SARS-CoV-2 Worsens Outcomes in Cancer Patients

By Will Boggs MD

October 15, 2020

NEW YORK (Reuters Health) - Outcomes are worse in patients with cancer who test positive for SARS-CoV-2 than in those who test negative, according to a study of US Veterans Affairs electronic health records.

Patients with cancer seem to be at higher risk of infection with SARS-CoV-2, and some studies have reported increased COVID-19-related mortality in cancer patients.

Dr. Nikhil C. Munshi from VA Boston Healthcare System, Harvard Medical School, and Dana-Farber Cancer Institute, Boston, Massachusetts and colleagues used data from the VA Corporate Data Warehouse, the repository for EHR data for patients seen at VA facilities nationwide, to evaluate the prevalence and outcomes of COVID-19 infection among 22,914 patients with a history of cancer who were tested for SARS-CoV-2.

Overall, 7.8% of these cancer patients tested positive for SARS-CoV-2, with significantly higher positivity rates among African Americans (15.0%) versus White patients (5.5%) and among Hispanic/Latino patients (10.9%) versus non-Hispanic/Latino patients (7.7%).

"The real prevalence of COVID-19 remains uncertain," the authors note, "as a substantial number of patients are not or have not been tested, particularly in the context of asymptomatic disease."

The prevalence of COVID-19 was higher in patients with hematologic malignancy (10.9%) than in those with solid tumors (7.8%) and was lower in cancer patients who were current smokers (5.3%) than in those who were former smokers or who had never smoked (9.5%).

Patients receiving cancer therapy, including chemotherapy or immune checkpoint inhibitors, within the last 6 months had a significantly lower prevalence of COVID-19, compared with other patients.

SARS-CoV-2-positive cancer patients had higher frequency of hospitalizations (43.8% versus 31.5% of those testing negative), ICU admissions (19.7% versus 7.8%, respectively), respiratory support (7.9% versus 1.3%), and COVID-19-attributable death (14.0% versus 3.1%), according to the online report in Journal of the National Cancer Institute.

Increasing age and the presence of other comorbidities were significantly associated with an increased rate of COVID-19-attributable death, and African American ethnicity was significantly associated with an increased COVID-19-attributable hospitalization rate.

"In conclusion, the presence of cancer changes the susceptibility to COVID-19 infection and affects overall outcome," the authors write. "The overall disease behavior is modulated by patient-related as well as cancer-related factors which needs to be considered in development of COVID-19 preventative strategies as well as modulation of cancer therapies to optimize the patient care."

"Importantly," they add, "having equal access to care is an important component to improving overall outcome."

Dr. Jeremy L. Warner from Vanderbilt University, Nashville, Tennessee, who recently reviewed the clinical impact of COVID-19 on patients with cancer, told Reuters Health by email, "Although not particularly novel, this result reinforces what we and others have already observed - Black race is associated with increased hospitalization, a proxy for more severe infection. Although they didn't observe an increase in mortality for Black patients with cancer, they may have been underpowered to detect this, since our recent analysis of nearly 4000 patients presented at ESMO does find this association."

"This data was collected through May 4," he said. "Given the unfortunate persistence and worsening of the pandemic since then, I hope the authors will consider repeating and expanding on their analysis!"

Dr. Ilias Siempos from Weill Cornell Medicine, New York, whose recent meta-analysis suggested an association of cancer with worse clinical outcomes among patients with COVID-19, told Reuters Health by email, "A finding that may inform clinical practice is that patients receiving cancer therapy within the last 6 months had statistically significantly lower prevalence of COVID-19 compared to those who received therapy >6 months ago or never received therapy. This finding may reassure oncologists and patients that appropriate cancer therapy should be initiated/maintained even in the midst of the pandemic."

"Reports from large cohorts on the association between cancer and prevalence/outcomes of COVID-19 are necessary to inform clinical practice and trigger research questions," he said.

SOURCE: Journal of the National Cancer Institute, online October 8, 2020.