Patients with cancer who were infected with COVID-19 were much more likely to die from the disease than those without cancer, according to research from physician-researchers at Montefiore Health System and Albert Einstein College of Medicine. Their findings were published by Mehta et al in Cancer Discovery.
“Our findings emphasize the need to prevent patients with cancer from contracting COVID-19 and—if they do—to identify and closely monitor these individuals for dangerous symptoms,” said Vikas Mehta, MD, MPH, a co–lead author of the study, a surgical oncologist at Montefiore, and Associate Professor of Otorhinolaryngology/Head and Neck Surgery at Einstein. “We hope that our findings can inform states and communities that have not yet been so severely struck by this pandemic about the unique vulnerability patients with cancer face.”
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The study involved 218 patients with cancer who tested positive for COVID-19 from March 18 to April 8, 2020, at Montefiore Medical Center in the Bronx, New York—one of the regions in the United States hit hardest by the pandemic. A total of 61 patients with cancer died from COVID-19, a dramatically high case fatality rate of 28%. The mortality rate for COVID-19 in the United States is 5.8%, according to the World Health Organization.
“A key element is that mortality appears to be more closely related to frailty, age, and comorbidities than to active therapy for cancer,” said co–senior author Balazs Halmos, MD, MS, Director of the Multidisciplinary Thoracic Oncology Program at Montefiore and Professor of Medicine at Einstein.
“Our data suggest that we should not stop lifesaving cancer therapies, but rather, develop strategies to minimize potential COVID-19 exposures and reevaluate therapies for our most vulnerable cancer populations,” explained co–senior author Amit Verma, MBBS, Director of the Division of Hemato-Oncology at Montefiore and Professor of Medicine and of Developmental and Molecular biology at Einstein.
The time period during which these patients were treated was earlier in the epidemic, when testing was almost exclusively done in sicker, symptomatic patients who required hospitalization. This may partially explain the high fatality rate within the study’s cancer population. However, even when compared to mortality rates in patients without cancer at Montefiore and across New York City during the same time period, patients with cancer demonstrated a significantly higher risk of dying from COVID-19.
As a group, patients infected with COVID-19 who had hematologic cancers, such as leukemia and lymphoma, had the highest mortality rate: 37% (20 of 54 patients). For patients with solid malignancies, the mortality rate was 25% (41 of 164). Differences were observed among specific solid cancers: the mortality rate for patients with lung cancer was 55%; for those with colorectal cancer, it was 38%; for those with breast cancer, 14%; and for those with prostate cancer, 20%.
Certain underlying conditions—older age, hypertension, heart disease, and chronic lung disease—were significantly associated with increased mortality among patients with cancer infected with COVID-19.
A detailed analysis of patients with cancer who died from COVID-19 shows that more than half of these individuals—37 of 61—had been in places with a higher risk of exposure to COVID-19—such as nursing homes, hospitals, or emergency departments—within the 30 days before being diagnosed with COVID-19. This was before widespread social distancing had been implemented.
Montefiore has already changed clinical practice as a result of the study’s findings. The center now uses telemedicine and early and aggressive social distancing for patients with cancer, and has opened a dedicated cancer outpatient and inpatient clinical service. It has also instituted bilingual peer counseling and deployed social workers and food deliveries to its at-risk population.
The study authors concluded, “These data suggest the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population.”
Disclosure: For full disclosures of the study authors, visit cancerdiscovery.aacrjournals.org.