Outcomes of COVID-19 Infection in Patients with Cancer

Annals of Oncology reported a study in which Zhang and colleagues presented the characteristics and outcomes in 28 patients with cancer from three hospitals in Wuhan, China who had COVID-19 infection, and found that these patients were at relatively greater risk of serious events and mortality (loss of life).

Characteristics of Patients with Cancer Diagnosed with COVID-19

The 28 patients with cancer were among 1,276 patients diagnosed with COVID-19 at three hospitals during January and February 2020 (2.2% of patients). All had laboratory test confirmation of COVID-19 infection, and a total of eight (28.6%) had contracted COVID-19 in hospital. Approximately 61% of the patients with cancer diagnosed with COVID-19 were men (17 patients), and their median age was 65. Lung cancer was the most common cancer among these patients (7 patients, 25%).

15 patients (53.6%) had severe events (admission to an intensive care unit, intubation with mechanical ventilation, or death); 8 patients (28.6%) died from the infection. Receiving any cancer treatment in the previous 14 days, including chemotherapy, immunotherapy, targeted therapy or radiotherapy, was associated with a marked increase in the risk of serious events (a 4-fold increase in risk). A ground-glass appearance on computed tomography scans and findings consistent with COVID-19 were associated with an increased risk of severe events.

In conclusion, it should be recognized that patients with cancer receiving active cancer treatment are at greater risk of COVID-19 infection and experience a more severe course of COVID-19. Testing these patients for COVID-19 is important, and avoiding the use of immunosuppressive drugs or adjusting their doses should also be considered.

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Commentary, Early Observations and Unanswered Questions

The frequency of COVID-19 infection in the patients with cancer described in the report was approximately 1.7 times higher than in the Chinese population of the same age, and mortality (loss of life) in these patients was 10 times higher than that reported for COVID-19 overall. Although these figures are a serious concern for patients with cancer, caution is needed when interpreting the findings: the number of cases here is very small, and the data were collected retrospectively. In addition, generalizing these findings to other countries may be problematic for several reasons. First, the prevalence of cancers in China differs from that in Western countries; 8 of the 28 cases were esophageal, liver, stomach or nasopharyngeal cancer, which are less common in Western countries. Furthermore, no patients with hematological malignancies (blood and lymph cancers) were reported; these patients may have greater immunosuppression than patients with solid (organ) tumors. Patients receiving outpatient cancer treatment at chemotherapy centers may not be affected by COVID-19 to this extent. The hospitals included in the study were also COVID-19 referral centers, so they may have treated more critically ill patients than other centers. Despite these limitations, this early report by Zhang and colleagues makes an important contribution to our understanding of the risk and effects of COVID-19 infection in patients with cancer and may allow oncologists to adapt COVID-19 treatment clinically. At a minimum, patients with cancer should follow social isolation rules strictly and should be candidates for early, rapid assessment of symptoms suggestive of COVID-19, including laboratory testing and chest CT.

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