In a study of the COVID-19 crisis in China reported in The Lancet Oncology, Liang et al found that patients with cancer may be at a higher risk of COVID-19 respiratory disease requiring admission to hospital than individuals without cancer, and that those with cancer who contract the virus have a higher likelihood of poor disease outcomes.

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Study Details

The study involved analysis of data from 1,590 evaluable cases from 575 hospitals in China with a data cutoff of January 31, 2020. All patients were diagnosed with laboratory-confirmed COVID-19 acute respiratory disease and were admitted to hospital.

Key Findings

Eighteen (1%) of the 1,590 patients with COVID-19 disease had a history of cancer; this proportion appears to be higher than the incidence of cancer in the total Chinese population (285.83 [0.29%] per 100,000 people, according to 2015 estimates). Lung cancer was the most common type of cancer in infected patients, present in 5 (28%) of 18. Of 16 patients with known treatment status, 4 (25%) had received chemotherapy or surgery within the past month; 12 (75%) were in routine follow-up after primary resection.

Compared to patients with COVID-19 without a history of cancer, those with cancer were older (mean age = 63.1 vs 48.7 years), more likely to have a history of smoking (4 [22%] of 18 vs 107 [7%] of 1,572), had more polypnea (8 [47%] of 17 patients vs 323 [23%] of 1,377), and had more severe baseline computed tomography manifestations (17 [94%] of 18 vs 1,113 [71%] of 1,572). No significant differences in sex, other baseline symptoms, other comorbidities, or baseline x-ray severity were observed.

Patients with cancer were at higher risk of a severe event (defined as the composite of admission to the intensive care unit requiring invasive ventilation or death), with severe events occurring in 7 (39%) of 18 patients with cancer vs 124 (8%) of 1,572 patients without cancer (P = .0003).

Patients with cancer who had undergone chemotherapy or surgery in the past month were at greater risk of clinically severe events (3 [75%] of 4 patients) vs those who had not (6 [43%] of 14 patients; odds ratio [OR] = 5.34, P = .0026 in analysis adjusting for risk factors including age, smoking history, and other comorbidities).

In multivariate analysis, cancer history was associated with the highest risk for severe events (OR = 5.399, P = .003). Among patients with cancer, older age was the only risk factor associated with increased risk for severe events (OR = 1.43, P = .072). Cancer was associated with a shorter time to development of severe events (median time = 13 days vs 43 days in those without cancer, P < .0001; hazard ratio = 3.56, 95% confidence interval = 1.65–7.69, after adjustment for age).

As stated by the investigators: “In this study, we analyzed the risk for severe COVID-19 in patients with cancer for the first time, to our knowledge; only by nationwide analysis can we follow up patients with rare but important comorbidities, such as cancer. We found that patients with cancer might have a higher risk of COVID-19 than individuals without cancer. Additionally, we showed that patients with cancer had poorer outcomes from COVID-19, providing a timely reminder to physicians that more intensive attention should be paid to patients with cancer, in case of rapid deterioration.”

The researchers proposed three major strategies for patients with cancer in the COVID-19 crisis:

• Intentional postponing of adjuvant chemotherapy or elective surgery for stable cancer should be considered in endemic areas.
• Stronger personal protection provisions should be made for patients with cancer or cancer survivors.
• More intensive surveillance or treatment should be considered when patients with cancer are infected with COVID-19, especially in older patients or those with other comorbidities.

Jianxing He, MD, of the Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, is the corresponding author for The Lancet Oncology article.

Disclosure: The study was supported by the China National Science Foundation and the Key Project of Guangzhou Scientific Research Project. For full disclosures of the study authors, visit thelancet.com.