Patients with cancer and COVID-19 have a higher risk of severe disease and mortality, researchers reported.
Of 89 cancer patients admitted to the intensive care unit (ICU) due to COVID-19, 32 died, a mortality rate of 36%, reported Michael Dang, MD, a critical care fellow at Memorial Sloan Kettering Cancer Center in New York City, at the virtual CHEST conference, the annual meeting of the American College of Chest Physicians.
"The landscape of COVID-19 data is continuously changing," Dang said in his oral presentation. "Mortality rates are typically higher than general medical populations, but cancer with COVID-19 is survivable."
Mortality rates appeared to be higher among the patients with hematologic cancers, he said. Of the 51 patients with solid tumors, most commonly non-small cell lung cancer and breast cancer, 14 died, for a mortality rate of 27%; of the 38 patients with hematologic cancers, most commonly leukemia and lymphoma, 18 died, for a mortality rate of 47%.
Of the 59 patients requiring mechanical ventilation, 32 died, a 54% mortality rate. If the patient was neutropenic, the mortality was very high -- six of nine died.
In the study, Dang and colleagues included critically ill patients who were being treated for cancer and COVID-19 from March 16 through June 30, 2020 in two ICUs. The patients had a mean age of 64, 58% were men, 66% were white, 18% were Black, and 10% were Asian/Indian. COVID-19 cases were confirmed via reverse-transcriptase polymerase chain reaction assays performed on nasopharyngeal swab specimens.
In addition to being treated for cancer, the patients had multiple comorbidities. About 51% had hypertension, 28% had diabetes, 12% had cardiovascular disease, 53% had a history of cigarette smoking, and 9% had asthma or chronic obstructive pulmonary disease.
About half of the patients had received active cancer therapy within the previous 90 days, but all cancer therapies were suspended when they were admitted to the ICU, noted Dang.
The patients were treated with a variety of therapies for COVID-19, including hydroxychloroquine, azithromycin, remdesivir, convalescent plasma, N-acetylcysteine, and tocilizumab (Actemra). About 75% of the patients were given steroids as well.
Commenting on the study, Wasif Saif, MD, deputy physician-in-chief and medical director at Northwell Health Cancer Institute in Lake Success, New York, told 鶹ý, "Our data ... showed high mortality in cancer patients with COVID infection. Therefore, it is extremely important to prevent infection with COVID-19 in this very vulnerable patient population with hematologic and oncologic malignancies on active chemotherapy."
He noted that similar to influenza infection, cancer patients who are infected with SARS-CoV-2 are at very high risk of requiring longer length of hospital stay and mechanical ventilation, as well as higher case-fatality rates if they are older than 60 years of age and have chronic medical conditions.
"Additionally, patients who are immunocompromised either due to underlying disorder or those on chronic immunosuppressive therapy are at increased risk of both morbidity and mortality related to COVID-19," Saif said.
"Patients with cancer are at a higher risk of developing complications secondary to COVID-19 because of myelosuppressive effects of treatment, as well as the underlying cancer, which suppresses their immune system," he added. "It is important to recognize that in addition to underlying malignancy and cytotoxic agents, COVID-19 infection in itself also causes lymphopenia, which further weakens the immune system."
Disclosures
Dang and Saif disclosed no relevant relationships with industry.
Primary Source
CHEST
Dang M, et al "Characteristics and ICU outcomes of patients with cancer with acute respiratory failure due to COVID-19" CHEST 2020.