Alipour Vahid, Rezapour Aziz, Shali Mahboobeh, Harati Khalilabad Touraj
Health Management and Economics Research Center Iran University of Medical Sciences Tehran Iran.
Department of Management and Intensive Care, School of Nursing and Midwifery Tehran University of Medical Sciences Tehran Iran.
Health Sci Rep. 2021 Jan 26;4(1):e240. doi: 10.1002/hsr2.240. eCollection 2021 Mar.
The mechanism by which a suppressed immune system of a cancer patient makes them susceptible to COVID-19 is still unclear. Any delay or discontinuation of cancer care due to the pandemic is expected to have a detrimental impact on the outcome of cancer. A few studies have addressed the incidence of COVID-19 among cancer patients, but the small sample size of such studies makes it difficult to draw inference to the general population.
For our review, 'Pubmed' database and Google search engines were used for searching the relevant articles. The criterion used for review includes their relevance to the defined review question, which is the pathophysiological mechanism of COVID-19 among cancer patients and the relevant therapeutic interventions therewith. This review includes 20 studies and other relevant literature which address the determinants of COVID-19 among Cancer patients.
Delay in cancer diagnosis will increase the stage progression of cancer patients and increased mortality in the future. A short delay in administering cancer related treatment to aid the odds of patient surviving the acute SARS-CoV-2 infection, should be at the discretion of the treating Physician. Oncologists dilemma in the current situation includes titrating the density of drug doses and intensity of treatment regimen, for the optimal management of metastatic and adjuvant cancer patients. Patients are thus subjected to suboptimal treatment and undetected disease recurrence, To circumvent the immunosuppressive effects of chemotherapy, Providers need to consider staggered regimen or alternate therapies such as biological/immunotherapy, targeted therapy, anti-angiogenic drugs, hormone therapy and/or antibody-based therapeutics.
This review provides insights on the pathogenesis of SARS-CoV-2, which could enable Physicians in formulating therapeutic strategies for the management of severe patients, more so in Oncology settings, thus reducing the mortality. The key is to balance the continuation of urgent cancer care, but rationing the elective treatment according to the circumstances.
癌症患者免疫系统受到抑制使其易感染新冠病毒的机制仍不清楚。由于疫情导致癌症治疗的任何延迟或中断预计都会对癌症治疗结果产生不利影响。一些研究探讨了癌症患者中新冠病毒的发病率，但此类研究样本量较小，难以推断总体人群情况。
在本次综述中，使用“PubMed”数据库和谷歌搜索引擎搜索相关文章。用于综述的标准包括文章与既定综述问题的相关性，即癌症患者中新冠病毒的病理生理机制及其相关治疗干预措施。本综述纳入了20项研究及其他相关文献，这些文献探讨了癌症患者中新冠病毒的决定因素。
癌症诊断延迟会增加癌症患者的分期进展，并导致未来死亡率上升。在给予癌症相关治疗以提高患者在急性新冠病毒感染中存活几率方面的短暂延迟，应由治疗医生自行决定。肿瘤学家在当前情况下的困境包括调整药物剂量密度和治疗方案强度，以实现对转移性和辅助性癌症患者的最佳管理。患者因此接受了次优治疗且疾病复发未被发现。为规避化疗的免疫抑制作用，医疗服务提供者需要考虑采用错开的治疗方案或替代疗法，如生物/免疫疗法、靶向疗法、抗血管生成药物、激素疗法和/或基于抗体的疗法。
本综述提供了关于新冠病毒发病机制的见解，这有助于医生制定重症患者的治疗策略，尤其是在肿瘤学环境中，从而降低死亡率。关键是要在继续进行紧急癌症治疗的同时，根据具体情况合理安排选择性治疗。
