Early COVID-19 data raise questions on cancer patient risk
medwireNews: People with a current diagnosis or history of cancer may have an increased likelihood of developing COVID-19, with associated worse outcomes, suggests early research from China.
These findings provide “a timely reminder to physicians that more intensive attention should be paid to patients with cancer, in case of rapid deterioration,” say the authors of the study published as a comment in The Lancet Oncology.
The authors of two accompanying correspondence articles caution, however, that the data do not conclusively demonstrate an association between cancer and COVID-19.
Researcher Jianxing He and co-workers from The First Affiliated Hospital of Guangzhou Medical University report on a cohort that included 1590 patients with laboratory-confirmed COVID-19, the disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), at data cutoff at the end of January 2020. Of these, 18 patients had a current diagnosis or history of cancer, with lung cancer (28%) the most common tumor type.
The incidence of cancer in the cohort was 1.13%, which the investigators note “seems to be higher” than that in the overall Chinese population, at 0.29%, as per the 2015 cancer epidemiology data.
Patients with cancer were significantly older than those without cancer, at an average age of 63.1 versus 48.7 years, and were significantly more likely to have a history of smoking (22.2 vs 6.8%), severe abnormalities on baseline computed tomography (CT; 94.4 vs 70.8%), and polypnea at presentation (47.1 vs 23.5%).
Notably, cancer patients had a significantly greater risk for the composite endpoint of clinically severe events – comprising admission to the intensive care unit, requirement of invasive ventilation, and death – than their counterparts without cancer, at rates of 39% and 8%, respectively.
And a time-dependent analysis showed that the median time to severe events was significantly shorter among patients with versus without cancer, at a median of 13 and 43 days, respectively, indicating that “patients with cancer deteriorated more rapidly,” say He et al.
The risk for clinically severe events appeared to be higher for the four patients who had received chemotherapy or surgery for cancer in the past month than for the 14 who were undergoing routine follow-up after treatment, with events observed in 75% and 43%, respectively, and a significant odds ratio (OR) of 5.34 after adjusting for factors such as age, smoking history, and other comorbidities.
But noting that the majority of cancer patients were not receiving treatment and “had no obvious immunosuppression,” the authors of the first correspondence article suggest there is no association between cancer and the risk for acquiring SARS-CoV2.
Hanping Wang and Li Zhang (both from Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China) add: “COVID-19 is a highly contagious infection to which everyone, to our knowledge, is susceptible; the most important morbidity factor is exposure to an infection source.”
They also highlight the difference in age between cancer and non-cancer patients, which suggests that “older age is associated with worse COVID-19 outcomes.”
And indeed, He and colleagues report that older age was the only factor associated with an increased risk for severe events among cancer patients, with an OR of 1.43, although the association did not reach statistical significance.
Huahao Shen and colleagues from the Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China, who authored the second correspondence article, draw attention to the small number of cancer patients in the cohort.
They write: “We are concerned that such a small sample size with a large amount of heterogeneity, presenting as various cancer types with different biological behaviours, highly variable disease courses (from 0–16 years), and diverse treatment strategies” is “not ideally representative of the whole population with cancer.”
Therefore, Shen et al conclude that “any conclusions that generalise to all patients with cancer should be interpreted with caution.”