The oncology community is engaged in ongoing research efforts to determine the effect of cancer and its treatment on the outcomes of patients who develop coronavirus 2019 disease (COVID-19) from SARS-CoV-2 infection. It is hypothesized that patients with cancer are at a greater risk of complications and/or death from COVID-19 because of immunosuppression or comorbidities associated with their malignancy or anticancer treatment. There is also an increased risk of exposure to the virus as a result of multiple health care encounters during their cancer care.
Understanding the potential COVID-19–related risks to patients with cancer is important because additional mitigation measures may be required — and it may help the cancer care team devise a treatment strategy that can minimize the patient’s risk of developing COVID-19 or experiencing complications associated with the virus.
Some early studies provide some information about these risks and include observational studies and registry data. However, it is important to note that sample sizes to date are small, and more studies are needed (and are currently under way) to more definitively determine the risk of active cancer and/or its treatment on the outcomes from COVID-19.
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Active Cancer
A study of 218 patients with cancer in New York City found that patients with cancer were at a significantly higher risk of developing complications or dying from COVID-19 compared with matched controls who had COVID-19 but did not have cancer.1 The authors cited that the general case fatality rate from New York City and the same health system ranged from 6% to 14%, whereas the case fatality rate for patients with solid tumors was 25% and 37% for hematologic malignancies. The case fatality rate increased with older age, but remained substantially higher among patients with cancer. In addition, comorbidities such as heart disease and chronic lung disease increased the risk of death.
Data from a cohort of 800 patients with cancer and symptomatic COVID-19 from the United Kingdom are consistent with the data from the New York City cohort, with a case fatality rate of 28%.2 Risk of death with older age (odds ratio [OR], 9.42; 95% CI, 6.56-10.01; P <.0001) and presence of comorbidities, including hypertension (OR, 1.95; 95% CI, 1.36-2.80; P <.001) or other cardiovascular disease (OR, 2.32; 95% CI, 1.47-3.64; P =.002), were also elevated in this cohort. However, type of cancer and stage of cancer were not associated with the risk of death.
Another cohort in the United Kingdom of 35 patients with hematologic malignancy and COVID-19 demonstrated a case fatality rate of 40%, which increased with older age or the presence of comorbidities.3 An international cohort of 295 patients with lung cancer and COVID-19 found a case fatality rate of 49%.4
A cohort of 105 patients with cancer and COVID-19 from Wuhan, China, also found that patients with cancer were significantly more likely to die (OR, 2.34; 95% CI, 1.15-4.77; P =.03), be admitted to the intensive care unit (OR, 2.84; 95% CI, 1.59-5.08; P <.01), develop at least 1 critical symptom (OR, 2.79; 95% CI, 1.74-4.41; P <.01), or require mechanical ventilation compared with patients without cancer.5 Patients with metastatic cancer were at particularly higher risk of death (OR, 5.58; 95% CI, 1.71-18.23; P =.01). Another cohort from Hubei, China, demonstrated a case fatality rate of 20% among patients with cancer and severe COVID-19, as well as poorer prognosis among patients with a hematologic malignancy.6
A large cohort of 928 patients with cancer and severe COVID-19 from the United States, Canada, and Spain found a lower case fatality rate of 13%, which included 12% among patients with solid tumors or 14% among patients with hematologic tumors.7 However, patients with progressive cancer had a higher case fatality rate of 25%.
