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Are all patients with cancer at heightened risk for severe Coronavirus Disease 2019 (COVID-19)?

Cancer patients are traditionally considered at high-risk for complicated respiratory viral infections, due to their underlying immunosuppression. In line with this notion, early case series reported high mortality rates of SARS-CoV-2 infection in patients with malignancy. However, subsequent large prospective epidemiological surveys indicate that the risk for severe COVID-19 may be largely attributed to the multiple confounders operating in this highly heterogeneous population of patients rather than the cancer or its treatment per se. In this viewpoint, we critically discuss the conundrums of SARS-CoV-2 infection in cancer patients and underscore mechanistic insights on the outcome of COVID-19 as it relates to cancer therapy and the type and status of the underlying malignancy. We emphasize the concept that not all cancer patients are at similarly high-risk for a complicated COVID-19 course and the need to develop a roadmap of translational and clinical research on COVID-19 in this challenging group of patients.