Patients with inactive cancer and not currently undergoing treatments also face a significantly higher risk of severe illness from COVID-19, a study from Penn Medicine shows.
Past reports have established an increased risk of severe disease and death for sick or hospitalised cancer patients with COVID-19 compared to patients without cancer, but less is known about patients in the general population. The findings underscore the importance of COVID-19 mitigation, like social distancing and mask-wearing, and vaccinations for all patients, not just those recently diagnosed or with active disease.
"Patients who have cancer need to be careful not to become exposed during this time," said senior author Dr Kara N Maxwell, an assistant professor of haematology-oncology and genetics in the Perelman School of Medicine at the University of Pennsylvania and a member of the Abramson Cancer Centre and the Basser Centre for BRCA.
"That message has been out there, but these latest findings show us it's not only for patients hospitalized or on treatment for their cancer. All oncology patients need to take significant precautions during the pandemic to protect themselves."
The researchers analysed the records of more than 4,800 patients who had been tested for COVID-19 from the Penn Medicine BioBank, a centralised bank of samples, and linked data from the health system's electronic health records, to investigate the association between cancer status and COVID-19 outcomes.
Of the 328 positive cases through June 2020, 67 (20.7%) had a cancer diagnosis in their medical history (80.6% with solid tumour malignancy and 73.1% with inactive cancer).
Patients with COVID-19 – including both those with active cancer (18) and inactive cancer (49) – had higher rates of hospitalisations compared to non-cancer patients (55.2% vs 29%), intensive care unit admissions (25.7% vs 11.7%), and 30-day mortality (13.4% vs 1.6%).
While worse outcomes were more strongly associated with those with active cancer, patients in remission also faced an overall increased risk of more severe disease compared to COVID-19 patients without cancer.
Notably, the proportion of Black patients – who make up 20% of the patients in the biobank – was significantly higher in both cancer and non-cancer COVID-19-positive patients (65.7% and 64.1%, respectively) compared to all patients tested for SARS-CoV-2.
The findings parallel prior reports showing the disproportionate impact of COVID-19 on minority communities.
Studies show that cancer patients have a higher risk of COVID-19 complications, due in part to factors such as older age, higher smoking rates, comorbidities, frequent health care exposures, and the effects of cancer therapies. These latest results also suggest cancer itself and its impact on the body may play a role in exacerbating COVID-19 infections.
"Our finding that cancer patients with COVID-19 were more likely than non-cancer patients to experience hospitalisation and death even after adjusting for patient-level factors supports the hypothesis that cancer is an independent risk factor for poor COVID-19 outcomes," they wrote.
In a separate, related study Penn Medicine researchers report that cancer patients receiving in-person care at a facility with aggressive mitigation efforts have an extremely low likelihood of COVID-19 infection.
Of 124 patients in the study receiving treatment at Penn Medicine, none tested positive for the virus after their clinical visits (an average of 13 per patient).
The results suggest those efforts, when combined with social distancing outside the healthcare setting, may help protect vulnerable cancer patients from COVID-19 exposure and infection, even when ongoing immuno-modulatory cancer treatments and frequent healthcare exposure are necessary, the authors said.
Study details (1)
Rates of COVID-19-Related Outcomes in Cancer Compared with Non-Cancer Patients
Lova Sun, Sanjna Surya, Anh N Le, Heena Desai, Abigail Doucette, Peter Gabriel, Marylyn Ritchie, Daniel Rader, Ivan Maillard, Erin Bange, Alexander Huang, Robert H Vonderheide, Angela DeMichele, Anurag Verma, Ronac Mamtani, Kara N Maxwell
Published in NCI Cancer Spectrum on 21 January 2021
Abstract
Cancer patients are a vulnerable population postulated to be at higher risk for severe coronavirus disease 2019 (COVID-19) infection. Increased COVID-19 morbidity and mortality in cancer patients may be attributable to age, comorbidities, smoking, healthcare exposure, and cancer treatments, and partially to the cancer itself. Most studies to date have focused on hospitalized patients with severe COVID-19, thereby limiting the generalizability and interpretability of the association between cancer and COVID-19 severity. We compared outcomes of SARS-CoV-2 infection in 323 patients enrolled in a population-based study prior to the pandemic (n = 67 cancer patients; n = 256 non-cancer patients). After adjusting for demographics, smoking status, and comorbidities, a diagnosis of cancer was independently associated with higher odds of hospitalization (odds ratio = 2.16, 95% confidence interval = 1.12 to 4.18) and 30-day mortality (odds ratio = 5.67, 95% confidence interval = 1.49 to 21.59). These associations were primarily driven by patients with active cancer. These results emphasize the critical importance of preventing SARS-CoV-2 exposure and mitigating infection in cancer patients.
Study details (2)
SARS-CoV-2 seropositivity and seroconversion in patients undergoing active cancer-directed therapy
Lova Sun, Sanjna Surya, Noah G. Goodman, Anh N Le, Gregory Kelly, Olutosin Owoyemi, Heena Desai, Cathy Zheng, Shannon DeLuca, Madeline L Good, Jasmin Hussain, Seth D Jeffries, Yolanda R. Kry, Emily M Kugler, Maikel Mansour, John Ndicu, AnnaClaire Osei-Akoto, Timothy Prior, Stacy L Pundock, Lisa A Varughese, JoEllen Weaver, Abigail Doucette, Scott Dudek, Shefali Setia Verma, Sigrid Gouma, Madison E Weirick, Christopher M McAllister, Erin Bange, Peter Gabriel, Marylyn Ritchie, Daniel J Rader, Robert H Vonderheide, Lynn M Schuchter, Anurag Verma, Ivan Maillard, Ronac Mamtani, Scott E Hensley, Robert Gross, E Paul Wileyto, Alexander C Huang, Kara N Maxwell, Angela DeMichele
Published in medRxiv on 15 January 2021
Abstract
Multiple studies have demonstrated the negative impact of cancer care delays during the COVID-19 pandemic, and transmission mitigation techniques are imperative for continued cancer care delivery. To gauge the effectiveness of these measures at the University of Pennsylvania, we conducted a longitudinal study of SARS-CoV-2 antibody seropositivity and seroconversion in patients presenting to infusion centers for cancer-directed therapy between 5/21/2020 and 10/8/2020. Participants completed questionnaires and had up to five serial blood collections. Of 124 enrolled patients, only two (1.6%) had detectable SARS-CoV-2 antibodies on initial blood draw, and no initially seronegative patients developed newly detectable antibodies on subsequent blood draw(s), corresponding to a seroconversion rate of 0% (95%CI 0.0-4.1%) over 14.8 person-years of follow up, with a median of 13 healthcare visits per patient. These results suggest that cancer patients receiving in-person care at a facility with aggressive mitigation efforts have an extremely low likelihood of COVID-19 infection.
[link url="https://www.pennmedicine.org/news/news-releases/2021/january/patients-in-cancer-remission-at-high-risk-for-severe-covid19-illness"]University of Pennsylvania School of Medicine material[/link]
[link url="https://academic.oup.com/jncics/advance-article/doi/10.1093/jncics/pkaa120/6104876"]JNCI Cancer Spectrum study[/link]
[link url="https://www.medrxiv.org/content/10.1101/2021.01.15.21249810v1"]medRxiv study[/link]