Research highlight

Epidemiology: COVID-19 illness severity in patients with cancer

Nature Medicine

June 24, 2020

40% of 423 patients with cancer at a New York City cancer center diagnosed with COVID-19 were hospitalized, 20% developed severe respiratory illness and 12% died within 30 days, according to a study published in Nature Medicine. The paper suggests that advanced cancer, receipt of chemotherapy and recent cancer surgery might not exacerbate the risk of developing severe COVID-19 symptoms. However, patients treated with checkpoint inhibitor immunotherapy were more likely to be hospitalized with respiratory complications from the infection.

As of 10 April 2020, 9,385 deaths of people diagnosed as being infected with SARS-CoV-2 had been reported in New York State, of which 8.4% were patients with cancer. Previous studies from China and Italy have suggested that there is a higher COVID-19 death rate in patients with cancer, but little is known about the interplay between the two illnesses, or how active cancer treatment might exacerbate the effects of COVID-19.

Mini Kamboj and colleagues describe the demographic and clinical characteristics of 423 patients with cancer and COVID-19 at Memorial Sloan Kettering Cancer Center in New York City from 10 March 2020 to 7 April 2020. 212 patients were male and 211 were female, and most (56%) were over 60 years of age. These patients were more frequently diagnosed with solid tumors, including breast cancer (20%), colorectal cancer (9%) and lung cancer (8%), and over half of these (65%) presented with metastatic disease. Lymphoma was the most common blood cancer (11%). 59% of patients also had pre-existing conditions such as diabetes, hypertension, chronic kidney disease or cardiac disease, which have also been associated with increased illness severity. Of the 20% of patients with severe respiratory illness, 11% required high-flow oxygen and 9% required respirators. There were seven pediatric cases, which were mild and without complications.

The authors identified risk factors for hospitalization, including having a blood-cancer diagnosis, non-white race, corticosteroid use and immune-checkpoint-inhibitor therapy; the risk factors for severe respiratory illness were similar but not identical. Cancer treatment with immune-checkpoint inhibitors was an independent predictor of severe respiratory illness. The study also found that metastatic disease, recent administration of chemotherapy or major surgery within the previous 30 days were not significantly associated with either hospitalization or severe respiratory illness.

The authors’ assessment of a 12% case-fatality rate is lower than other previous estimates from published studies of COVID-19 in patients with cancer. They caution that further research in larger patient populations is needed to identify risks from COVID-19 in various cancers and with different oncologic therapies.

doi: 10.1038/s41591-020-0979-0

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