medwireNews: In patients with cancer, the risk for and severity of COVID-19 differs by tumor type, indicates an analysis of data from the UK Coronavirus Cancer Monitoring Project (UKCCMP).
“Morbidity and case–fatality rates from COVID-19 in UK patients with cancer who attend hospital are relatively high, particularly in older patients and those with haematological malignancies, but not all cancer patients are affected equally,” report Gary Middleton (University of Birmingham, UK) and collaborators.
“This important finding could allow clinicians some ability to risk stratify their patients and make informed decisions on appropriate levels of social isolation and shielding,” they write in The Lancet Oncology.
Of the 1044 patients with active cancer who received a laboratory-confirmed diagnosis of SARS-CoV-2 infection between 18 March and 8 May 2020, just under a third (30.6%) died, with mortality attributed to COVID-19 in the majority (92.5%) of cases.
The all-cause case fatality rate (CFR) after COVID-19 diagnosis was significantly associated with age, increasing from 0.10 for the youngest age group (40–49 years) to 0.48 for the oldest age group (≥80 years), and also with sex, such that men had a nearly twofold increased risk for death after presenting with COVID-19 relative to women.
Analysis by type of primary tumor showed that patients with leukemia had a significantly higher CFR than the reference group of those with digestive tract tumors (excluding colorectal cancer), at an odds ratio (OR) of 2.25 after multivariable correction for age and sex.
Middleton et al note that men with prostate cancer had a significantly increased risk for death from COVID-19 versus the reference group in univariable analysis, while patients with breast and female genital cancers had a reduced risk, but statistical significance was lost after adjusting for confounders, “highlighting the effect of patient age and sex.”
A closer look at the 227 patients with hematologic cancers showed a significantly elevated risk for a severe or critical COVID-19 disease course in these patients versus those with nonhematologic malignancies, with an adjusted OR of 1.57. Hematologic cancer patients were also significantly more likely to need high-flow oxygen (OR=1.82), noninvasive ventilation (OR=2.10), or admission to an intensive care unit (OR=2.73).
And the mortality risk during COVID-19-related hospitalization in individuals with hematologic malignancies was compounded by receipt of chemotherapy within 4 weeks of the SARS-CoV-2 diagnosis (OR=2.09).
“The immunological disruption observed in patients with leukaemia and the use of intensely myelosuppressive treatment regimens might result in a combination of risks, in terms of the likelihood of initial SARS-CoV-2 infection, its ability to gain a foothold in the host, and in terms of the downstream disease course and likelihood of severe consequences, such as cytokine storm and multi-organ failure,” suggest Middleton and co-authors.
But they acknowledge the challenges in interpreting the results “as this study relied on ICD-10 cancer subtype codes and leukaemia encompasses a heterogeneous group of conditions.”
The investigators also highlight other limitations including the lack of information on “performance status, patient comorbidity scale or index, and ethnicity data” and they conclude: “Future work by the UKCCMP, in collaboration with international consortia, will define risk in much greater granularity, including different subtypes of a given tumour.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group
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