Cancer patients on chemotherapy at high risk of severe COVID-19 complications

A retrospective study in a single centre in the Philippines has found that cancer patients with recent anticancer treatment, particularly chemotherapy, and who tested positive for the novel coronavirus disease (COVID-19) have higher rates of severe complications. In addition, these patients tend to acquire infection in the hospital, which then leads to an increased risk of severe illness.

This study by Frances Victoria F. Que and her team at St. Luke’s Medical Center in Quezon City, Philippines, was presented at the recently concluded European Society for Medical Oncology (ESMO) Asia Virtual Congress 2020.

The researchers carried out this retrospective, single-centre, cohort study of cancer patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted in a tertiary hospital from March to May 2020. They compared clinical characteristics, laboratory data, and treatment histories between patients with mild and severe outcomes. The differences between groups were analysed using chi-square test and Fisher’s exact test.

Nineteen cancer patients with COVID-19 infection participated in the study. The most common tumour type was breast cancer (26.3 percent), followed by lung (21 percent) and genitourinary (10.5 percent). Majority had early stage cancer (63.2 percent). [ESMO Asia 2020, abstract 325P]

Of the patients, 15 (78.9 percent) received anticancer treatment within 2 weeks prior to admission. The most common treatments were cytotoxic (21.05 percent) and targeted therapy (21.05 percent). Patients who developed severe outcomes tended to have lung cancer, stage IV disease, recent anticancer treatment, and higher levels of inflammatory markers.

Moreover, findings of bilateral opacities on chest x-ray (p=0.009) and ground glass densities on chest computed tomography scan (p=0.002) significantly correlated with having severe complications. Having nosocomial infections also seemed to result in severe outcomes (p=0.004).

“Our findings suggest that cancer patients require urgent and special attention during the pandemic, especially those who are receiving anticancer treatment,” the researchers said.

These results were consistent with those of an earlier study in Wuhan, China, which reported higher infection rate of SARS-CoV-2 in cancer patients than the general population, as well as of deterioration of condition and poor outcomes among cancer patients with COVID-19. [J Med Virol 2020;doi:10.1002/jmv.25972]

In addition, more than half of these patients in the Wuhan study (55.8 percent) had complications, such as liver injury (36.5 percent), acute respiratory distress syndrome (17.3 percent), sepsis (15.4 percent), myocardial injury (15.4 percent), renal insufficiency (7.7 percent), and multiple organ dysfunction syndrome (5.8 percent). Eleven (21.2 percent) cancer patients with COVID-19 died.

The current study was limited by its small population, although the findings were consistent with other published studies, according to the researchers.

“The COVID-19 pandemic is a rapidly evolving crisis worldwide. Cancer patients represent a highly vulnerable group during this pandemic and are facing the most severe and critical consequences of this outbreak,” they said.