Age, comorbidities may be to blame for higher COVID-19 mortality in cancer patients

The increased risk of mortality among patients with cancer diagnosed with COVID-19 may be due to their older age and presence of comorbidities, according to a study presented at ECCVID 2020.

The results were based on a retrospective analysis of the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) registry. Of the 3,071 patients with COVID-19 enrolled between March and August 2020 (59.5 percent male), 435 patients with cancer were identified.

Patients with cancer tended to be older than those without cancer (primarily aged 76–85 years vs 56–65 years). Mean Charlson Comorbidity Index (CCI) score among patients with cancer was 4.65 and 23.5 percent had an Eastern Cooperative Oncology Group (ECOG) performance status of >2. Common comorbidities were cerebrovascular disease, cardiovascular disease, and chronic kidney disease.

Fifty-nine percent of patients with cancer had solid tumours, while 17.5 and 11 percent had lymphoma and leukaemia, respectively. Fifty-four percent (n=193) had active cancer and 22 percent (n=96) had received anticancer therapy within the past 3 months before COVID-19 diagnosis. 

Patients were hospitalized for a median 15 days and the median observation period was 14 days. Clinical manifestation of COVID-19 was characterized into four phases namely uncomplicated (asymptomatic/mild symptoms), complicated (need for oxygen supplementation), critical (need for life-supporting therapy), and recovery (improvement/discharge).

A majority of patients with cancer (62.5 percent) presented with the uncomplicated phase of COVID-19. Fifty-five percent progressed to the complicated or critical phases and 27.5 percent required intensive care unit (ICU) admission, with 65.5 percent of the latter requiring mechanical ventilation.

Prior to adjustment, COVID-19 mortality rate was significantly greater among patients with vs without cancer (22.5 percent vs 14 percent; p<0.001), with a median survival of 48 days in patients with cancer and not reached in those without cancer. Survival at 30 days was more likely in those without vs with cancer (77 percent vs 70.5 percent; p=0.001).

Risk of mortality was twofold in men compared with women (28 percent vs 13.5 percent; p<0.001) and higher in patients with active cancer (recurrent or metastatic cancer or receiving anticancer therapy) vs without active cancer (26.5 percent vs 17 percent; p=0.027).

After adjusting for age, sex, and comorbidities, there was no significant difference in COVID-19 mortality between patients with and without cancer regardless of age (36–55 years: 8.0 percent vs 4.0 percent; 56–65 years: 11.0 percent vs 7.0 percent; 66–85 years: 26.5 percent vs 23.5 percent; >86 years: 37.0 percent vs 38.5 percent).

“Although cancer and non-cancer patients have similar rates of infection, it is generally assumed that cancer patients are at higher risk for death and worse outcomes from COVID-19,” noted Dr Maria Rüthrich from the Jena University Hospital, Jena, Germany.

Previous studies have shown that advanced age, male sex, and comorbidities are risk factors for these outcomes. In addition, cancer-related features such as “immune-compromising effects of the underlying malignancy” and anticancer therapies may have a role to play, she said.

“Even though mortality and survival appear to be comparable in non-cancer and cancer patients after adjustment for age, sex, and comorbidity, our results line out that cancer patients are at higher risk for worse outcome from COVID-19 due to a significantly older age and higher rate of comorbidities,” concluded Rüthrich. “It does not appear to be the cancer itself that is leading to these poor outcomes,” she said.