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COVID-19 Sequelae Prevalence, Risk Factors, and Outcomes in Patients With Cancer


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In a retrospective European study reported in The Lancet Oncology, David J. Pinato, PhD, and colleagues found that among patients with cancer who recovered from COVID-19 infection, a substantial proportion have sequelae that can affect survival and oncologic outcomes. Among patients on systemic anticancer therapy, outcomes were better for those who resumed therapy with dose or regimen modifications vs those who discontinued treatment. 

David J. Pinato, PhD

David J. Pinato, PhD

The study involved data from the European OnCovid registry on patients aged ≥ 18 years with a history of cancer and confirmed COVID-19 infection from sites in Belgium, France, Germany, Italy, Spain, and the United Kingdom. Patients diagnosed with SARS­–CoV-2 infection between February 2020 and February 2021 were eligible for analysis.

Key Findings

A total of 1,557 COVID-19 survivors who underwent clinical reassessment after a median of 22.1 months (interquartile range [IQR] = 8.4–57.8 months) from cancer diagnosis and 44 days (IQR = 28–329 days) from COVID-19 diagnosis were included in the analysis.

Among the 1,557 patients, 234 (15.0%) reported COVID-19 sequelae, including respiratory symptoms in 116 (49.6%), residual fatigue in 96 (41.0%), neurocognitive symptoms in 17 (7.3%), and weight loss in 13 (5.5%).

Sequelae were more likely to occur in men vs women (P = .041), patients aged ≥ 65 years vs other age groups (P = .048), those with two or more vs less than two comorbidities  (P = .0006), those with a history of smoking vs no smoking history (P = .0004), those who were hospitalized for COVID-19 (P < .0001), those with complicated COVID-19 (P < .0001), and those who received COVID-19 therapy (P = .0002).

In analysis adjusting for time to post–COVID-19 reassessment, sex, age, comorbidities, tumor characteristics, anticancer therapy, and COVID-19 severity, sequelae were associated with an increased risk of death (hazard ratio [HR] = 1.80, 95% confidence interval [CI] = 1.18–2.75) after a median post–COVID-19 follow-up of 128 days (95% CI = 113–148 days).

KEY POINTS

  • Among 1,557 patients included in the analysis, 234 (15.0%) reported COVID-19 sequelae, including respiratory symptoms in 116 (49.6%), residual fatigue in 96 (41.0%), neurocognitive symptoms in 17 (7.3%), and weight loss in 13 (5.5%).
  • Sequelae were associated with an increased risk of death after a median post–COVID-19 follow-up of 128 days.
  • Permanent discontinuation of anticancer therapy was independently associated with increased risk of death, whereas no increased risk was observed in patients who resumed treatment with dose or regimen adjustments.

Analysis of resumption of systemic anticancer therapy among 466 patients who had been on such therapy within 4 weeks prior to their COVID-19 diagnosis showed that 70 (15.0%) permanently discontinued therapy and 178 (38.2%) resumed treatment with a dose or regimen adjustment. On multivariate analysis, permanent discontinuation was independently associated with increased risk of death (HR = 3.53, 95% CI = 1.45–8.59), whereas no increased risk was observed in patients who resumed treatment with dose or regimen adjustments (HR = 0.84, 95% CI = 0.35–2.02).

The investigators concluded, “Sequelae post–COVID-19 affect up to 15% of patients with cancer and adversely affect survival and oncological outcomes after recovery. Adjustments to systemic anticancer therapy can be safely pursued in treatment-eligible patients.”

Dr. Pinato, of the Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, is the corresponding author for The Lancet Oncology article.

Disclosure: The study was funded by the UK National Institute for Health Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust. For full disclosures of the study authors, visit thelancet.com.

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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