- Hubei, China 
- Wuhan, China
- New York City, USA

Cancer in COVID-19 Patients by Geographical Location

- Hematologocial Cancers are types of cancers that affect the blood, including lymphoma, leukemia, and myeloma.

Hematological Cancers and COVID-19

- Researchers aimed to investigate how different tumor types can influence the prevalence of severe SARS-CoV-2 and case-fatality rate.  It was determined that tumor type does have an effect on how susceptible one is to SARS-CoV-2 and the disease phenotypes that result.  In particular, COVID-19 patients with hematological cancers, such as myeloma, leukemia, and lymphoma, appeared to be at higher risk of exhibiting more severe clinical outcomes, needed more intense support interventions, and were more likely to die than COVID-19 patients with malignancies that were not hematological.   

- COVID-19 patients with lung or prostate cancer did not exhibit a higher case-fatality rate than the other COVID-19 patients with other cancer types.  In addition, patients with malignancies in the female genital tract or with breast cancers seemed to be at a decreased risk of being infected with COVID-19 or dying from the virus, but this protection is rather a result of the patients being female, as indicated by a multivariable analysis conducted.  


COVID-19 Prevalence and Mortality in Patients with Cancer and the Effect of Primary Tumor Subtype and Patient Demographics

As cancer patients are 3.6 times more likely to progress to severe COVID-19 if infected than individuals without cancer, some critical questions around care and treatment for cancer patients need to be asked in order to maintain their safety. 



Clinical Considerations and Precautions for Cancer Patients During the COVID-19 Pandemic 

- COVID-19 and sickle cell disease - Haematologica

Sickle Cell Disease and COVID-19

• Emerging studies show a worse trend among cancer COVID-19 patients compared to non-cancer COVID-19 patients.

• Other studies also indicate that the percentages of SARS-CoV-2 infection and severe events in cancer patients are not higher compared to the general population. Therefore, ongoing investigation is needed to better understand the comorbidity of COVID-19 and cancer.

• Because the majority of the reports associated with cancer patients with COVID-19 involve cohort studies with a relatively small sample size, limited clinical information, high heterogeneity of tumor stages and cancer types as well as diverse treatments, current understanding of the comorbidities are limited.

• Clinical outcomes and the biological basis for the comorbidity of cancer and COVID-19 remain to be resolved. 

• The possibility of COVID-19 recurrence brings a new sense of urgency to develop strategies to optimize the management and care of cancer patients with COVID-19. 

• The authors hope to bring attention to the symptoms, prognoses, and treatment options of cancer patients with COVID-19, and to stimulate research into the daunting challenge of addressing COVID-19 and cancer comorbidities.

COVID-19 in Cancer Patients: Risk, Clinical Features, and Management

- Since cancer patients are at such a high risk for COVID-19, it is very important that physicians keep their treatment regimens for all medications under extreme control and very monitored
- It was identified that patients with hematologic cancers tend to have poorer outcomes than those with solid tumors and therefore they must be kept under constant surveillance for COVID-19 infection
- The purpose of this paper is to give a 1-year recap on cancer management techniques instituted during the COVID-19 pandemic


Safeguarding COVID-19 and cancer management: drug design and therapeutic approach

- This node acts as a general summary of the comorbidity of cancer and COVID-19 from a paper that analyzed many other papers detailing the same thing at its time of release.
- Via a pooled meta-analysis of studies from around the globe analyzing the prevalence of cancer in COVID-19 patients, it was found that the prevalence of cancer in COVID-19 patients is about 2%, which is higher than the overall prevalence of cancer in the population (I think).
- This leads to a hypothesized conclusion that while there is not a lot of data for COVID-19 infection and cancer patients, there is an elevated risk for these patients. However, due to inconclusive and generally lacking data on this topic, this conclusion is not concrete.
- Many major cancer centers worldwide have taken extra precaution when it comes to the treatment of these patients as many cancer treatments (e.g., chemotherapy) weaken the immune system as a side effect.
- There has currently been no order to withhold chemotherapy, radiotherapy, immunotherapy, or delaying adjuvant therapy to treat cancer patients, however extra care must be taken by patients and physicians alike to not allow these high-risk patients to become infected.

University of Michigan - Ann Arbor

Johns Hopkins University

Ohio State University, Columbus

University of Texas at Austin

Michigan State University

COVID-19 comorbidities are high risk conditions that put patients at greater risk for infection and negative outcomes. Some COVID-19 comorbidities have been found to be: 
- Cancer 
- Cardiovascular Disease
- Diabetes
- Digestive Diseases
- HIV
- Hypertension
- Immunological Disease
- Liver Injury
- Obesity
- Renal disease
- Respiratory System Disease

COVID-19 Patient Comorbidities

- Many cancer treatments work by suppressing rapidly-dividing cells. Note that cancer cells divide rapidly, but some healthy cells (e.g., white blood cells) also divide rapidly. Hence, the immune system weakens, making the patient more likely to get infected and experience severe COVID-19 complications.

COVID-19 and Cancer Comorbidity

Desai, A., Sachdeva, S., Parekh, T., & Desai, R. (2020). COVID-19 and Cancer: Lessons From a Pooled Meta-Analysis. JCO global oncology, 6, 557–559. https://doi.org/10.1200/GO.20.00097

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193801/

COVID-19 and Cancer: Lessons From a Pooled Meta-Analysis

- AIDS and Behavior
- American Journal of Cancer Research
- American Journal of Hypertension
- American Society of Clinical Oncology Journals
- Annals of Allergy, Asthma & Immunology
- Annals of Internal Medicine
- Annals of Oncology
- Blood Advances
- BMC
- Brain, Behavior, and Immunity
- Cancer Discovery
- Cell Metabolism
- Clinical Immunology
- Clinical Infectious Diseases
- Clinical Reviews in Allergy & Immunology
- Clinical Transplantation
- Cureus
- Diabetes Care
- Diabetes & Endocrinology
- Diabetes & Metabolic Syndrome: Clinical Research & Reviews
- Diabetes, Obesity, and Metabolism
- Diabetes Research and Clinical Practice
- EClinicalMedicine
- European Journal of Cardio-Thoracic Surgery
- European Journal of Clinical Nutrition
- European Respiratory Journal
- Frontiers in Medicine 
- Frontiers in Public Health
- Gut
- Haematologica
- International Journal of Infectious Diseases
- International Journal of Obesity
- Journal of Alzheimer’s Disease
- Journal of American Nephrology
- Journal of Clinical Medicine
- Journal of Endocrinological Investigation
- Journal of Infection
- Journal of Infectious Diseases
- Journal of Intensive Care Medicine
- Mayo Clinic Proceedings
- Medicine
- Nature
- Nutrition, Metabolism & Cardiovascular Diseases
- Obesity
- Obesity Research & Clinical Practice
- Oxford Academic Journals
- Paediatric Respiratory Reviews
- Polish Archives of Internal Medicine
- Practical Diabetes
- PRiMER (Peer-Reviewed Reports in Medical Education Research) 
- Proceedings of the National Academy of Sciences 
- Public Library of Science
- The Brazilian Journal of Infectious Diseases
- The Journal of the American Medicine Association Cardiology
- The Journal of Allergy and Clinical Immunology
- The Lancet
- The National Center for Biotechnology Information
- The New England Journal
- Thrombosis Research
- Translational Stroke Research 

COVID-19 Comorbidities References by Journal

COVID-19 may be worse in patients with comorbidities, and this can cause damage to the heart, liver, kidneys, and blood and immune systems. Many patients have had multiple organ failure that started with pneumonia, and became worse when therapeutic effects were unsatisfactory. Comorbidities can cause a patient's deterioration, leading to multiple organ failure. Organ function should be closely monitored and protective measures such as mechanical ventilation, glucocorticoids, antivirals, symptomatic treatments, and anti-shock therapy should be administered if necessary. 

Multiple Organ Injuries in COVID- 19 Patients with Comorbidities

- Implication of Obesity In Patients with COVID-19 
- Obesity in COVID-19 Patients by Geographic Location 
- Risk of Cytokine Storm in Obese COVID-19 Patients
- Higher Concentrations of IL-17 and TNF-α Lead to Greater Respiratory Damage
- Association of Obesity and Age with severe cases of COVID-19
- Association of Obesity and Hospital Stay Length

Obesity as a Comorbidity of COVID-19 

- Hypertension and COVID-19 by Geographic Location
- Hypertension and COVID-19 by Topic

Hypertension as a Comorbidity of COVID-19

- Respiratory System Disease in COVID-19 Patients by Geographic Location 
- Asthma as a Comorbidity of COVID-19

Respiratory System Disease as a Comorbidity of COVID-19

- Clinical Features and Outcomes of Patients With Human Immunodeficiency Virus With COVID-19
- The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective (General Summary of HIV and COVID-19 Interaction)
- Maintaining HIV care during the COVID-19 pandemic
- HIV in COVID-19 Patients by Geographic Location
- COVID-19 and HIV Coinfection

HIV as a Comorbidity of COVID-19

- By country
- Liver Transplantation
- Chronic Liver Disease

Liver Injuries as a Comorbidity of COVID-19 

Cancer as a Comorbidity of COVID-19 

Patients with digestive diseases like inflammatory bowel disease (IBD) or gastrointestinal cancer are at a higher risk to experience more severe symptoms of COVID-19. Autopsy studies are important in understanding how COVID-19 affects the digestive system. More data needs to be collected to determine the exact relationship between digestive diseases and COVID-19. 

Digestive Diseases as a Comorbidity of COVID-19

- Cytokine Storm Syndrome
    -  Secondary Haemophagocytic Lymphohistiocytosis
- Common Variable Immunodeficiency 
- Figure illustrating how pathogenic T cells and inflammatory monocytes enter pulmonary circulation and incite an inflammatory storm and immune disorder 
- Severe Combined Immunodeficiency

Immunological Diseases as a Comorbidity of COVID-19

- Prevalence of pathophysiology, prognosis, and practical considerations
- Knowledge in progress
- The link between diabetes and ACE2
- Diabetes in COVID-19 patients by geographic location 
- Degree of Hyperglycemia on COVID-19 mortality
- Diabetes Medication on COVID-19 mortality
- COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology

Diabetes as a Comorbidity of COVID-19

During the COVID-19 era the regular treatment and communication between physicians and patients regarding preexisting comorbidities has been disrupted. New guidelines and safety precautions must be put in place in order for physicians to still treat their patients and treat them through the use of telehealth or other means. While there are a lot of similarities between new communication policies being implemented across different areas of medicine, there are also many differences due to comorbidity specific criteria which facilitates different levels of involvement and communication between physicians and patients.


The comorbidities addressed under this node include:
- Cancer
- Cardiovascular Diseases
- Digestive Diseases
- Elective Surgeries
- Liver Diseases
- Psychological Disorders
- Renal Diseases

Changes to COVID-19 Patient Comorbidity Treatment and Communication

Cardiovascular disease is a risk factor for severe COVID-19, and COVID-19 causes cardiovascular complications. 

Cardiovascular Disease and COVID-19

- A retrospective multi-center experience of renal transplants from India during COVID-19 pandemic

Renal Diseases as a Comorbidity of COVID-19

The Centers for Disease Control and Prevention (CDC) in the U.S. recommend some guidelines for cancer patients, which they consider a high-risk population, and their caregivers to protect them from COVID-19. The basic recommendations are the same as what they suggested to the general public, which includes watching out for fever (38ºC or higher), knowing the signs and symptoms of infection, cleaning your hands often, avoiding touching one's face, using a face covering, avoiding people as much as possible, and keeping a distance of at least 6 feet (2 m).

Basic Recommendation

1. Due to the highly contagious nature of COVID-19, its spread in the general public is very rapid. It is highly likely that newly diagnosed and existing patients with cancer might not get treatment on time. Additionally, mental stress about getting the infection during this infectious disease outbreak could drastically impact cancer patients' decisions to go to the hospital for follow up visits and treatment. 
2. Ethical considerations 
3. Recommended to increase the use of telemedicine in cancer care. 



Treatment Challenges

- This analysis aimed to compare characteristics of COVID-19 patients with and without cancer and assess whether cancer is associated with COVID-19 morbidity or mortality.
- COVID-19-positive patients with an inpatient or emergency encounter at the Mount Sinai Health System between March 1, 2020, and May 27, 2020, were included and compared across cancer status on demographics and clinical characteristics. 
- Patients with cancer were statistically significantly older, more likely to be non-Hispanic Black and to be admitted to the hospital during their encounter, and had more comorbidities than noncancer COVID-19 patients.
- COVID-19 patients with cancer may have a higher risk for adverse outcomes. Although there was no statistically significant difference in mortality, COVID-19 patients with cancer have statistically significantly higher risk of thromboembolism and sepsis.


Clinical Course of Cancer Patients With COVID-19: A Retrospective Cohort Study

- General Cancer and Radiological Treatment
- Surgical Oncology Treatment Changes

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