Dr. Grothey: My name is Axel Grothey, I’m one of the editors of the PracticeUpdate Oncology website, and I myself am a medical oncologist at West Cancer Center in Memphis, also Tennessee, so we’re sharing in a state, actually, where we have not yet seen the full brunt of the coronavirus epidemic when we compare it to New York.
Now, Jeremy was, Dr. Warner was invited to come to this interview because of initiatives which he started, starting a registry on patients with cancer and coronavirus infection. Jeremy, talk a little bit about it. What was the initiation? Why did you try to get a registry going, and how did this whole thing emerge over the time?
Dr. Warner: It started really with a small, very small number of people, primarily a resident at the University of Connecticut named Aakash Desai, who sent an email to several of us around the country asking if we ought to put together a registry sort of in the early days. So, this was a full two weeks ago which feels like a lifetime at this point. So, that email prompted a flurry of social media, primarily on Twitter, and you know, the beginning of what’s now become a movement or sort of a large consortium of cancer centers and a few other organizations that are coming together to really try to learn more about how this virus is affecting cancer patients in particular.
Dr. Grothey: You even have a website registered, ccc19.org, and a logo, etc. So, it’s really been a very viral and very, very increasingly interesting effort. So, why is COVID-19 important for cancer patients? Why do you think it’s important to get data on what’s happening right now?
Dr. Warner: So, I think unfortunately, cancer patients are probably the highest risk category from multiple angles. The first one really to emphasize is that they’re high touch with the medical and the healthcare establishment. Cancer care for most patients is multidisciplinary, they’re often going to various clinics, whether it be surgery, medical oncology, radiation. They often have to go to ancillary, additional services, social work, financial counseling, just you know, many touches with the medical system. And then for patients who are on treatment, you’ve got the infusion room where usually it’s semiprivate quarters, if that, you’ve got phlebotomy, you’ve got frequent scans, you’re in the radiation department which is incredibly crowded these days, as you can imagine, since imaging is an integral part to COVID-19 diagnosis. So, when you think about all those contact points, cancer patients are just at high risk for exposure, you know, forgetting about the effect of the disease itself.
But then when you think about the effects of the virus, you know, you really start to get concerns because of the immunocompromised status of cancer patients, and having cancer itself can be thought of as some form of immunocompromised, certainly in my field, which is lymphoid malignancies or cancers of the lymphatic and the immune system those cancers usually replace a normally functioning immune system to some degree, and so those patients are probably at an extra high risk. And then of course, the therapies we use, both the conventional cytotoxic therapies, which reduce the immune system, as well as the newer immunotherapies which enhance the immune system, and that might actually not be a good thing here when we’re thinking about sort of the physiology of the COVID-19 for the severely ill. A lot of it seems to be a hyperactive response of the immune system, and so there’s a lot of concern around those new immunotherapy drugs.
And so you know, for all those reasons, cancer patients, I think, are at an incredibly high risk, but what really drove the consortium is that we just don’t know. We don’t have enough data yet.
Dr. Grothey: So, is this being funded by anything? Is it just an academic collaboration? How are you pulling this off?
Dr. Warner: The volunteerism has been amazing. We have close to 80 investigators who have indicated their willingness and their time to contribute to this. We have 37 institutions now signed up in the US. We’ve got a lot of international interest, and we’re doing our best to expand quickly, but you know, clearly volunteerism takes you a certain point, so we’re looking at funding options.
You know, right now we don’t know, but many of the centers are NCI-designated Comprehensive Cancer Centers, and there’s a general call that’s gone out for supplemental funding to those cancer centers, Cancer Center Support Grant, the P30 grants, and so it’s possible that this consortium could get some funding through that, because yeah, I mean, high quality data entry is really the bottleneck, and at some point it would be fair to compensate the individuals, obviously, who are doing that hard work, which right now it’s a lot of very intrepid and perhaps somewhat sidelined hematology and oncology fellows, and that’s great, but you know, we’ll see how it evolves over the next weeks or so.
Dr. Grothey: I mean, I think it shows the power of social media at a time when people want to get together, and secondly, also, if there is really an area where people identify an unmet need, you know, we do come together academically. It’s something that I think is part of our DNA as oncologists and hematologists, that we like to improve outcomes for our patients and get more information.