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Cover page of the Journal of Health Sciences


 
 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 292-293

Severe acute respiratory syndrome coronavirus 2: Oncology-related perceptions


1 Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Department of Pathology, Trinity School of Medicine, St. Vincent and the Grenadines, West Indies, St. Vincent and the Grenadines

Date of Submission25-Nov-2020
Date of Acceptance21-Apr-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Parul Jain
Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_404_20

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How to cite this article:
Singhai A, Jain P, Solanki R. Severe acute respiratory syndrome coronavirus 2: Oncology-related perceptions. Indian J Health Sci Biomed Res 2021;14:292-3

How to cite this URL:
Singhai A, Jain P, Solanki R. Severe acute respiratory syndrome coronavirus 2: Oncology-related perceptions. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Jun 17];14:292-3. Available from: https://www.ijournalhs.org/text.asp?2021/14/2/292/317414



Dear Editor,

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has brought whole mankind over the planet earth to stand still and is undoubtedly the biggest threat to humanity over the last century. It has shown to have serious deleterious effects on infected persons with preexisting comorbidities. Data from the world over have also shown the highest rates of SARS-CoV2-induced mortalities in such individuals. Cancer patients constitute one such prominent discipline that needs special addressal on account of significant case load and rapid chances of disease progression. This manuscript presents a brief outlook of the pathogenic mechanisms involved in SARS-CoV2-infected cancer patients.

There are multiple confounding factors playing their roles while affecting such patients such as different stages of cancer presentation, involvement of different organ systems, and different modalities of treatment that makes framing a generalized opinion in such settings unfeasible. Few reports have claimed a poor prognosis in SARS-CoV2-infected cancer patients as evidenced by increased dependency on intensive care and/or ventilator support with progression to mortality in the substantial number of cases. Even noninfected cancer patients have experienced higher morbidity and mortality rates owing to inaccessibility to routine diagnostic and therapeutic follow-ups due to widely imposed lockdowns. Thus, SARS-CoV2 pandemic has definitely jeopardized oncology care globally either directly through infection or indirectly through lockdown-induced nonapproach to laboratory and hospital services, thereby enhancing cancer progression.[1],[2]

A study of immune mechanisms involved in SARS-CoV2 infection reveals that it gets entry in the host cells by binding to angiotensin-converting enzyme-2 (ACE-2) receptors; their subsequent deregulation and further release of inflammatory cytokines and chemokines may lead to “storm”-like condition causing severe manifestations such as respiratory distress, multiorgan failure, and secondary infections. Apart from this primary pathway, SARS-CoV2 infection may also proceed through secondary inflammatory response by the formation of antigen-antibody complexes with subsequent complement system activation and resulting multiorgan damage.[3]

However, from oncology-related perspective, it is assumed that cancer progression is associated with blunt immune mechanisms exhibiting pathways in contrary to the ones described above in the immunopathogenesis of SARS-CoV2 infection. There is over-expression of immunosuppressive cytokines and leukocytes and suppression of pro-inflammatory cytokines and mononuclear phagocyte system.[4] This perspective fails to explain etiopathogenesis behind increased morbidity and mortality in SARS-CoV2-infected cancer patients. The possible explanation for this fallacy can be answered with increased association of history of smoking in cancer patients; at least 12 types of cancers are smoking-related namely lung, larynx, oral cavity and pharynx, esophagus, pancreas, bladder, stomach, colon and rectum, lever, cervix, kidney, and acute myeloid leukemia.[5] There is confirmed evidence that the use of tobacco or smoking significantly upregulates the expression of ACE-2 receptors, which possibly explains increased susceptibility and severity of SARS-CoV2 infection in cancer patients. In addition, smoking also acts as an independent risk factor through causation of chronic obstructive pulmonary disease which can worsen severity in infected patients.[6]

Thus, it can be hypothesized that SARS-CoV2 has definite negative prediction for healing and survival in cancer patients through direct or indirect mechanisms as described above. Further evidence-based and peer reviewed research is needed to frame a conclusive guideline point to draw beneficiary management policies in this regard.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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.  Back to cited text no. 1
    
2.
Yarza R, Bover M, Paredes D, López-López F, Jara-Casas D, Castelo-Loureiro A, et al. SARS-CoV-2 infection in cancer patients undergoing active treatment: analysis of clinical features and predictive factors for severe respiratory failure and death. Eur J Cancer. 2020 Aug;135:242-50.  Back to cited text no. 2
    
3.
Gheblawi M, Wang K, Viveiros A, Nguyen Q, Zhong JC, Turner AJ, et al. Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2. Circ Res 2020;126:1456-74.  Back to cited text no. 3
    
4.
Wang Y, Hays E, Rama M, Bonavida V. Cell-mediated immune resistance in cancer. Cancer Drug Resist 2019;2:???. [doi. 10.20517/cdr. 2019.98].  Back to cited text no. 4
    
5.
Center for Disease Control and Prevention. Smoking and Cancer Available from: https://www.cdc.gov/tobacco/campaign/tips/diseases/cancer.html#:~. [Last accessed on 2020 Jun 15, updated on 2020 Mar 23].  Back to cited text no. 5
    
6.
World Health Organisation. Tobacco use and COVID-19. Available from: https://www.who.int/news-room/detail/11-05-2020-who-statement-tobacco -use-and-covid-19. [Last accessed on 2020 Jun 15, updated on 2020 May 11].  Back to cited text no. 6
    




 

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