Even Patients With Cancer in Remission at Risk for Severe COVID

M. Alexander Otto, PA, MMS

January 26, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

It's been shown that hospitalized cancer patients and those undergoing active treatment are at high risk for severe COVID-19 complications. A new study shows that patients with cancer in remission are at higher risk, too.

For the study, investigators from the University of Pennsylvania analyzed 323 patients with SARS-CoV-2 infection in a research database with more than 4800 patients. About 20% of database patients were Black, but they accounted for almost 65% of the infections, reflecting previous reports of increased risk for COVID among Black people.

Sixty-seven of the infected patients had cancer, including 18 patients with active cancer and 49 patients whose cancer was in remission. After adjusting for demographics, smoking status, and comorbidities, a diagnosis of cancer more than doubled the odds of hospitalization and increased the odds of 30-day mortality nearly sixfold.

Worse outcomes were more strongly associated with active cancer, but patients whose cancer was in remission were also at higher risk than patients who did not have cancer.

It's not only "patients hospitalized or on treatment...all oncology patients need to take significant precautions during the pandemic to protect themselves," senior investigator Kara Maxwell, MD, PhD, hematologist/oncologist and assistant professor at the Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, said in a press release.

The study was published online on January 21 in JNCI Cancer Spectrum.

The good news is that steps to prevent SARS-CoV-2 infection work, suggests a second report from the University of Pennsylvania. Among 124 cancer patients who underwent outpatient infusions from May to October 2020, not a single one experienced seroconversion over a median of 13 clinical visits. That second study was published on January 16 in medRxiv and is pending peer review.

The zero seroconversion rate likely reflects "the success of transmission mitigation measures within healthcare facilities," say investigators led by Lova Sun, MD, a hematology/oncology fellow at the University of Pennsylvania.

Like many institutions, the University of Pennsylvania Health System (Penn Medicine) is aggressive in protecting outpatients against the virus, say the authors. Among other steps, patients are queried about symptoms and contacts before their office visit, and their temperature is taken when they come in. Masks are worn; check-in is contactless; the number of visitors is limited; and patients who test positive are treated in a separate space.

In addition, patients in the study also reported that they wore masks and practiced social distancing in their daily lives.

Approached for comment, hematologist/oncologist Charles Shapiro, MD, a professor at the Icahn School of Medicine at Mount Sinai and director of translational breast cancer research at Mt. Sinai Hospital, New York City, said he wasn't surprised that the prevention measures followed at Penn Medicine work. They are very similar to the measures followed at Mt. Sinai oncology clinics, and "there've been very few COVID cases in our shop," he said.

The bigger take-home message from both studies is that cancer patients, regardless of their age, and even if they are in remission, should be prioritized for vaccination against COVID-19, which is the best way to mitigate risk. "I strongly urge my patients to get it" if they can, he said.

The problem in New York City is that immunizations are largely limited to people aged 65 years and older. Younger cancer patients are left out, and access has been spotty for all patients. "Vaccine is available one day, then not the next. It's disheartening," Shapiro told Medscape Medical News. "Hopefully, with the new administration, this will smooth out," and the age limit will drop, he added.

The study was supported by the National Institutes of Health, among other organizations. Lova, Maxwell, and Shapiro have disclosed no relevant financial relationships.

JNCI Cancer Spectr. Published online January 21, 2021. Abstract

medRxiv. Published online January 16, 2021. Full text

M. Alexander Otto is a physician assistant with a master's degree in medical science, and an award-winning medical journalist who has worked for several major news outlets before joining Medscape, including McClatchy and Bloomberg. He is an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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