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Are Lung Cancer Patients More Susceptible To COVID-19?

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Published on June 24, 2020

Are Lung Cancer Patients More Susceptible To COVID-19?

Are lung cancer patients more susceptible to complications from the coronavirus? Do they have a higher risk and mortality rate? How careful do these patients need to be?

In this segment from our recent Lung Cancer Answers Now program, host Andrew Schorr talks to Amy Moore, PhD, Director of Science and Research for the Go2 Foundation for Lung Cancer, and Dr. Heather Wakelee of Stanford University School of Medicine. They discuss current data from recent studies and explain the implications for lung cancer patients. Watch now to learn more.

This is the first part of a three-part series. Watch Part 2 here. Watch Part 3 here.

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Transcript | Are Lung Cancer Patients More Susceptible To COVID-19?

Andrew Schorr:
Good morning. Good afternoon. Good evening, wherever you may be in the world. I'm Andrew Schorr in Southern California. Joining us are some tremendous experts in lung cancer. You can see them joining us now. There's Amy Moore from the Go2 Foundation for Lung Cancer. She's in Northern California, the science director there. Dr. Heather Wakelee, who's a professor and a lung cancer specialist at Stanford University in Stanford, California near San Francisco. Linnea Olson who's been living a number of years with lung cancer, who joins us from outside Boston. This is the lung cancer Answers Now program from Patient Power. I want to start with Amy Moore, who is with the Go2 Foundation for lung cancer. Amy, thank you for being with us. You have a virology background.

Dr. Moore:
Yes. I do.

Andrew Schorr:
We're talking about virus now. Is there any comment you want to make right off the top related to the worry that people dealing with lung cancer have about their susceptibility or complications from the virus?

Dr. Moore:
Absolutely. Thank you for the question. I mean, as I have said in other venues, this is an intersection that I had never fully anticipated, and I think it is something that is of concern to the cancer community, because there is data that has been coming out recently from a couple of different efforts. I know you've discussed one of these in previous episodes. A consortium that was initiated in Italy, but is an international consortium, showing that lung cancer patients are in fact at elevated risk for more severe manifestations of COVID and have higher rates of mortality. I think it's important to note that our information is evolving rapidly and those findings are based on the information we have available now. There are of course, perhaps limitations to that and we can get into some of the nuances, maybe of that discussion, because I think it's important.

But, the takeaway from the early studies are that in fact, lung cancer patients are at elevated risk, particularly those on chemotherapy seem to be at more risk and they have higher rates of mortality. Complementing that, there's a separate study that's looking at all cancer types, something called the CCC-19 study. What they found is that cancer patients, especially within the first 30 days following diagnosis of COVID, have higher rates of mortality, so about 13% of all cancer patients die from COVID infection. Again, we need to understand what that risk looks like, I think, here in the US. Italy was hit hard and they have an elderly population. Is that risk the same for all lung cancer patients? What does it look like specifically for different treatment types? But again, our message is that the lung cancer community needs to take precautions until we fully understand what the risk is for them.

Andrew Schorr:
Dr. Wakelee anything you want to add to that? You treat lung cancer patients, and some people have chemo. Some people have immunotherapy. There's a variety of different treatments. Some people have had a lung removed. What do you tell people? Or is it not a one-size-fits-all discussion?

 Dr. Wakelee:
Like most things in cancer, there's definitely not a one-size-fits-all. Dr. Moore was discussing a couple of database registries. One is TERAVOLT, which is the lung cancer-specific one and then the CCC- 19. Those have given us a lot of insight, but they're also limited because they are databases, based on people collecting information about patients, all anonymously, of course, but putting it together in a way where we can then look and see how did age impact things? How did gender impact things or sex? How did the different treatments impact? But the data is only as good as what's put in and we have to keep in mind that early on in the pandemic, the only people who were tested to see whether or not they had the illness were those who were really sick. It's likely that there were a lot of lung cancer patients in Italy, in New York, who were ill with COVID-19, but never got sick enough that they were tested and known to have it.

So, when we think about what's the rate of getting the illness, if you have cancer, what's the mortality, you have to keep in mind that those are all calculated based on who we knew got COVID and that's by definition, going to be the sickest people, because those are the ones who got tested, especially early in Italy. In talking to my colleagues and friends there, they couldn't get tested. Even though the healthcare workers who were very ill with terrible cough, couldn't get tested. It was only a month or two later that they got antibody testing and yes, they had had COVID. We're still collecting more information. I actually, in my patient population here in Northern California, I've been very fortunate with my patients that no one has gotten terribly sick with COVID-19, but many of them have actually been diagnosed.

Some of them only because we were doing screening testing before they could get specific therapies. I think as more of the less symptomatic people are tested and we get that information, the numbers of mortality might get a little bit better. That being said, just like anyone with a chronic health issue and cancer even more so, we've got to be really careful. I certainly encourage my patients to wear their masks, wash their hands carefully and avoid crowds and do all of the cautious things that we're all trying to do to keep this pandemic under control until the research gets to a point of giving us the vaccine, which we're hopefully getting to eventually.

Andrew Schorr:
Right, and I imagine you're doing a good bit of telemedicine, where if a patient doesn't have to come to Stanford Medical Center, you're consulting with them on video like this.

Dr. Wakelee:
Exactly, which is I'm a mixed thing. I always, I'm delighted, my patients don't have to fight the traffic, which is gradually coming back, but was gone for a little bit. I'm delighted that they are able to be in the comfort of their own home. But I really, I miss a lot of the connections and obviously we're not able to examine people as well, but so it has its good and bad parts. I think that one, we've learned a lot in the last few months about how we can provide care in a way that we wouldn't have dreamed of a few, four or five months ago. Hopefully we'll be able to bring some of that forward as we gradually emerged from the pandemic so that we can have better access for patients. Some things happen actually with trials also, where some of the oral medications - patients used to always have to come in to get them no matter what and we figured out ways where we can actually ship them and have that be okay on the trial.

So, saving the patient some of those extra trips and, and questioning some of the things that are done on trials, which are done certain ways because we've always done them as opposed to because we have to do them. So, making the trial burden a little easier for a lot of people, hopefully in the future.

Andrew Schorr:
Well, that's a good segue to our discussion with Linnea Olson. Linnea, a little bit about your lung cancer story. You were diagnosed when with what?

Linnea Olson:
I was diagnosed in April of 2005 with Stage IB, non-small cell lung cancer.

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Resources
CCC-19 study and official site
TERAVOLT study

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