In a multi-institutional Chinese study reported at the American Association for Cancer Research (AACR) Virtual Annual Meeting in the COVID-19 and Cancer Session and in Cancer Discovery, Dai et al found that the risk of severe events as a result of COVID-19 infection was higher in patients with cancer compared with patients without cancer, with greatest risk observed among patients with metastatic cancers.
Study Details
The study involved 105 COVID-19–infected patients with cancer from 14 hospitals in Wuhan who were enrolled between January 1 and February 24, 2020. A randomly selected control group of 536 patients with COVID-19 infection who did not have cancer were matched with patients with cancer by age, hospital, and hospitalization time. Lung cancer was the most common cancer type (n = 22, 21%), followed by gastrointestinal cancer (n = 13, 12%), breast cancer (n = 11, 10%), thyroid cancer (n = 11, 10%), and hematologic cancers (n = 9, 9%).
Key Findings
Compared to patients without cancer, patients with cancer had a higher risk of death (odds ratio [OR] = 2.34, P =.03), a higher risk of intensive care unit (ICU) admission (OR = 2.84, P < .01), a higher risk of developing at least one severe or critical symptom (OR = 2.79, P < .01), and more of a need for invasive mechanical ventilation. In analysis adjusting for age, sex, smoking, and comorbidities including diabetes, hypertension, and chronic obstructive pulmonary disease, odds ratios were 2.17 (P = .06) for death, 1.99 (P < .01) for any severe symptoms, 3.13 (P < .01) for ICU admission, and 2.71 (P = .04) for use of invasive mechanical ventilation.
“The findings in this study suggest that patients with cancer infected with SARS-CoV-2 tend to have more severe outcomes when compared to patients without cancer.... In addition, patients who underwent cancer surgery showed higher death rates and higher chances of having critical symptoms.”— Dai et al
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Compared to patients without cancer, patients with cancer had a longer mean length of hospital stay (27.01 vs 17.75 days, P < .01).
Those with hematologic cancers appeared to have higher rates of death (33%), ICU admission (44%), severe/critical symptoms (67%), and use of invasive mechanical ventilation (22%) than patients with other types of cancer. Patients with lung cancer appeared to have the second-highest risk levels for these outcomes (18%, 27%, 50%, and 18%, respectively).
Patients with metastatic cancers were at increased risk of death (OR = 5.58, P =.01), ICU admission (OR = 6.59, P < .01), severe conditions (OR = 5.97, P < .01), and invasive mechanical ventilation (OR = 55.42, P < .01) compared to patients without cancer. No significant differences in these outcomes were observed among patients with nonmetastatic cancers vs patients without cancer.
Patients with lung cancer or other cancers with lung metastasis had significantly higher risks of death, ICU admission, critical symptoms, and use of invasive mechanical ventilation (all P < .01) than patients without cancer, whereas no significant differences in these outcomes were observed between patients with other cancers without lung metastases.
Among patients with cancer, 13 received radiotherapy; 17, chemotherapy; 8, surgery; 4, targeted therapy; and 6, immunotherapy within 40 days before onset of COVID-19 symptoms. All patients who received targeted therapy or immunotherapy were patients with lung cancer receiving EGFR inhibitors or programmed cell death protein 1 inhibitors. Among the six patients receiving immunotherapy, two died and four had critical symptoms.
Surgery appeared to contribute to a high risk of poor outcomes, with death occurring in two patients who had undergone surgery, ICU admission occurring in three, severe/critical symptoms occurring in five, and invasive ventilation need in two. Radiation therapy was not associated with increased risk of adverse outcomes.
The investigators concluded: “The findings in this study suggest that patients with cancer infected with SARS-CoV-2 tend to have more severe outcomes when compared to patients without cancer. Patients with hematological cancer, lung cancer, and cancers in metastatic stages demonstrated higher rates of severe events compared to patients without cancer. In addition, patients who underwent cancer surgery showed higher death rates and higher chances of having critical symptoms.”
Disclosure: The study was supported by the National Natural Science Foundation of China, Singapore Ministry of Health's National Medical Research Council, and others. For full disclosures of the study authors, visit cancerdiscovery.aacrjournals.org.
