A new app developed for high-risk cancer patients helps them and their doctors weigh the risks and benefits of delaying chemotherapy if the risk of contracting Covid-19 is high during treatment.
According to STAT news, the app can show oncologists and patients whether immediate treatment can improve or affect their chances of survival after treatment. The app was developed by the University of Michigan at Ann Arbor and aims to help those involved make important decisions more easily by presenting them with available data. The researchers also hope to alleviate people’s concerns about the timing of their cancer treatment and prognosis. The app can be downloaded to a smartphone or a computer.
“OncCOVID provides interpretable results in terms of risk (e.g. the number of weeks or months of life lost due to a treatment delay of a certain duration). The results of OncCOVID can be used to facilitate discussions at the time of treatment with patients, ”said the editorial that assessed the effectiveness of the app.
A study of the app published in JAMA Oncology found that medical recommendation is also based on a patient’s susceptibility to COVID-19, depending on the person’s cancer stage and the number of local COVID-19 cases. Cancer patients are more likely to get infected with the SARS-CoV-2 virus.
Assessing the susceptibility of a cancer patient
A nationwide study based in China found that people fighting cancer could be more susceptible to COVID-19 due to their weakened immune systems, whether it be from the cancer itself, chemotherapy, or surgery.
“In addition, we have shown that cancer patients had worse outcomes with COVID-19, prompting doctors to remind them that cancer patients should be given more attention in the event of rapid deterioration,” the researchers wrote in The Lancet Oncology.
They also suggested postponing chemotherapy or elective surgery in hospitals with many Covid patients. The OncCovid app is designed to help decide whether delaying treatment is a good idea.
How the app works
Patients or doctors can enter data on individual patient characteristics such as age and gender as well as characteristics of their illness such as the stage of cancer. Up to 47 characteristics and disease characteristics can be entered. Then the number of Covid-19 cases in nearby hospitals is taken into account. “To estimate the risk of COVID-19 mortality, we estimated the risk of infection with COVID-19 and the subsequent risk of [death] when infected, “the researchers wrote. Survival is calculated for both immediate and delayed cancer treatments.
“Individual overall survival estimates have been linked to patient age, number of comorbidities, treatment received, and specific estimates of COVID-19 risk in the local community,” said the study, led by Holly Hartman, PhD student in biostatistics.
The study provides an example. A 70-year-old woman who was living in New York City when the pandemic peaked would have an 8% worse 5-year survival rate with immediate treatment. She had triple negative stage II breast cancer as well as diabetes and high blood pressure. However, according to the OncCOVID app, she would have a better survival rate if she postponed standard treatment (including breast preservation surgery, chemotherapy, and adjuvant radiation therapy) to three months later.
Where the data came from
To estimate the survival rate of 25 pre-pandemic cancer types, data was taken from the National Cancer Institutes Surveillance, Epidemiology and Final Results program (2005-2006), which collects data on cancer patients. The effects of treatment delay at the individual level by cancer type and stage were taken from the National Cancer Database. Another data set was taken from patients in the spring of 2020 to determine the rate of those who died of Covid-19 by age and number of underlying diseases. In total, the study included data from nearly 7 million people.
Limitations of OncCOVID
Standard answers are shown for specific risk factors, so much is assumed about the patient. Hence, users are prompted to enter multiple values for a range of results that can change different situations. The uncertainty of COVID-19 infection rates can expose a patient who has delayed treatment to a more risky hospital environment than before.
Seema Prasad is a freelance health reporter based in Bengaluru, India. She tweeted @SeemaPrasad_me