This short presentation made in Paris Saint-Joseph Hospital is aimed to help Understanding the impact of COVID-19 pandemia in Cancer patients in term of prevention, diagnostic, and treatment.

1. COVID-19 versus CANCER
Prof Eric Raymond
Head of Medical Oncology – Paris Saint-Joseph Hospital
France

2. COVID-19 by numbers
In France 4.5% of patients have been
admitted in resuscitation units and
2.5% died
Mortality rates:
Worldwide <4.1%
In France <3.3%
Establishing relevant data may be
problematic because all infected
people are not clearly identified (or
confirmed) and because of the number
of false negative PCR testing
Confirmed cases worldwide
81,238 in China
132,016 cases outside China
Confirmed cases in Europe
including
35,713 cases in Italy
Confirmed cases in France
Casualties in Europe
Including
2,978 cases in Italy
Worldwide casualties
3,250 cases in China
5,593 cases outside China
Casualties in France
Data from March 19, 2020 at 3pm:
https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/articles/infection-au-nouveau-coronavirus-sars-cov-2-covid-19-france-et-monde

3. The majority of COVID-19 infections is mild
but may be more severe in some patients
0 10 20 30 40 50 60 70 80 90
MILD
SEVERE
CRITICAL
Stay at home
Hospitalization
Intensive care
China Centre for Disease Control & Prevention

4. COVID-19
Symptoms
Several of those signs are
frequently observed in
cancer patients at various
stages of their diseases
Confusion factors

5. Pre-existing conditions found in
COVID-19 infected patients
0 2 4 6 8 10 12
Cardiovascular Diseases
Diabetes
Chronic Respiratory Diseases
High Blood Pressure
Cancer
No pre existing conditions
10.5%
7.3%
6.0%
5.6%
0.9%
China Centre for Disease Control & Prevention
6.3%
CANCERS

6. Age stands as a major factor for infection
Age ranges are also those
of patients with cancer

7. Outcome of patients with cancer in China

8. Discussion of COVID-19 – CANCER data
• The proportion of patients with cancer histories was higher in a cohort with
COVID-19 than in the population in China
• Eighteen COVID-19 patients with cancer histories among 1,590 COVID-19
patients (1.1%) from 575 hospitals in 31 provincial regions
• More frequently in patients with lung cancer (and smoking/preexisting lung
diseases ?)
Lancet Oncol 2020 Published Online March 3, 2020

9. Discussion of COVID – CANCER data (con’t)
• Of these 16 patients (two of the 18 patients had unknown treatment status)
• Four patients (25%) had undergone surgery or chemotherapy within the previous month
• Twelve patients (75%) had recovered from initial cancer treatments (eg, surgery or
chemotherapy) and had no obvious immunosuppression at the time of infection
• It is unlikely that the COVID-19 infections in the 12 survivors of previous
cancers were related to cancer but more likely to regular contamination
• Patients with cancer had worse outcomes from COVID-19, but were also
reported with a median age of 63·1 years that was higher than for those
without cancer (48·7 years) and may have had other comorbidities
Lancet Oncol 2020 Published Online March 3, 2020

10. Summary
• Data on COVID-19 in patients with cancer are sparse (only 18 reported patients while
more cancer patients may have been infected) and primarily deriving from patients in
Great China
• Data suggest that cancer is a risk factor associated with an increased risk of COVID-19
infection
• Outcome of patients seems to be worst in patients with cancer although confounding
factors are genuine comorbidities frequently found in patients with cancer (age,
underlying pulmonary disease, cardiovascular diseases, tobacco, etc.…) and possibly
treatment induced immunosuppression (no yet conclusive data)

11. Care of cancer patients is likely to become more
complex during the COVID-19 pandemia
•Keep cancer patients protected from COVID-19
•Maintain cancer therapy
•Inform patients and healthcare professionals

12. Immediate consequences for oncology
patients in Paris Saint-Joseph Hospital

13. Avoiding COVID-19 infection in cancer survivors is wised
considering the high risk of detrimental outcome
• Confinement shall be strictly maintained in cancer survivors, avoiding
unnecessary in-hospital visits, imaging, and consultations
• Remote follow up using teleconsultations for cancer survivors shall be
preferred to maintained regular contacts with patients, postponing non-
essential follow up imaging whenever possible
• We may take advantage of call or videoconference contacts with patients to
reinforce information on protective measures against COVID-19 infection and
to provide psychological supports

14. Cancer therapy shall be maintained for patients
requiring immediate actions to treat cancer,
while preventing COVID-19 infection
• Oncology wards shall remain COVID-19-free (keep COVID-19 infected patients in
dedicated units)
• Additional protections of patients with cancer shall be proposed (mask protection and
hydro-alcoholic hand washing being systematically proposed to patients at the entrance
in oncology wards)
• Professionals in charge of cancer patient care shall wear protective masks and wash
hands with hydro-alcoholic solutions before and after each patient care
• Strict restrictions (or avoidance) of visits for persons accompanying patients in oncology
units
• Patients in oncology shall keep at least 1 meter distances from one to another
• Individual transportation from home to hospital is warranted
• Information on confinement and protective measures at home shall be provided to
cancer patients during the visit in hospital
• Clinical and psychological care and follow up of cancer patients shall be reinforced

15. Information/monitoring/research
• Information for healthcare professionals shall be constantly updated according
to constantly evolving data (patient & healthcare professional protections)
• Cancer patients with concomitant COVID-19 infection shall be entered in
prospective cohorts to monitor follow up, allowing adjusting care according to
accumulating information (enlarging databases from Western patients)
• Cancer patients with concomitant COVID-19 infection can be entered in
developing prospective clinical trials against COVID-19 infection