Yeungnam Univ J Med.  2021 Oct;38(4):344-349. 10.12701/yujm.2021.01144.

Treatment decision for cancer patients with fever during the coronavirus disease 2019 (COVID-19) pandemic

• Lee IH
• Koh SA
• Lee SJ
• Lee SA
• Cho YY
• Lee JY
• Kim JY

• KMID: 2521714
• DOI: http://doi.org/10.12701/yujm.2021.01144

Abstract

Background
Cancer patients have been disproportionally affected by the coronavirus disease 2019 (COVID-19) pandemic, with high rates of severe outcomes and mortality. Fever is the most common symptom in COVID-19 patients. During the COVID-19 pandemic, physicians may have difficulty in determining the cause of fever (COVID-19, another infection, or cancer fever) in cancer patients. Furthermore, there are no specific guidelines for managing cancer patients with fever during the COVID-19 pandemic. Thus, this study evaluated the clinical characteristics and outcomes of cancer patients with fever during the COVID-19 pandemic.
Methods
This study retrospectively reviewed the medical records of 328 cancer patients with COVID-19 symptoms (fever) admitted to five hospitals in Daegu, Korea from January to October 2020. We obtained data on demographics, clinical manifestations, laboratory test results, chest computed tomography images, cancer history, cancer treatment, and outcomes of all enrolled patients from electronic medical records.
Results
The most common COVID-19-like symptoms were fever (n=256, 78%). Among 256 patients with fever, only three (1.2%) were diagnosed with COVID-19. Most patients (253, 98.8%) with fever were not diagnosed with COVID-19. The most common solid malignancies were lung cancer (65, 19.8%) and hepatobiliary cancer (61, 18.6%). Twenty patients with fever experienced a delay in receiving cancer treatment. Eighteen patients discontinued active cancer treatment because of fever. Major events during the treatment delay period included death (2.7%), cancer progression (1.5%), and major organ dysfunction (2.7%).
Conclusion
Considering that only 0.9% of patients tested for COVID-19 were positive, screening for COVID-19 in cancer patients with fever should be based on the physician’s clinical decision, and patients might not be routinely tested.

Keyword

Cancer; Coronavirus disease 2019; COVID-19; Fever; Neoplastic fever

Reference

References

1. Zhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol. 2020; 31:894–901.

2. Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020; 395:1907–18.

3. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020; 21:335–7.

4. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020; 323:1775–6.

5. Zhao D, Yao F, Wang L, Zheng L, Gao Y, Ye J, et al. A comparative study on the clinical features of coronavirus 2019 (COVID-19) pneumonia with other pneumonias. Clin Infect Dis. 2020; 71:756–61.

6. Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: a meta-analysis. J Med Virol. 2020; 92:1902–14.

7. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020; 324:782–93.

8. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020; 94:91–5.

9. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis. 2020; 34:101623.

10. Foggo V, Cavenagh J. Malignant causes of fever of unknown origin. Clin Med (Lond). 2015; 15:292–4.

11. Schneider A, Kirsten H, Lordick F, Lordick F, Lübbert C, von Braun A. Covid-19 in outpatients: is fever a useful indicator for SARS-CoV-2 infection? PLoS One. 2021; 16:e0246312.

12. Islam KU, Iqbal J. An update on molecular diagnostics for COVID-19. Front Cell Infect Microbiol. 2020; 10:560616.

13. Seyed Hosseini E, Riahi Kashani N, Nikzad H, Azadbakht J, Hassani Bafrani H, Haddad Kashani H. The novel coronavirus Disease-2019 (COVID-19): mechanism of action, detection and recent therapeutic strategies. Virology. 2020; 551:1–9.

14. Yüce M, Filiztekin E, Özkaya KG. COVID-19 diagnosis: a review of current methods. Biosens Bioelectron. 2021; 172:112752.

15. Boutros M, Moujaess E, Kourie HR. Cancer management during the COVID-19 pandemic: choosing between the devil and the deep blue sea. Crit Rev Oncol Hematol. 2021; Mar. 15. [Epub]. https://doi.org/10.1016/j.critrevonc.2021.103273.

16. Hanna TP, Evans GA, Booth CM. Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic. Nat Rev Clin Oncol. 2020; 17:268–70.

17. Jee J, Foote MB, Lumish M, Stonestrom AJ, Wills B, Narendra V, et al. Chemotherapy and COVID-19 outcomes in patients with cancer. J Clin Oncol. 2020; 38:3538–46.

18. Pasikhova Y, Ludlow S, Baluch A. Fever in patients with cancer. Cancer Control. 2017; 24:193–7.

19. Lee JB, Jung M, Kim JH, Kim BH, Kim Y, Kim YS, et al. Guidelines for cancer care during the COVID-19 pandemic in South Korea. Cancer Res Treat. 2021; 53:323–9.