In an article published in the Journal of Clinical Oncology, Emily E. Johnston, MD, MS, and colleagues detailed characteristics, effects on cancer treatment, and outcomes of SARS–CoV-2 infection in pediatric patients with cancer based on data from The Pediatric Oncology COVID-19 Case Report registry.
Study Details
The observational study included clinical and sociodemographic characteristics of 917 registry patients aged ≤ 21 years from 94 institutions in 36 states who were receiving cancer therapy and were infected with SARS–CoV-2 from the pandemic onset through February 2021. Data were compared with SEER (Surveillance, Epidemiology, and End Results) data on patients diagnosed with any malignancy between 2011 and 2016 at age ≤ 21 years.
Emily E. Johnston, MD, MS
Key Findings
Among the 917 patients, median age at SARS–CoV-2 infection was 10.8 years (range = 0–21 years). A total of 43.6% were Hispanic, 59.3% were publicly insured, 65.8% had hematologic malignancies, 92.0% had received cancer treatment within 90 days of SARS–CoV-2 diagnosis, and 34.8% had at least one noncancer comorbidity.
Compared with the SEER cohort, the infection cohort had significantly higher proportions of Hispanic patients (43.6% vs 29.7%, P < .01), publicly insured patients (59.3% vs 33.5%, P < .01), and patients with hematologic malignancies (65.8% vs 38.3%, P < .01).
In the infection cohort, 64.1% of patients had symptomatic infection; those with hematologic malignancies were more likely to be symptomatic than those with solid tumors (67.3% vs 58.0%, P < .01). A total of 31.2% were hospitalized (36.0% vs 22.0% for hematologic malignancies vs solid tumors, P < .01), 10.9% required respiratory support, 9.2% were admitted to the intensive care unit (ICU), and 1.6% died due to SARS–CoV-2 infection.
Cancer therapy was modified in 44.9% of patients in the infection cohort. Hispanic ethnicity was associated with increased risk of changes in cancer-directed therapy (adjusted risk ratio [RR] = 1.3, 95% confidence interval [CI] = 1.1–1.6), reflecting increased risk of change due to neutropenia or thrombocytopenia (adjusted RR = 1.7, 95% CI = 1.03–3.0).
Patients with comorbidities were at an increased risk of hospitalization (adjusted RR = 1.3, 95% CI = 1.1–1.6) and ICU admission (adjusted RR = 2.3, 95% CI = 1.5–3.6). Public insurance (adjusted RR = 1.3, 95% CI = 1.04–1.7), hematologic malignancy (adjusted RR = 1.6, 95% CI = 1.3–2.1), and absolute neutrophil count of 0 to 499/ µL (adjusted RR = 1.4, 95% CI = 1.2–1.7) were associated with an increased risk of hospitalization.
The investigators concluded, “These findings provide critical information for decision-making among pediatric oncologists, including inpatient vs outpatient management, cancer therapy modifications, consideration of monoclonal antibody therapy, and counseling families on infection risks in the setting of the… pandemic. The over-representation of Hispanic and publicly insured patients in this national cohort suggests disparities that require attention.”
Dr. Johnston, of the Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
