According to research published by Russell et al in Frontiers in Oncology, patients with a longer-established diagnosis of cancer are at increased risk for more severe infection with COVID-19, as well as death from the virus. Patients of Asian ethnicity or who were receiving palliative treatment for cancer were also at a higher risk of death from COVID-19.

“Large studies with detailed information on COVID-19 safety measures and oncologic care are urgently warranted to explore the intersection of COVID-19 and cancer in terms of clinical outcomes, so as to inform oncologic care during this outbreak and potential future pandemics. Our findings provide a first insight into possible effects of cancer and its treatments on COVID-19 outcomes,” said study author Mieke Van Hemelrijck, PhD, of King’s College London, in a statement.

Study Details

The study analyzed the outcomes of 156 patients with cancer and a confirmed COVID-19 diagnosis between February 29 and May 12, 2020. Eighty-two percent of patients had presented with mild or moderate COVID-19 infection and 18% with severe infection at Guy’s Cancer Centre in London. Advanced statistical methods were employed to identify which demographic and/or clinical characteristics were associated with COVID-19 severity or death.

Most patients in the cohort were male and from a lower socioeconomic background. Half were White; 22%, Black; and 4%, Asian. Hypertension was the most commonly reported comorbidity, followed by diabetes, renal impairment, and cardiovascular disease.

The most common malignancy types reported in patients in the cohort were urologic/gynecologic (29%), hematologic (18%), and breast (15%). When classified according to COVID-19 severity, the largest proportion of cancers were hematologic (36%), while 40% of patients had stage IV cancer and 46% of patients were diagnosed with malignancy in the last 12 months. Benign lung conditions were more commonly reported for those who presented with severe COVID-19.

Results

Patient follow-ups conducted 37 days later found 22% of patients from the cohort had died from COVID-19 infection. Patients of Asian ethnicity, who were receiving palliative treatment, or who had received a diagnosis of cancer more than 24 months before onset of COVID-19 symptoms were at a higher risk of death. Patients who presented with dyspnea or high C-reactive protein levels were also at higher risk of dying from COVID-19. An inverse association was observed with increased levels of albumin.

Severe COVID-19 infection was associated with presenting with fever, dyspnea, gastrointestinal symptoms, or a diagnosis of cancer more than 24 months previously.

The study authors concluded, “A longer-established diagnosis of cancer was associated with increased severity of infection as well as COVID-19 death, possibly reflecting the effects a more advanced malignant disease has on this infection. Asian ethnicity and palliative treatment were also associated with COVID-19 death in patients [with cancer].”

Commentary

Study author Saoirse Dolly, MBBS, PhD, of Guy’s and St Thomas’ NHS Foundation Trust, said, “…Over 11 weeks, 1,507 patients were tested [by] polymerase chain reaction for COVID-19. One hundred and fifty-six (10%) were positive for COVID-19 infection…18% developed severe infection and 34 patients…sadly died (22%). Age, [sex], ethnicity, or cancer treatment were not associated with severity of COVID-19 infection. With median of 37 days follow-up, Asian ethnicity, being on palliative treatment, or having cancer for more than 2 years was positively associated with COVID-19–related death.”

“This real-world observation provides valuable insights…during the COVID[-19] pandemic. The data needs to be validated in larger series with longer follow-up of patients to provide more definitive guidance on the management of oncology patients through the COVID-19 outbreak.”

Disclosure: For full disclosures of the study authors, visit frontiersin.org.