COVID-19 Symptom Severity Increased in Cancer Survivors

Adult cancer survivors in the United States were more likely to report severe COVID-19 symptoms compared to the general population, based on data from a new study of nearly 9000 individuals presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 2025 Annual Meeting. 

“COVID-19 can have many long-lasting adverse effects on individuals’ health outcomes and wellbeing,” said Jincong (Jason) Freeman, PhD, of the University of Chicago, Chicago, in an interview. The population of cancer survivors in the United States is both aging and growing, and studies have shown that this population may be more vulnerable to COVID-19, but data on symptoms, vaccination, and long COVID in cancer survivors are lacking, Freeman said.

Freeman and colleagues conducted a secondary analysis of data from the 2022 National Health Interview Survey (NHIS). The study population included 8936 adults aged ≥ 18 years, 7.6% of whom were cancer survivors; approximately two thirds were White individuals, 19.2% were Hispanic individuals, 9.6% were Black individuals, 4.8% were Asian individuals, and 3.0% were of other races or ethnicities.

The researchers reviewed data on symptom severity and COVID-19 vaccination status. Significantly more cancer survivors had severe COVID-19 symptoms compared to the general population (17.9% vs 14.3%, P = .019). In addition, significantly more cancer survivors received a COVID-19 vaccine compared to the general population (88.6% vs 78.6%, P < .001).

Long COVID was defined as symptoms of at least 3 months’ duration that were not present before infection with COVID-19, and 19.7% of the study participants overall met these criteria. In a weighted logistic regression analysis, long COVID was significantly more common in cancer survivors compared to the general population (23.6% vs 19.4%, P = .009).

The finding that cancer survivors experienced more severe COVID-19 symptoms than the general population was not unexpected, as the survivor population is older and often experience more chronic health conditions and/or a weakened immune system, Freeman told Medscape Medical News. However, “To our surprise, cancer survivors had similar odds (still a bit high given an odds ratio of 1.05) of experiencing long COVID to the general population, which contradicts our initial hypothesis that survivors would have significantly greater odds,” he said. “But we observed that the COVID-19 vaccination rate was higher in cancer survivors (88.6%) than in the general population (78.6%), which likely explains the similar odds of long COVID-19 due to the vaccine’s protective effect for the survivor population,” he noted.

A key takeaway from the study is the need to continue to identify and address COVID-19 symptom severity in cancer survivors, said Freeman. “At the same time, although the COVID-19 vaccination rate is higher in the cancer survivor population, 1 in 9 (1 in 5 of the general population) still did not receive at least one dose of the vaccine,” he noted. The results suggest that clinics and cancer programs should promote COVID-19 vaccination regardless of cancer history while ensuring equitable access to COVID-19 care and services, he added.

An important limitation of the study was that the 2022 NHIS did not collect information on which COVID-19 vaccines people received, Freeman told Medscape Medical News. “We were wondering whether COVID-19 symptoms and long COVID might vary by vaccine type viral vector, and protein subunit,” he noted.

The researchers also were unable to assess specific symptoms and whether cancer survivors experienced them prior to COVID-19, notable because some cancer survivors may experience similar symptoms during and after treatment, said Freeman.

“We were not able to untangle symptoms from COVID-19, long COVID, or cancer treatment sequelae; therefore, further studies are needed to address these limitations,” he said.

Study Adds to COVID-19 Knowledge Storehouse

“The more data we have, the more we information we have available about the various impact of COVID on different groups,” said Shirin A. Mazumder, MD, and infectious diseases specialist in Memphis, Tennessee, in an interview. “It is important to continue to add to the existing knowledge base, so we have a better understanding of COVID-19 and how best to protect and treat our patients,” she said.

Mazumder said that the increased frequency of severe symptoms in cancer survivors was not unexpected, but clinicians should be aware that symptoms of COVID-19 can be more severe in cancer survivors. Consequently, these patients should be monitored closely once diagnosed with COVID-19 to ensure that antiviral treatment is offered if appropriate to potentially reduce the rate of complications, she added.

Some potential variables that merit further study include the severity of COVID-19 as related to what type of cancer the patient had, the type of cancer treatment the patient received, and when treatment was completed, Mazumder told Medscape Medical News.

“Evaluating the rate of hospitalization in this patient population would be valuable to better characterize the degree of severity, and evaluating the duration of time that has lapsed from the last COVID vaccine to when patients developed symptoms also would be useful,” she said.

The study received no outside funding. The researchers had no financial conflicts to disclose. Mazumder had no financial conflicts to disclose.