Emerging reports suggest that patients with cancer are more vulnerable to SARS-CoV-2 infection and have more severe coronavirus disease 2019 (COVID-19) symptoms. Nonetheless, and perhaps understandably, many of these reports have notable limitations, including small cohort sizes and/or a lack of age and comorbidity-matched control groups. Now, a retrospective analysis of data from 105 patients with cancer and COVID-19 plus 536 age and comorbidity-matched individuals without cancer with COVID-19 provides new evidence in this area.
Patients with cancer included those with lung cancer (22), gastro-intestinal cancers (13), breast cancer, thyroid cancer (11 for both groups) and haematological malignancies (9). Of these patients, 54.3% were diagnosed with cancer within the 12 months prior to admission with COVID-19, and 16.2% had metastatic (stage IV) disease. Patients with cancer and those without were matched in terms of median age and age distribution and incidence of common comorbidities, including, among others, hypertension (28.6% versus 24.3%), cardiovascular disease (11.4% versus 7.3%) and diabetes (6.7% versus 5.4%).
Patients with cancer and those without had similar COVID-19 symptom profiles at initial presentation, albeit with a lower prevalence of fever (64.8% versus 74.8%; P = 0.04) and a higher prevalence of chest distress (14.3% versus 6.2%; P = 0.02). Nonetheless, patients with cancer had a higher risk of death (OR 2.34, 95% CI 1.15– 4.77; P = 0.03), intensive care unit admission (OR 2.84, 95% CI 1.59–5.08; P < 0.01) or having at least one severe or critical COVID-19 symptom (OR 2.79, 95% CI 1.74–4.41; P < 0.01). Patients with stage IV disease had a notably higher risk of death from COVID-19 (OR 5.58, 95% CI 1.71–18.23; P = 0.01), and when data from these patients were removed from the analysis, this difference in risk became statistically insignificant.
In conclusion, these data provide further evidence that patients with cancer have worse COVID-19 outcomes, and the inclusion of a control group strengthens this evidence. Nonetheless, larger datasets are needed to determine how these risks apply to each patient with cancer.
Dai, M. et al. Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak. Cancer Discov. https://doi.org/10.1158/2159-8290.CD-20-0422 (2020)
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Sidaway, P. COVID-19: more evidence emerges. Nat Rev Clin Oncol 17, 451 (2020). https://doi.org/10.1038/s41571-020-0390-2