Chinese Study Finds Cancer Patients at Greater Risk with COVID-19
Cancer patients were found to be at higher risk for more severe COVID-19 outcomes according to a recent study by Chinese researchers presented at the American Association of Cancer Research (AACR) virtual meeting yesterday. Patients with blood cancers (leukemia, lymphoma and myeloma) had higher rates of severe events due to their compromised immune system and increased susceptibility of catching an infection.
Chinese researchers performed a multicenter study of 105 cancer patients and 536 non-cancer patients all testing positive for COVID-19. They found that blood cancer, lung cancer or metastatic (stage IV) cancer patients had the highest frequency of severe events. Non-metastatic cancer patients had similar outcomes as the general population. Cancer patients who received surgery surgery had higher risks of having severe events, while patients with only radiotherapy did not demonstrate significant differences in severe events when compared to patients without cancer.
It makes sense that cancer patients are more susceptible to infections due to coexisting chronic diseases, overall poor health status, and systemic immunosuppressive states caused by both cancer and anticancer treatments, but until now no data was shared to determine which cancer patients were most at risk. Using data collected from 14 hospitals in Hubei Province China (the outbreak epicenter outbreak) the researchers documneted their findings of 63-64 year old cancer and non-cancer COVID-19 patients and the study included 339 females and 302 males.
Type of Cancer Treatment
The cancer patients in the study had received the following types of cancer therapy within 40 days of their COVID-19 diagnosis.
|Type of Therapy||Number||Percent|
|Targeted therapy (all EGFRTK1)||4||3.81%|
|Immunotherapy (all PD-1 inhibitors)||6||5.71%|
- In-hospital infections: 19.4% for cancer patients vs. 1.49% without cancer
- Lung cancer patients had higher risk of death, higher ICU admission and higher use of ventilators
- Patients undergoing radiotherapy had no increased risks
- Patients receiving the immunotherapy had higher rates of death (2 of 6 patients) and higher critical symptoms (4 of 6 patients)
- Patients in surgery had higher risk of death (2 of 8 patients), higher chances of ICU admission (3 of 8 patients) higher critical symptoms (5 of 8 patients) and higher use of ventilation (2 of 8 patients)
- Cancer patientss had a 3x increase in the death rate compared to patients without cancer
- Cancer patients had a 10x increase in acquiring COVID-19 during a hospital stay compared to patients without cancer
- 55.56% of the blood cancer patients had severe immunosuppression, which may be the main reason of deteriorated outcomes
- If a cancer patient had early stage of disease without metastasis, there was no difference between the cancer and non-cancer population in terms of COVID-19 related death rate or severity
- ARDS (Acute Respiratory Distress Syndrome) was induced by cytokine storm and was the main cause of death for the patients on an immunotherapy (study sample size was very small)
- There was no difference in outcomes of cancer patients in treatment vs. out of treatment
- There was a significant diffeerence between COVID-19 cancer patients vs. COVID-19 patients without cancer
- Mean length of hospital stay was 27 days for cancer patients vs. 17.75 days without cancer
The study authors note that the study size is still relatively small and when managing the crisis the hospital staff didn't have the time to record and collect all the data needed for a deeper study. Most cancer patients were being treated at a different facility from where their COVID-19 treatment occurred and the records were not aggregated. Larger studies are needed and will surely happen over time.
Note from Myeloma Specialist Dr. Rafat Abanour:
Dear myeloma patients (and cancer patients in general). Please do not believe all of the studies being presented in the press about studies from China indicating worse outcomes for cancer aptients if they develop COVID-19 disease. The truth is we are still collecting data and we need to validate the studies from overseas first. It is important that you avoid getting the disease by following the guidelines of social distancing and discuss with your physicans your risks and what you can do about your treatment as most physicians do balance the risks and benefits of every action they take. And put the mask on!