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Patients on Active Chemotherapy May Not Be at Increased Risk for COVID-19 Infection


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Due to concerns that patients with cancer may be at higher risk for contracting the coronavirus—and may have more severe complications if infected—during the COVID-19 pandemic, hospitals and clinical practices have changed protocols to routine cancer care to reduce patients’ exposure to the virus.

A retrospective study by Chen et al presented during the AACR Virtual Meeting: COVID-19 and Cancer investigated the risk factors for COVID-19 infection among patients with cancer (Abstract S11-02). The study found that compared with patients not on any active treatment, those receiving chemotherapy were 35% less likely to develop COVID-19. Consistent with the general population, older age, minority race/ethnicity, and obesity were all associated with COVID-19 incidence among patients with cancer. According to the study authors, disruptions in cancer diagnosis and treatment during the COVID-19 pandemic should be minimized.

Study Methodology

The researchers conducted a retrospective cohort study of 1,174 patients with cancer tested for SARS-CoV-2 infection between March 1, 2020, and June 6, 2020, at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center in New York. Data were collected on the patients’ age (mean age = 67), sex, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian, other, or unknown), body mass index (BMI), smoking habits, time since cancer diagnosis, cancer type, current cancer status, most recent cancer treatment type within the past year, time since last cancer treatment prior to COVID-19 testing, and infusion center visit within the past year.

Chi-squared tests and multivariable logistic regression were used to examine the association between demographic, clinical, tumor, and treatment-related factors and COVID-19 test results, while controlling for covariates.

KEY POINTS

  • Compared with patients with cancer not on active treatment, those receiving chemotherapy were 35% less likely to develop COVID-19, and were less likely to test positive for the virus than those not on treatment.
  • Patients with cancer who tested positive for COVID-19 had higher death rates than those who tested negative for the infection.
  • Consistent with the general population, older age, minority race/ethnicity, and obesity were associated with COVID-19 infection among patients with cancer.

Results

The researchers found that of the 1,174 patients tested for COVID-19, 317 (27%) were positive for the virus. About 27% had a recent cancer diagnosis, 56.7% had active disease, and 56.7% were on active cancer treatment within the past year. In multivariable analysis, older age and higher BMI were associated with COVID-19 infection. Compared to non-Hispanic Whites, Black and Hispanic patients were more likely to test positive for COVID-19 (odds ratio [OR] = 2.21, 95% confidence interval [CI] = 1.44–3.40 and OR = 2.71, 95% CI = 1.91–3.83, respectively).

A recent cancer diagnosis, active disease, and active cancer treatment were not associated with COVID-19 infection. Compared to patients with cancer not on active treatment, those receiving chemotherapy were less likely to develop COVID-19 (OR = 0.65, 95% CI = 0.44–0.95). The researchers observed excess deaths among patients who tested positive vs negative for COVID-19 (28.4% vs 8.3%, P < .001).

Clinical Relevance

Consistent with the general population, we found that older age, minority race/ethnicity, and obesity were associated with COVID-19 [infection] among [patients with] cancer. Surprisingly, patients on active treatment, including chemotherapy, were not at increased risk for COVID-19. Therefore, delays in cancer diagnosis and treatment during the COVID-19 pandemic should be minimized,” concluded the study authors.

“Our study shows that with proper precautions in the clinical setting, disruptions in lifesaving cancer treatment should be minimized during the COVID-19 pandemic,” said Monica F. Chen, MD, a third-year resident in the Department of Medicine at Columbia University, Vagelos College of Physicians and Surgeons, and NewYork-Presbyterian Hospital, and lead author of this study, in a statement.

Disclosure: The study was funded by the National Cancer Institute. Dr. Chen declared no conflicts of interest.

 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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