Cancer May Not Suggest Poor Health Outcomes After COVID-19, Study Shows

Patients with cancer who contract COVID-19 were not more likely to get severely ill or die from the virus than people who do not have cancer, a recent study showed.

Across all patients in the study, only age and obesity were associated with worse COVID-19 outcomes.

Because patients who have received recent treatment for cancer are likely to be immunocompromised, the question of whether they are more susceptible to dire complications of COVID-19 has been the subject of numerous studies over the last eight months, with mixed results.

By shedding more light on the issue, the results of this latest research could be meaningful in helping patients and their doctors make treatment decisions, according to its authors, a team from Weill Cornell Medicine/NewYork-Presbyterian.

“This finding suggests that a diagnosis of active cancer alone and recent anticancer therapy do not predict worse COVID-19 outcomes, and therefore, recommendations to limit cancer-directed therapy must be considered carefully in relation to cancer-specific outcomes and death,” the study authors wrote in their paper published in the Journal of Clinical Oncology. “Our results suggest that patients with cancer with limited comorbidities (additional health conditions) may continue their cancer care with caution.”

The study looked retrospectively at data about patients admitted to two of the health system’s hospitals for COVID-19 treatment between March 3 and May 15, 2020.

It included 585 adults with COVID-19 (median age, 71 years; 55% men), 117 of whom had either a blood cancer or a solid tumor (18.8% genitourinary, 16.2% gastrointestinal, 16.2% chronic leukemia and 12.8% breast). Patients with cancer received treatment or were under active surveillance within six months of entering the hospital. Nearly half of the patients with cancer were receiving therapy, with 45% of them having received chemotherapy or immunosuppressive treatment within 90 days of admission, the study authors reported. Each patient with cancer was matched, for the sake of comparison, with four patients who had COVID-19 without cancer. The patients compared with each other were similar in age, gender and the number of other health conditions they had, such as diabetes, asthma, obesity and hypertension.

The researchers found that symptoms upon diagnosis with COVID-19, as well as complications encountered while in the hospital such as admission to the intensive care unit or use of a ventilator, were similar between the cancer and noncancer groups. There were no statistically significant differences in the levels of sickness or death between patients with and without cancer. The researchers recorded 29 deaths (24.8%) among hospitalized patients with cancer compared with 100 deaths (21.4%) among patients without cancer.

They suggested that earlier studies linking cancer and its treatments to worse COVID-19 outcomes were flawed because they failed to take into account age, gender and other health conditions contributing to worse outcomes. They noted, however, that the reason other health conditions were not linked with poor COVID-19 outcomes in their study could have been because most patients had few health issues besides the virus and cancer. The study authors added that it was difficult for them to evaluate the role of ethnicity or smoking in COVID-19 outcomes, as the patients in their study were largely white and nonsmokers. Finally, many of the patients with chronic myeloid leukemia were taking Bruton’s tyrosine kinase inhibitors to treat the cancer, which are anti-inflammatory, and could have contributed to their recovery from COVID-19, the authors pointed out.

Nevertheless, the researchers believe their findings should have a bearing on care decisions for patients with cancer.

“During the COVID-19 pandemic, we may be able to deliver anticancer care safely to patients who are younger with limited comorbidities,” the study authors wrote. “We may consider a more conservative approach in older patients with metastatic cancer and multiple comorbidities, for whom the efficacy of continued lines of therapy may be limited. Conversely, we would consider cautious continuation of therapy in patients with fewer comorbidities and in whom therapy is associated with significant benefit.”

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