[Infections as oncologic emergencies]

[Chemotherapy of malignant tumors]

The application of chemotherapy against malignant tumors might control the malignant disease but harbours many pitfalls. The chemotherapy type is chosen depending on the entity and stage of the tumor as well as on the patient's characteristics and fitness. Patients under therapy should be informed on the potential side effects and should be closely monitored by physicians, familiar with the common as well as the substance specific side effects of the drugs used. Preventive or timely application of supportive medication can prevent or diminish drug-induced toxicities. The attending physician has to be aware of the potential treatment-related emergency situations during application as well as several days after. One of the most common and dangerous emergencies that requires immediate medical attention is fever in neutropenia.The use of new medical drug classes, targeted molecular and immune therapies has changed and improved disease control in many tumor entities in a revolutionary manner. Overall, combination treatments including targeted drugs, immunotherapy and/or classical chemotherapy show improved efficacy in tumor control. These novel (combination) therapies may provoke different side effects that physicians need to be familiar with and take into account.

Clinical outcomes in cancer patients with COVID-19 in Sweden

BACKGROUND

The results of studies on the relationship between cancer and COVID-19 have been conflicting and therefore further studies are needed. We aimed to examine the incidence of COVID-19 among patients at one of the largest oncology departments in Sweden, and to evaluate and identify risk factors for poor outcomes, hospital care and death, associated with COVID-19 among cancer patients.

MATERIAL AND METHODS

This retrospective study included cancer patients at a single center who tested positive for SARS-CoV-2 by PCR either in hospital, primary health care center or commercial laboratory between 1 March and 14 August 2020. Clinical and demographic data were collected from the medical records. Logistic regression analysis was used to identify variables that associated the primary outcomes of need for hospital care and death within 30 days of positive test.

RESULTS

Of 10,774 patients from the Department of Oncology at Sahlgrenska University Hospital, 135 tested positive for SARS-CoV-2 (1.3%). Twenty-eight patients were excluded from further the data collection since they did not meet the inclusion criteria. Altogether, 107 cancer patients were included and the case fatality rate (CFR) was 12% (13) within 30 days of confirmed SARS-CoV-2 infection by PCR. Increasing years of age (OR 1.10; CI 95% 1.03-1.18), palliative treatment intent (OR 15.7; CI 95% 1.8-135.8), and transition to end-of-life care (OR 52.0; CI 95% 3.7-735.6) were associated with increased odds of death within 30 days. Male sex was associated with needing hospital care (OR 3.7; CI 95% 1.50-9.1).

CONCLUSION

As in the general population, male sex was found to be at greater risk of needing hospital care for COVID-19, with terminal cancer disease, and older age increasing the odds of fatality. Compared to the general population, slightly more cancer patients had COVID-19. The CFR was within the lower range of others reported in cancer patients.