COVID-19 patients with recent cancer treatment and COVID-19, especially metastatic solid tumors and hematologic malignant neoplasms, had a dramatically higher risk of adverse outcomes from SARS-CoV-2 infection, according to a recent study whose results were published in JAMA Oncology.

On the other hand, the University of Texas MD Anderson Cancer Center–led researchers state that patients with no recent cancer treatment had similar outcomes to those without cancer. "The findings have risk stratification and resource use implications for patients, clinicians, and health systems," they write.

The study team analyzed rates of mortality, mechanical ventilation, ICU stay, and hospitalization within 30 days of COVID-19 diagnosis.among patients with or without cancer.

Looking at a cohort of 507, 307 patients with COVID-19, the researchers determined that those diagnosed with cancer who received anticancer treatment within 3 months before COVID-19 diagnosis had an increased risk of death, ICU admission, and hospitalization. Outcomes for patients without recent cancer treatment were similar or better than in patients without cancer.

"As the COVID-19 pandemic continues, understanding the clinical outcomes of patients with cancer and COVID-19 has become critically important," the authors note.

Data for the study were obtained from the Optum de-identified COVID-19 electronic health record data set from January 1 to December 31, 2020. Participants (mean age of 48.4 years; 55.4% women) were divided into three groups:

• Patients without cancer 

• Patients with no recent cancer treatment

• Patients with recent cancer treatment (within 3 months before COVID-19 diagnosis) consisting of radiation therapy or systemic therapy

The overwhelming majority—97.2%—did not have cancer, according to the study. Even among the 2.8% of patients with cancer (representing 14,287 patients), most—69.9%—did not receive treatment. The remaining 30.1% of cancer patients received some type of treatment.

In unadjusted analyses, patients with cancer, despite the type of treatment received, were more likely to have adverse outcomes compared with patients without cancer. The authors cite the mortality rate as an example: 1.6% for patients without cancer, 5.0% for patients with no recent cancer treatment, and 7.8% for patients with recent cancer treatment.

The researchers note that, after adjustment, patients with no recent cancer treatment had similar or better outcomes than patients without cancer,  (mortality odds ratio [OR], 0.93 [95% CI, 0.84-1.02] and mechanical ventilation OR, 0.61 [95% CI, 0.54-0.68]).

"In contrast, a higher risk of death (OR, 1.74; 95% CI, 1.54-1.96), ICU stay (OR, 1.69; 95% CI, 1.54-1.87), and hospitalization (OR, 1.19; 95% CI, 1.11-1.27) was observed in patients with recent cancer treatment," the authors point out. "Compared with patients with nonmetastatic solid tumors, those with metastatic solid tumors and hematologic malignant neoplasms had worse outcomes (e.g., mortality OR, 2.36 [95% CI, 1.96-2.84]; mechanical ventilation OR, 0.87 [95% CI, 0.70-1.08]). Recent chemotherapy and chemoimmunotherapy were also associated with worse outcomes (e.g., chemotherapy mortality OR, 1.84 [95% CI, 1.51-2.26])."

The authors discuss some reasons why COVID-19 might be more severe in patients with cancer, including that they tend to be older and have more comorbidities than the general population. "In addition, the immune system of patients with cancer is frequently compromised as a consequence of anticancer treatments, the disease itself, or both," they add.

The study has broad implications, as the number of cancer survivors was estimated to be 16 million as of January 2019, according to the report.

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