Researchers examine the connection between lung cancer and COVID-19

On February 27, 2020, the flagship journal of the International Association for the Study of Lung Cancer, the Journal of Thoracic Oncology, published a case study that described two patients from Wuhan, China who recently underwent lung lobectomies for adenocarcinoma and were retrospectively found to have had COVID-19 at the time of surgery.

Eleven months later, the lung cancer research community gathered virtually at the IASLC 2020 World Conference on Lung Cancer Singapore to share a number of research findings examining the intersection of COVID-19 and lung cancer. Researchers from a variety of countries participated in a press briefing to examine the connection between lung cancer and COVID-19.

The press briefing will be moderated by IASLC President-Elect Dr. Heather Wakelee, chief of the Division of Medical Oncology at Stanford University and deputy director of the Stanford Cancer Institute. Patient Advocate and lung cancer survivor Ivy Elkins, MBA, cofounder of the EGFR Resisters and a member of the IASLC Lung Cancer News (ILCN) Editorial Group, will contribute insights from the advocacy community's perspective.

Earlier this year, Ms. Elkins co-authored an article for ILCN that reported that Black patients, Indigenous People, patients of Pacific island descent, and Hispanic patients are 3.7 times, 3.5 times, 3.1 times, and 2.8 times, respectively, more like to succumb to COVID-19, than White patients. These disparities cannot be explained by differences in income alone. It is, therefore, very likely that the pandemic will only exacerbate lung cancer health care delivery gaps in these already disenfranchised communities.

Studies underscore significance of mental health impact and importance of support organizations

The fear of contracting COVID-19 among patients with lung cancer is palpable, and three new research studies presented today underscore how vulnerable patients with lung cancer feel as they cope with the pandemic. Dr. Domenico Galetta, of the Medical Thoracic Oncology Unit of IRCCS Oncology Institute of BARI Italy, examined 176 patients with lung and breast cancers, as well as lymphoma, for signs of psychological distress and found that about a quarter of them report severe symptoms of Post traumatic stress disorders (PTDS) with female presenting higher levels when compared with males. (Featured Poster, FP06.04).

Patients with lung cancer have higher distress compared to the other groups. This condition risks being overlooked by clinical concerns, so we underline the importance [in our abstract] to place even more attention on the psychological needs of patients."

Dr. Domenico Galetta, Medical Thoracic Oncology Unit, IRCCS Oncology Institute, BARI, Italy

Another study conducted by the Chicago-based LUNGevity Foundation echoed Dr. Galetta's findings. The group surveyed 302 patients with lung cancer about anxiety regarding access to lung cancer care, patient preparedness to navigate care, and information needs (Abstract 3800).

Overall, 96% of respondents were concerned that the pandemic will affect their cancer care, and 46% reported interruption in lung cancer care, including not being able to see their doctor. Another 18% said they experienced increased difficulty in receiving appropriate care, and 45% of respondents worry about accessing care post pandemic.

"Our study reveals that patients with lung cancer continue to feel vulnerable and ill-equipped to navigate cancer care post shelter-in-place. Indeed, patient-specific factors (treatment status) and local COVID-19 caseload are important predictors of patient worries. Access to healthcare should be taken into account both during patient--physician discussions and during lung cancer-care planning at a systems-level," according to Jessica Selig, LUNGevity Foundation, Research, Chicago.

At a time when patients are in more need of support services, including mental health support, organizations that provide these services report their resources have been negatively affected during the pandemic.

The Global Lung Cancer Coalition (GLCC) is a partnership of 40 patient organizations across 29 countries, dedicated to improving outcomes for patients with lung cancer. The GLCC conducted a survey of its members and found that 64% receive more requests from patients with lung cancer as compared with before the pandemic, but 67% had closed or discontinued services such as support groups and seminars. GLCC found that 18 percent of organizations surveyed added new programs such as new digital services, including calls to patients and online consultations and extending helpline hours and adding new online content.

"Patient advocacy and support organizations are providing more support to patients during the pandemic. However, many organizations have seen a decrease in funding, making it more challenging to [continue or increase support programs]. Patient organizations need urgent financial support to continue to meet increased patient needs and, for some, to survive," said Dr. Matthew Peters, of Concord Hospital, Concord, Australia (Abstract 3384).

Would the pandemic affect access to lung cancer care or slow diagnosis? One study from Spain suggests that occurred in 2020

A study conducted by a group led by Dr. Roxana Reyes, of the Hospital Clínic de Barcelona, Thoracic Oncology Group, Barcelona, collected data of new cases of lung cancer diagnosed in two periods, during COVID and the same period in 2019, and found a decrease in the incidence by 38% during COVID.

Of those, researchers found that in the group of NSCLC there was more symptomatic and severe disease at diagnosis compared to 2019, with worse outcomes (Abstract 3700).

"During COVID, the number of new cases diagnosed decreased by 38% (43 NSCLC; 19 SCLC), compared to before-COVID period (67 NSCLC; 33 SCLC)," Dr. Reyes reported.

"Among those hospitalized, the mortality during hospitalization was 44% vs. 17% before COVID."

TERAVOLT Study Reveals Persistently High COVID-19 Mortality Rates Among Patients with Thoracic Malignancies but no Significant Difference According with Race or Ethnicity

Previously reported data on patients with thoracic malignancies who develop COVID-19 have suggested a higher mortality rate compared to the general population and to other cancer types, particularly in patients aged 65 or older or those patients suffering from active or progressive disease. This underscores importance of COVID-19 vaccination in this vulnerable patient population, when available.

The TERAVOLT study, a multicenter, international observational study composed of a cross-sectional component and a longitudinal cohort component that examined more than 1,000 patients with both lung cancer and COVID-19, found that overall mortality remains high, and males have significantly higher hospitalization and mortality rates compared to females. Importantly the researchers found no significant differences in COVID-19 related mortality among different racial or ethnic groups, according to Dr. Umit Tapan, of Boston Medical Center in Boston. (Poster P09.18).

Can telemedicine play a role for patients with lung cancer during the pandemic?

Although much of the world has moved to remote working and virtual meetings, there was concern about medicine's ability to adapt to the constraints caused by COVID-19. The use of telemedicine has flourished, but what role might it play for patients with complex diseases such as lung cancer?

Previous research has shown that patients with lung cancer who pursue an exercise regimen before treatment, a process known as prehabilitation , may increase their chances of survival. However, since the COVID-19 pandemic, the capacity to deliver face-to-face hospital appointments has significantly been reduced. If these crucial in person visits are curtailed by COVID-19, patients may suffer.

However, a study by Stephanie Wynne, of Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, , London, demonstrated that virtual, home-based prehabilitation is feasible and may improve patients' pre-surgical physical activity levels and exercise capacity (Abstract 3614).