More Data Cement COVID’s Impact on Patients With Cancer

TOPLINE:

New data confirmed the impact COVID infection can have on patients with cancer and identified several risk factors associated with hospitalization and death. Receipt of chemotherapy as well as a baseline history of stroke, atrial fibrillation, or pulmonary embolism were each associated with nearly double the risk for COVID-related hospitalization. Prior vaccination halved this risk. Older age and earlier hospitalization were associated with a greater risk for death. 

METHODOLOGY:

• Patients undergoing active cancer treatment are at increased risk for severe COVID-19 due to immunosuppression, but risk factors for hospitalization and death are not well-defined.
• Researchers conducted a prospective cohort study involving 1572 patients with cancer (median age, 60 years; 53.4% women), enrolled within 14 days of a positive SARS-CoV-2 test; participants had received active treatment for cancer within 6 weeks before testing or had undergone prior stem cell transplant or chimeric antigen receptor T-cell therapy. Patient screening and enrollment took place between May 2020 and February 2022.
• Treatments included chemotherapy (34.3%), targeted therapy (27.7%), and immunotherapy (10.6%). Breast (23.6%) and lung (13.9%) cancers were the most common cancer types. Overall, 64% of participants had metastatic disease, and at enrollment, 64% had not received a COVID vaccine.
• Study outcomes were COVID-related hospitalization or death. Risk factors for hospitalization and for death among hospitalized patients were evaluated separately.

TAKEAWAY:

• At 90 days after an initial positive test, COVID-related mortality was 3.0% and remained stable at subsequent follow-ups. The highest incidence occurred in patients with lymphoma, followed by those with acute leukemia or lung cancer; the lowest incidence occurred in those with other types of solid tumors and blood cancers.
• Hospitalization for COVID-19 occurred in 18.4% of patients within 90 days of enrollment. The risk for hospitalization was elevated among patients who received chemotherapy (hazard ratio [HR], 1.97) and those with a history of stroke, atrial fibrillation, and pulmonary embolism (HR, 1.78). Vaccination prior to infection reduced the risk for hospitalization by nearly half (HR, 0.52).
• Hospitalization for COVID-19 within 30 days of infection was associated with an increased risk for death (HR, 14.6). Among patients hospitalized for COVID within 30 days, age 65 years or older was the only significant predictor of COVID-specific death (HR, 3.49).
• Over the 2-year follow-up, there were 1739 disruptions to cancer treatment; 50.7% of these were attributed to COVID-19, and most occurred within 30 days of a positive test. 

IN PRACTICE:

“The data from this prospective cohort study confirm and expand previous retrospective case series that have found factors, including hematologic cancers, chemotherapy receipt, and lung cancer, as associated with COVID-19 severity,” the authors of the study wrote, noting that the results “showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.”

SOURCE:

This study, led by Brian I. Rini, MD, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, was published online in JAMA Oncology.

LIMITATIONS:

Information on specific strains was not available. This study lacked a control group of patients without COVID-19, which limited causal inference. Additionally, as participants were enrolled through the National Cancer Institute trial networks, generalizability to a broader population could be limited. 

DISCLOSURES:

This study was funded in part by the Coronavirus Aid, Relief, and Economic Security Act and the National Cancer Institute National Clinical Trials Network, Experimental Therapeutics Clinical Trials Network, and Community Oncology Research Program grants via the U10 funding mechanism. Several authors declared receiving grants and/or personal fees and having other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.