Cancer type, stage, and recent treatment may affect outcomes of COVID-19 in cancer patients, according to a study of patients from China.
The data showed that patients with hematologic malignancies and those with metastatic cancers had higher risks of developing severe or critical COVID-19 symptoms, being admitted to the ICU, requiring ventilation, and dying.
On the other hand, patients with nonmetastatic cancer had outcomes comparable to those of noncancer patients with COVID-19.
Similarly, cancer patients who had recently undergone surgery or received immunotherapy were more likely to have poor outcomes, whereas cancer patients treated with radiotherapy had outcomes similar to those of noncancer COVID-19 patients.
Hongbing Cai, MD, of Zhongnan Hospital of Wuhan University in China, presented these results at the AACR virtual meeting I. The results also were published in Cancer Discovery.
Cancer vs. noncancer patients
The study included 105 cancer patients with COVID-19 who were treated from Jan. 1 to Feb. 24, 2020, at 14 hospitals in Wuhan, China. Patients had lung (20.95%), gastrointestinal (12.38%), breast (10.48%), and thyroid cancers (10.48%) as well as hematologic malignancies (8.57%). Dr. Cai and colleagues matched the COVID-19 cancer patients to 536 COVID-19 patients without cancer. Patients were matched by hospital, duration of hospitalization, and age.
“COVID-19 patients with cancer had higher risks of all severe outcomes,” Dr. Cai noted.
Compared with noncancer patients, the cancer patients had a higher risk of:
- Severe or critical COVID-19 symptoms – odds ratio, 2.79 (P < .01).
- Being admitted to the ICU – OR, 2.84 (P < .01).
- Requiring invasive mechanical ventilation – OR, 14 (P < .01).
- Death – OR, 2.34 (P = .03).
Cancer type and stage
Dr. Cai noted that outcomes were the worst among patients with hematologic malignancies and those with metastatic cancer (stage IV).
Compared with patients without cancer, those with hematologic malignancies had a higher risk of:
- Severe/critical symptoms – OR, 10.61 (P < .01).
- ICU admission – OR, 9.66 (P < .01).
- Invasive mechanical ventilation – OR, 38 (P < .01).
- Death – OR, 9.07 (P = .01).
Compared with patients without cancer, those with metastatic cancer had a higher risk of:
- Severe/critical symptoms – OR, 5.97 (P < .01).
- ICU admission – OR, 6.59 (P < 0.01).
- Invasive mechanical ventilation – OR, 55.42 (P < .01).
- Death – OR, 5.58 (P = .01).
On the other hand, outcomes in patients with nonmetastatic cancer were not significantly different from outcomes in patients without cancer (P > .05 for all outcomes).
Cancer treatment
The treatments cancer patients received within 40 days before the onset of COVID-19 symptoms were radiotherapy (12.26%), chemotherapy (14.15%), surgery (7.62%), targeted therapies (3.81%), and immunotherapy (5.71%).
Compared with patients without cancer, those who received immunotherapy had a higher risk of:
- Severe/critical symptoms – OR, 10.61 (P < .01).
- Death – OR, 9.07 (P = .04).
Patients who underwent surgery had a higher risk of:
- Severe/critical symptoms – OR, 8.84 (P < .01).
- ICU admission – OR, 7.24 (P = .02).
- Invasive mechanical ventilation – OR, 44.33 (P < .01).
Conversely, outcomes in cancer patients who received radiotherapy were not significantly different from outcomes in patients without cancer (P > .10 for all).
These results suggest that “postponing surgery should be considered in outbreak areas,” Dr. Cai said, adding that scheduled radiotherapy can go ahead but with “intensive protection and surveillance.”
Dr. Cai said it remains to be seen whether patients with early-stage cancer need to postpone their treatments during the COVID-19 pandemic or whether immunotherapy aggravates severe outcomes in cancer patients with COVID-19. For now, she said, cancer patients should have individualized treatment plans based on their tumor type and stage.
Dr. Cai disclosed no conflicts of interest. This study was supported by the National Natural Science Foundation of China, the Singapore Ministry of Health’s National Medical Research Council, the National Institutes of Health/National Heart, Lung, and Blood Institute, and the Xiu Research Fund.
SOURCE: Cai H. AACR 2020. Patients with cancer appear more vulnerable to SARS-COV-2: A multicenter study during the COVID-19 outbreak; Dai M et al. Cancer Discov. 2020 Apr 28. doi: 10.1158/2159-8290.CD-20-0422.