Patients with cancer are more susceptible to infection with SARS-CoV-2, and patients receiving active anticancer treatment have a poorer prognosis compared with other patients in follow-up, according to results of an observational study published in Cancer.
Although overall the data have been mixed, this team of researchers from Wuhan previously reported that patients with cancer were at an increased risk of contracting COVID-19 compared with the general population in Wuhan. The aim of this study was to further characterize the outcomes of patients with cancer and COVID-19 in a larger cohort.
The multicenter observational study included 107 patients with cancer who were diagnosed with COVID-19 between January 2020 and March 2020. The median patient age was 66 years, 56.1% of patients were male, and 67.3% had comorbidities such as hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease.
The most common cancers in the cohort were of the lung (19.6%), gastrointestinal tract (18.7%), genitourinary tract (18.7%), and head and neck (15.9%). Most patients had early-stage disease (78.5%), and 21.5% had stage IV disease. Additionally, 34.6% of patients were receiving active anticancer therapy at the time of their COVID-19 diagnosis and 10.3% were receiving best supportive care.
Overall, 52.3% of patients developed severe COVID-19, which was defined as tachypnea 30 respiratory rate/min or higher, oxygen saturation of 93% or less, arterial partial pressure of oxygen per fraction of inspired oxygen of 300 mm Hg or less, mechanical ventilation, septic shock, or multiorgan failure requiring intensive care unit admission. Oxygen support was administered to 85% of patients, with 16.8% requiring mechanical ventilation. Acute respiratory distress syndrome (ARDS) occurred in 19.6% of patients, heart failure in 12.1%, and acute renal injury in 2.8%.
For their COVID-19, 92.5% of patients received an antiviral, including oseltamivir, umifenovir, interferon-α, ribavirin, lopinavir, or chloroquine phosphate. Steroid therapy was administered to 36.4%, and 20.6% of patients received immunoglobulin. Steroid therapy and immunoglobulin were used less frequently in patients in the group who were receiving active treatment compared with those in the group who were in active follow-up.
Overall, patients undergoing active anticancer treatment had a poorer prognosis than patients in follow-up (hazard ratio, 3.365; 95% CI, 1.455-7.782; P =.005), which remained similar when patients receiving best supportive care were excluded.
Patients receiving active anticancer treatment were also more likely to experience severe COVID-19 than those who were not (64.9% vs 45.7%, respectively), require mechanical ventilation (29.7% vs 10.0%, respectively), and death (37.8% vs 12.9%, respectively). More severe lymphopenia and anemia, and greater elevation in C-reactive protein and procalcitonin, was also observed among patients undergoing active treatment.
The authors concluded that “based on this and other studies, it is therefore imperative to consider the deferment of anticancer treatment, if possible, in patients with cancer who unfortunately are diagnosed with COVID-19.”
Zhang H, Wang L, Chen Y, et al. Outcomes of novel coronavirus disease 2019 (COVID-19) infection in 107 patients with cancer from Wuhan, China [published online June 23, 2020]. Cancer. doi: 10.1002/cncr.33042