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Are Lung Cancer Patients at Increased Risk From COVID-19?

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Published on June 24, 2020

Are Lung Cancer Patients at Increased Risk From COVID-19?

"Lung cancer patients are at elevated risk of a more severe manifestation of the disease and may have a higher risk of mortality", Dr. Amy Moore, Go2 Foundation for Lung Cancer, and Patient Power co-founder, Andrew Schorr discuss the unique risk that lung cancer patients face from Covid-19.

Currently, there are several studies working to understand the risks for patients at different phases of treatment, but much is still unknown and the best advice remains to socially distance, wear a mask and limit contact with others.

Dr. Moore emphasizes that much work is being done to understand both the current risks and long term consequences to lung cancer patients with already compromised lungs and immune systems. "The one thing that has been so heartening for all of us as scientists and physicians is the rapid mobilization and collaboration worldwide in the face of Covid-19".

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Transcript | Are Lung Cancer Patients at Increased Risk From COVID-19?

Andrew Schorr:
Hello, I'm Andrew Schorr from Patient Power in Southern California. Joining me from Northern California is Dr. Amy Moore, PhD, who is the Director of Science and Research with the GO2 Foundation for Lung Cancer. Dr. Moore, thank you for being with us.

Dr. Moore:
Thanks for having me, Andrew.

Andrew Schorr:
Okay, so here we are in this time of COVID-19 pandemic, lots of worry among lung cancer patients, families affected, and the advocacy groups such as yours. You all have been studying that, the patient concerns and just what are the issues. Let's talk about that for a minute. What would you like to share with our audience?

Dr. Moore:
Well, I think our efforts go back to the early days of the pandemic and the realization by myself and my colleagues across the lung cancer advocacy groups that COVID-19 presented a unique threat to the community we serve. As you know, there's been just an overwhelming amount of information that keeps coming out daily and things change rapidly and evolve rapidly as our understanding of the virus and COVID disease materializes.

Because of that, we felt it was critical that we come together and provide a unified voice, to really take it upon ourselves, as scientists, to vet the information that's out there, to distill it down in a way that patients could understand so that we could educate and empower them to take the necessary measures to protect themselves. Because we know the data that has emerged thus far suggests that lung cancer patients are at elevated risk of a more severe manifestation of the disease and may have higher rates in mortality, so it was important to us to do that work.

Andrew Schorr:
Right. You have research about that that is being presented to researchers around the world. What do we know from that so far?

Dr. Moore:
Well, the early studies out of China, and then of course out of Europe, especially Italy that was hard hit, have shown that cancer patients and lung cancer patients in particular, do seem to be at increased risk. We've talked about two different registry studies. One is looking at all cancer types, called CCC19, another that's looking at lung cancer specifically, that's the TERAVOLT registry, and both are showing that cancer patients are at elevated risk.

With CCC19, again, looking all cancer types, cancer patients diagnosed with COVID-19, especially within the first 30 days, have increased levels of mortality. We know that there's a risk there. In the lung cancer population, the data from the TERAVOLT study has shown that those patients may have as high as a 30% mortality rate, but there are caveats to that, right? We're working to understand that.

In Italy and some of the other places that were represented, there's a more elderly population, and a lot of the later stage patients just simply didn't even get admitted to ICU. Would they have had different outcomes had they been treated with more aggressive measures? We know that that's the case. Is the risk 30%? We don't know, but it's probably more than the one percent that the general public faces. We're working to understand that.

The focus of these updates, we started this back on March 3rd and did it weekly, and now we're moving to biweekly, but we've tried to address topics that we think are important for the community to hear or that we're hearing from them that they would like us to address. Initially, it was what is the virus? What do we know about it? What basic steps can we take to protect ourselves? Social distancing, wearing masks, washing hands.

Over time, that's evolved to what are the impacts of the pandemic on lung cancer treatment or screening for lung cancer? What are the impacts on research? How is research continuing in the face of the pandemic? I think we've tried to source what we feel are the most relevant updates for our community to hear, to look at all the data that's coming out and really try to, again, get down to the essential pieces that people should be aware of.

Andrew Schorr:
Okay, so will we get to the point, as you continue to study this, people who are in active chemotherapy treatment, maybe have a certain risk, people who are on immunotherapy, it may be a different risk? I don't know. People who are on certain targeted inhibitors, maybe a different risk? You'll start to get more granular so that people will say, "Well, how do I match up with the risk, given the care I'm getting?"

Dr. Moore:
Right. There's a lot of effort underway to understand that more fully. The data that has come out of this TERAVOLT study suggests that patients on chemotherapy perhaps have the highest risk compared to those on immunotherapy or targeted therapy, for example, but more work needs to be done. We need to understand that more fully. There are some discussions underway.

The National Cancer Institute has released some recent RFAs that's looking at serological testing. We think there are unanswered questions in the lung cancer community. What does zero prevalence look like? How many people have been infected, for example, and how many of those have antibodies? What does the immune response look like in lung cancer patients compared to patients without cancer? What does the immune response look like for patients who've had chemo or immunotherapy or targeted therapy? Does it look different and what does that mean?

It feels like we've been in the midst of this pandemic forever, but the reality is it's only been a few months, so we still don't know what the long-term consequences are. Right now, we've been talking about increased mortality and the acute crisis, if you will, but there are those who have been infected with the virus and have recovered. What are the long-term implications for those patients?

One thing that concerns me is a recent report that got some press of a 20-year-old healthy patient who received a double lung transplant because her lungs were so obliterated by the viral infection. What does that mean for lung cancer patients whose lungs are already compromised, or maybe they've had a lung removed or they've had some resections? Even if they're sick and recover and they don't have the more severe disease, or obviously they survive, they may still have some long-term issues. We need to explore that going forward. There's lots of questions that we need answers to, and lots of people mobilizing to ask those questions.

Andrew Schorr:
That was my next question. I'm not living with lung cancer. I have other cancers, but if I were, I'd say, "Well, are you worldwide working together to get the answers?"

Dr. Moore:
That's the one thing that I think has been so heartening for all of us, as scientists and as physicians, is just the rapid mobilization and collaboration worldwide in the face of COVID-19. It's an unprecedented crisis, I would say, for humanity. Because of that, we have to do things differently.

We are required to come together to collaborate, to ask those questions, to share data, share knowledge, share learnings from the work that we're doing to help us all navigate through this crisis. That is something that I think patients should have a lot of hope about, just this unprecedented level, I would say, of coordination and collaboration that's going on.

Andrew Schorr:
To sum up, dr. Moore, it sounds like a lot of questions are being asked and answers, or at least interim answers, are being compiled worldwide. You're trying to understand what it means for even subtypes of lung cancer patients.

In the interim, lung cancer patients need to take precautions. They need to take this really seriously. Masks, hand-washing, limiting contact with others, all of those things we hear about every day, because the risk does seem to be higher. Correct?

Dr. Moore:
That is my position. Now I have to say that some patients are asking the hard questions. For patients who maybe they think, "Oh, I've had this dream trip planned with my family," or "I don't want to miss these experiences because I don't know how much time I have left." I think what we've been doing, from an advocacy group perspective, is trying to provide the information so that patients can make the decisions that are best for them.

Yes, absolutely, I advocate for continued wearing of masks, social distancing, handwashing and I think that's going to be even more important now that the restrictions are lifting, states are reopening, cases are once again spiking. At the end of the day, each person has to do their own risk assessment.

I hear from some in the community that, "Well, there are limitations to these studies. They're showing the increased mortality" and that's true, but I don't think the risk is zero. We want people to protect themselves. You haven't fought this long against your disease to risk an exposure that could have bad outcomes for you, so yes, please continue to take appropriate precautions.

Andrew Schorr:
Dr. Amy Moore from the GO2 Foundation for Lung Cancer, thank you for what you're doing at GO2, and thank you for working with many other groups worldwide to get answers to these questions and for also propelling research. Thanks for being with us.

Dr. Amy Moore:
Thank you for allowing us to describe our work. I wish you well, and please stay safe down there in Southern California.

Andrew Schorr:
Thank you, Dr. Moore. I'm Andrew Schorr with Dr. Amy Moore from the GO2 Foundation for lung cancer, reminding you that knowledge can be the best medicine of all.


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