Older Cancer Patients At Risk For COVID-19
New research presented at the ESCMID Conference on Coronavirus Diseases suggests that the poor outcomes and higher death rates in cancer patients with COVID-19 could be due to them generally being older and having more underlying conditions, rather than cancer itself.
Presented on September 21, 2020, the study is by Dr. Maria Rüthrich, Jena University Hospital, Germany, and colleagues.
In their study, the authors retrospectively analyzed a cohort of 435 patients with cancer and COVID-19 between March and August 2020. The clinical manifestation of COVID-19 was described in 4 phases: uncomplicated (asymptomatic/mild symptoms), complicated (need for oxygen supplementation), critical (need for life-supporting therapy) and recovery (improvement/ discharge).
A total of 193 patients (54%) had an active malignant disease and 96 (22%) had received anti-cancer treatment within the last 3-months before testing positive for SARS-CoV-2.
At the detection of SARS-CoV-2 infection, 272 (63%) patients were in an uncomplicated phase of COVID-19 disease. Progression to complicated/ critical phases of COVID-19 was seen in 206 (55%) patients, while 119 (28%) patients received critical care.
A total of 78 of these 119 patients (66%) needed mechanical ventilation.
The COVID-19 mortality rate was 23%, while men were twice as likely to die as women (28% vs 14%).
Additionally, active cancer disease (e.g. recurrent or metastatic cancer, patients receiving anti-cancer therapy) was associated with higher mortality attributed to COVID-19 than in patients without active cancer disease (27% vs 17%)
Compared with non-cancer patients, the distribution of age and comorbidity differ significantly.
Thus, patients without cancer were younger (most frequent age category 56 - 65) and had less comorbidity (CCI 1.12 vs 1.59). Survival at 30 days was worse in cancer patients (70%) versus those without cancer (77%), and mortality rate higher (23% vs 14%).
However, after adjustments for age, sex, and comorbidity, survival and mortality attributed to COVID-19 were comparable to non-cancer patients.
Dr. Rüthrich offered this conclusion: "Even though survival and COVID-19 mortality of both groups appeared to be comparable, after adjusting for age, sex, and comorbidity, our results show that cancer patients are at higher risk of more serious disease and death due to being older than non-cancer patients with COVID-19, and also having more underlying conditions.”
“It does not appear to be cancer by itself is leading to these poor outcomes,” stated Dr. Ruthrich.
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