DR VIKAS SHARMA & SHILPA RAINA
The city of Wuhan, Hubei (China), witnessed the onset of a pandemic without precedent in modern times in December 2019. A new coronavirus subtype was found, with a high potential for human-to-human transmission and immense virulence. The novel coronavirus is less deadly than historically isolated coronavirus. It has triggered profound social upheaval, resulting in a dramatic restructuring of global health-care services. The COVID-19 pandemic has resulted in improvements in the way cancer patients are cared for all over the world. Cancer patients are thought to be at a higher risk of serious complications and mortality during the COVID-19 pandemic. This may be due to the immunosuppressive activity of both tumor and subsequent anti-neoplastic drugs, the use of immunomodulatory agents, repeated hospital visits and the older age and co morbidities common in cancer patients. Emerging evidence suggests that the COVID-19 pandemic has the potential to exacerbate pre-existing gaps, particularly among cancer patients. During the pandemic, the treatment of cancer patients was impacted at many levels, including triage decisions, surgery, and neo-adjuvant therapy as a bridge to minimize admissions and maintain health care services. Oncologists are now altering or substituting oral chemotherapy for intravenous chemotherapy where necessary in order to reduce hospital admissions. Cancer patients seem to be more vulnerable to COVID-19 because cancer, as COVID-19 comorbidity, can significantly affect the immunological scenario associated with viral infection. Cancer-induced myelopoiesis, followed by the proliferation of immunosuppressive immature myeloid populations, can, in effect, limit antiviral immunity. These changes have an effect on the virus-mediated breakdown of physiological robustness processes, making it a dramatic occurrence, especially in elderly patients. The epidemiological evidence from case series and observational research may not have a consistent explanation of cancer patients’ increased risk to be diagnosed with COVID-19; however they may conclude that these patients may have more serious COVID-19 symptoms than the general population. Understanding of immunometabolic processes that overlap patients with infection and cancer may clarify the data. Cancer and COVID-19 also take advantage of distinct inflammatory patterns expressed by macrophages, which facilitate disease development in their most extreme forms. Converging data suggests that macrophages play a primary role in the inflammatory states associated with COVID-19 and cancer. In response to micro environmental signals, macrophages may express a variety of functional proteins. The extremes of their functional versatility are commonly characterized as classical M1- and alternative M2-activation, which describe a cytotoxic inflammatory versus an anti-inflammatory, immunosuppressive activation state, respectively. Macrophages, in particular, play an important role in the dysfunctions associated with cancer and COVID-19 infection. Tumors cause an alternate macrophage activation state (M2), which facilitates immune-suppression and tumor progression. This situation correlates with reduced antiviral activity, making it more vulnerable to infections. Viral infections (e.g., COVID-19) induce classical M1 type inflammatory activation, which is associated with macrophage activating syndrome, lymphopenia, endothelial injury and hyper coagulation. Understanding the immune-metabolic settings in tumors and viral infections is a critical new difficulty in defining pathogenetic pathways in COVID-19 cancer patients.
To conclude, the study, along with a greater understanding of the molecular pathways of COVID-19 and cancer, confirm the increased susceptibility of cancer patients, leaving the issue of whether the probability of death from COVID-19 varies among cancer types unanswered. Potential drivers of disparate cancer survival resulting from the pandemic can include variable access to telemedicine, timely diagnosis and access to treatment. Despite oncology associations offering cancer care recommendations after the pandemic, the magnitude of possible patient advantages, clinical purpose and access to care both have a significant impact on the prioritization of cancer treatments. Since COVID-19 causes severe problems in cancer patients, attempts should be taken to limit hospital visits during the pandemic. The COVID-19 pandemic has compelled healthcare systems to reconsider their patient protocols and policies. Advancing new drug research is critical, both to reduce the number of deaths in the general population and among cancer survivors and to relieve the burden on healthcare services around the world, which are still unable to keep up with the number of casualties of this disease. In order to provide an appropriate therapy, it is critical to better understand the function of immune dysregulation in COVID-19 and the inflammatory mechanism. In clinical trials, some medications, either alone or in combinations, are being studied. To date, no drug has shown therapeutic efficacy and can be considered standard of care. When waiting for clinical improvement, any step should be taken to shield cancer patients from SARS-CoV-2 and prevent any interruption in cancer treatment. Overall, these developments will undoubtedly have an effect on the experiences of cancer patients. In this current landscape, as the cancer world is revising the appropriate quality of cancer treatment, efforts should concentrate on understanding the conditions that lead to avoidable mortality and facilitating the introduction of patient-beneficial interventions.
(The authors are from Division of Biochemistry, SKUAST-Jammu).