions to interrupt transmission of the COVID-19 infection, and all elective procedures should be deferred.[38],[39],[40] The decision to administer radiotherapy should be taken by a set of experts and should be offered close to the patient's residence in a non-COVID-19 health-care establishment, to avoid prolonged travel.[33],[41] We must realize that the entire task of management of cancer patients during the ongoing COVID-19 pandemic is a critical issue, that will essentially require a multi-faceted approach, involving active collaboration between different stakeholders.[42]

 Implications for Practice



The COVID-19 pandemic has emerged as a major challenge for health professionals, and it is quite essential for them to safeguard the vulnerable population groups. It is the need of the hour to advise patients with lung cancer to take extreme precautions and avoid all unnecessary exposure or social gatherings.[20],[21] Standard strategies to prevent acquisition of the infection, namely periodic hand washing, use of face masks, and following respiratory hygiene, should be strictly adhered.[21],[23] All known patients with lung cancer should avoid visits to hospital and, whenever they visit, the health-care professionals should evaluate them for the symptoms of COVID-19 infection.[22],[23],[24],[25]

 Implication for Research



As the infection is a novel viral infection, a lot needs to be still understood about the interactions between COVID-19 and lung cancer. There is a need to intensify research activities to formulate correct management plan for patients with lung cancer at different stages.[34],[35],[39] The available evidence signifies the role of smoking in producing a negative outcome and thus it can be further explored. Further, significant insight is required to understand the outcome of different therapeutic interventions on the prognosis of patients and thus all research should aim to improve the survival and well-being of patients.[37],[38],[39],[40],[41] There is a significant scope to employ tools such as social media, telemedicine, and triage using phones for initiating the process of screening patients with lung cancer.[42]

 Conclusion



The COVID-19 pandemic has significantly affected patients with lung cancer. Owing to the emergence of evidence of poor prognosis of infection among lung cancer patients, there is an indispensable need to adopt a multidisciplinary treatment approach. The aim should be to prevent the acquisition of infection, and to ensure provision of a timely, adequate, and rational line of management to these patients when infected with COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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