Lung Cancer Patients Grapple with COVID-19’s Impact

Amidst the COVID-19 pandemic, crucial information concerning the impact of COVID-19 infection on lung cancer patients remained scarce. The lung cancer community inevitably became anxious about the lack of data and guidance to navigate through those unprecedented circumstances.

Lung cancer patients faced numerous challenges, from managing their health and treatment to coping with the emotional toll. These factors call for a thorough investigation to address the intricate intersection of lung cancer as the world moves forward and vaccinations become an integral part of the discussion.

“We have so many questions: Which aspect of lung cancer or its treatments qualifies as an “underlying condition”? Are all patients at high risk, even if they are young and on targeted therapy?”

– Janet Freeman-Daily, metastatic lung cancer patient and survivor and patient advocate/activist.

Even when the pandemic is over, the lung cancer community remains concerned about:

• Their immunocompromised status - it has made them extremely vulnerable to COVID-19 infections. Treatments like chemotherapy and radiation therapy can weaken their immune system. The fear of having severe infections is amplified for these individuals, as they know their bodies may struggle to mount an effective defense.
• A COVID-19 infection could potentially exacerbate their already fragile health condition. The addition of COVID-19, which can lead to severe respiratory distress, is especially worrisome. The weakened immune system of lung cancer patients means they are more infection-prone in general. Even mild illnesses that others might easily recover from can become serious for them.
• The overlapping symptoms of lung cancer and COVID-19, such as cough, difficulty breathing (dyspnea), and chest pain. This overlap can cause anxiety for lung cancer patients who might mistakenly attribute new or worsening symptoms to COVID-19 rather than considering them as potential signs of cancer progression.

If unvaccinated, lung cancer patients

• Are seven folds more prone to COVID-19 infection
• Have three folds higher hospitalization and complication rates
• Have a fatality rate of over 30% from COVID-19

Scientists have provided possible explanations for the heightened vulnerability of lung cancer patients to severe COVID-19. A cell surface protein, angiotensin-converting enzyme 2 (ACE2), has been the focus of many COVID-19 studies. It serves as the entry point for the SARS-CoV-2 virus into respiratory cells (cells involved in breathing and gas exchange) and signals immune responses during viral infection. Coincidentally, ACE2 expression is elevated in tumor cells of cancer patients and lung tissue of smoking individuals. This may explain why lung cancer patients suffer a more severe case of COVID-19 (including COVID-19-mediated inflammation of the lungs), although further investigation is needed.

When the COVID-19 mass vaccination rolled out, several vaccine trials involving lung cancer patients demonstrated the safety of the vaccines for this group. COVID-19 mRNA vaccines exhibited a similar safety profile in lung cancer patients, including those on immunotherapy, as they did in healthy individuals.

“We are most concerned about side effects from immunotherapy in patients who have lingering COVID infections. Immunotherapy harnesses the power of the immune system which is already overreacting in the case of long COVID. This can cause side effects of the treatment to be more intense.”

- Dr. Amy Cummings, a thoracic medical oncologist at UCLA Health

Studies have also indicated that COVID-19 mRNA vaccines are effective for cancer patients undergoing chemo- and immunotherapies. Although the vaccine’s effectiveness may be slightly lower compared to healthy individuals, it still provides significant protection against severe COVID-19 for most lung cancer patients after receiving the second dose.

“There are a few patients who do not mount sufficient antibody titers. We are trying to figure out why these patients don’t respond and how we can protect these patients,” says Dr. Fred Hirsch, MD, Ph.D., executive director of the Center for Thoracic Oncology at Mount Sinai Health System, New York.

When there was a call for a COVID-19 booster vaccine, research data supported administering booster shots to appropriately immunize cancer patients with inadequate antibody response from their initial two vaccination courses.

Read more: Navigating Life After COVID-19 for Lung Cancer Patients