COVID-19 Increases Overall Risk of Death, Complications in Patients With Cancer, Study Shows

Patients with cancer who become infected with coronavirus disease 2019 (COVID-19) are far more likely to die or suffer severe complications than patients with COVID-19 who do not have cancer, according to new findings.

In study results released online in Cancer Discovery, and reported at the virtual meeting of the American Association of Cancer Research, a team of researchers from China, Singapore, and the United States showed that patients with cancer who develop COVID-19 were more likely to develop in-hospital infections or chest distress, or spend time in the intensive care unit (ICU). Patients being treated with immunotherapy appear to be at particularly high risk.

With a yearly estimate of 1.8 million new cancer cases for the United States in 2020, the patient population with a compromised immune system who could be affected by COVID-19 will only grow. The results were based on data through March, when 800,000 people in more than 200 countries had become infected with COVID-19, and there had been more than 40,000 deaths. Today, more than 3 million people have become infected worldwide, including 1 million in the United States; more than 214,000 have died, including more than 55,000 in the United States.

The pandemic has left in its wake forced treatment delays, shuttered clinical trials, and decimated pain medication supplies, notes Howard A. “Skip” Burris, MD, FACP, FASCO, chief medical officer and executive director of the Sarah Cannon Research Institute and president of the American Society of Clinical Oncology. Burris called these challenges “daunting,” because they can be “devastating for patients with fast-moving or hard-to-treat cancers.”

Fourteen hospitals from Wuhan, China, provided data for the randomized, controlled study on 641 patients enrolled between January 1, 2020, and February 24, 2020. There were 2 patient cohorts: patients without cancer who had COVID-19 (n = 536) and patients hospitalized with cancer and COVID-19 (n = 105). The mean ages were 64.00 and 63.50 years, respectively. They were matched by hospital, length of hospital stay, and age.

Overall, the patients with cancer fared worse compared with the patients without cancer, respectively, in number of in-hospital infections (19.04% vs 1.49%; P < .01) and smoking history (34.28% vs 8.58%; P < .01). In addition, there were more instances of chest distress in patients with both cancer and COVID-19 than among those with cancer only: 14.29% versus 6.16% (P = .02).

Results were divided by clinical outcomes, cancer type, cancer stage, cancer treatment, and timeline of severe events. In these subcategories, patients with cancer and COVID-19 fared worse across the board.

Clinical outcomes. The overall result in this subcategory was that the condition of patients with cancer and COVID-19 declined more rapidly than those with COVID-19 and no cancer. Broken down, they also had higher rates of the following:

• Death (odds ratio [OR], 2.34; 95% CI, 1.15-4.77; P = .03)
• ICU admission (OR, 2.84; 95% CI, 1.59-5.08]; P <.01)
• At least 1 severe complication (OR, 2.79, 95% CI; 1.74-4.41; P <.01)

Cancer type. The most common cancers among patients with COVID-19 and cancer were lung (20.95%), gastrointestinal (12.38%), breast (10.48%), thyroid (10.48%), and hematological (ie, leukemia, lymphoma, myeloma) (8.57%). However, patients with hematological and lung cancers fared the worst, with higher overall rates of death (33.33% and 18.18%, respectively), ICU admissions (44.44% and 27.27%), risk of severe/critical symptoms (66.67% and 50.00%), and possible use of invasive mechanical ventilation (22.22% and 18.18%).

Cancer stage. Cases of metastatic cancer (stage 4) in patients with COVID-19 led to overall higher risks for death (OR, 5.58; 95% CI, 1.71-18.23; P = .01), ICU admission (OR, 6.59; 95% CI, 2.32-18.72; P <.01), severe conditions (OR, 5.97; 95% CI, 2.24-15.91]; P <.01), and use of invasive mechanical ventilation (OR, 55.42; 95% CI, 13.21-232.47]; P <.01).

Cancer treatments. There were higher rates of death and chances of critical symptoms if patients with cancer and COVID-19 received immunotherapy: 33.33% and 66.67%, respectively. However, if these patients instead underwent surgery to treat their cancer, they had higher rates of ICU admission (37.50%) and use of invasive mechanical ventilation (25.00%).

Timeline of severe events. The principal measure here was hospital length of stay. The cohort with both cancer and COVID-19 had a 52.2% longer mean (SD) hospital stay compared with the COVID-19—only group: 27.01 (9.52) days versus 17.75 (8.64) days.

“Although COVID-19 is reported to have a relatively low death rate of 2% to 3% in the general population, patients with cancer and COVID-19 not only have a nearly 3-fold increase in the death rate than that of COVID-19 patients without cancer, but also tend to have much higher severity of their illness. Patients with cancer also have a 10-fold higher incidence of nosocomial SARS-COV-2 infections than patients without cancer. Altogether, these findings suggest that patients with cancer are a much more vulnerable population in the current COVID-19 outbreak,” the researchers concluded.

They suggest additional studies using a larger patient population, either from China or several countries, along with national and international research, because there are still very limited data on the patient population that has both cancer and COVID-19. Also because the 3 continents with the highest rates of COVID-19 (Asia, Europe, North America) also have the highest incidences of cancer, and the results may not be generalizable.

Reference

Dai M, Lie D, Liu M, et al. Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak. Cancer Discov. aacr.ent.box.com/s/2mh5713e6irjvcz6hb4c6y72bu1pljxq. Published April 27, 2020. Accessed April 28, 2020.