The study, published simultaneously in the journal Cancer Discovery, was among a number of AACR presentations highlighting the toll the pandemic is taking on patients with cancer worldwide. “Our results demonstrate that COVID-19 patients with cancer had higher risks in several outcomes,” says the study’s lead author, Hongbing Cai, MD, of Zhongnan Hospital at Wuhan University. “Strong protections should be made for patients with cancer, especially in outbreak areas.” The study is the first to report on a large group of cancer patients in a hot spot of this pandemic.
The Story the Data From China Tells About Cancer and COVID-19
Dr. Cai and her colleagues collected patient information from 14 hospitals in Hubei province, China — the epicenter of the COVID-19 outbreak — involving 536 hospitalized COVID-19 patients without cancer and 105 with cancer. While the death rate for COVID-19 in the general population was estimated in Wuhan at about 2 to 3 percent, the study found a threefold increased death rate among COVID-19 patients with cancer. The study also showed that patients with cancer have a 10-fold higher incidence of developing COVID-19 infections compared with people without cancer. One of the first studies to examine the impact of COVID-19 infection among cancer patients, the Wuhan-based research paints an especially bleak picture. Researchers found COVID-19 patients with cancer had higher rates of admission to intensive care units, higher rates of having at least one severe or critical symptom (complications such as septic shock, acute respiratory distress syndrome [ARDS] or acute kidney injury), and higher chances of being put on a ventilator. The study also showed that people with cancer deteriorated more rapidly than patients without cancer and took longer to recover. Patients with cancer had a mean hospital stay of 27 days compared with about 18 days for people without cancer.
The Most Vulnerable of the Vulnerable: People With Metastatic Cancer, Blood Cancers, and Surgical Patients
Among patients with cancer, those with metastatic cancer had the highest risk of death. The patients in the study represented a range of cancer types, but people with hematological cancers had the highest death rates. Hematological cancer patients may be at higher risk of death from COVID-19 because their disease involves poor function of white blood cells that normally play a role in mounting a robust immune response, the authors said. Cancer patients with COVID-19 who had surgery also fared poorly, while cancer patients who received radiation therapy did not have a statistically significant difference in severe events from COVID-19 infection when compared with COVID-19 patients without cancer. “For cancer patients scheduled for surgery, we recommend appropriate postponing of surgery in outbreak areas," Cai says. The study found no difference between COVID-19 patients in active treatment for cancer and those who had completed treatment — both had a higher risk of poorer outcomes compared with COVID-19 patients without cancer. Patients who have completed cancer treatment may have lingering cancer-related ailments, such as anemia, the authors noted.
Navigating the Nuances of Cancer Care During COVID-19 by Case and Location
Based on her data, Cai recommends that, during the pandemic, physicians devise highly individualized cancer treatment plans based on factors such as age, type of cancer, stage of cancer, treatment, and underlying health conditions. Other studies also point to the need to avoid blanket recommendations. A study of 137 cancer patients in France, for instance, indicated that other health problems, such as hypertension and diabetes, significantly increased the risk of poor outcomes in patients with cancer and COVID-19 infection. “It does not seem that COVID-19 by itself in cancer patients is presenting a higher risk of death,” says the lead author, Fabrice Barlesi, MD, of Gustave Roussy Cancer Campus in Villejuif, France. Additional factors that may impact the outcomes of COVID-19 infection among cancer patients may include race, ethnicity, and socioeconomic status, says Louis P. Voigt, MD, an intensivist at Memorial Sloan Kettering Cancer Center in New York City. Dr. Voigt noted that evidence already shows that COVID-19 in the United States has disproportionately affected blacks, Hispanics, and patients with fewer health and financial resources. “We have a lot of unanswered questions that need to be addressed,” he said.
