By Kathleen Wiley, RN, MSN, AOCNS®, and Elisa Becze, BA, ELS
Patients with cancer who contracted the COVID-19 coronavirus had high rates of 30-day all-cause mortality that was associated with general risk factors and risk factors unique to cancer, according to findings from one of the first data registry reports of patients with the dual diagnoses. The results were published in Lancet.
As the COVID-19 coronavirus emerged as a global pandemic, cancer researchers quickly jumped into action to understand how it affected people with cancer and how cancer influenced the virus’s outcomes as well. Data registries were created to track data from people with cancer with confirmed COVID-19 diagnoses to understand how the diagnoses coexist.
Initial Findings About COVID-19 and Cancer
Researchers evaluated data from March 16–April 16, 2020, tracked in the COVID-19 and Cancer Consortium (CCC-19) registry, which is funded by the American Cancer Society, National Institutes of Health, and Hope Foundation of Cancer Research. A total of 928 patients with any prior diagnosis of cancer—either active or in remission—were included in the analysis. The majority (37%) had a breast or prostate cancer diagnosis and had a median age of 66 years at time of COVID-19 diagnosis. Forty-three percent had active measurable disease, and 39% were currently undergoing cancer treatment when they contracted COVID-19.
As of May 7, 2020, 13% of patients died within 30 days of their COVID-19 diagnosis. Patients with cancer presented with symptoms of COVID-19 not unlike the rest of the population. The most common symptoms to prompt seeking medical attention were fever, cough, fatigue, and dyspnea. Only 4% of patients were asymptomatic at the time of diagnosis. Fourteen percent were admitted to intensive care units (ICUs), and 12% required mechanical ventilation. Researchers did not find a correlation between surgery within four weeks of a COVID-19 confirmed diagnosis and 30-day all-cause mortality, which may be useful as clinicians continue to consider delays in scheduled surgeries.
The researchers did find a correlation between cancer status and location at the time of death. Patients with active cancer were more likely to die outside of an ICU, whereas patients in remission from cancer were more likely to die in the ICU. Patients receiving palliative care for active cancer were more likely to die outside of an ICU than those receiving curative intent treatment. ICU admissions were highest in those who were current or former smokers, patients with a hematologic malignancy, and those with an Eastern Cooperative Oncology Group status of 2 or greater.
What Does This Mean for Future Research?
Multiple data registries are tracking similar data points and outcomes. More research is needed to determine whether the findings reported in this study are similar to those from other registries and if the data can be generalized across the cancer population. Continued data collection on people with cancer and COVID-19 will also help researchers understand the vulnerability that a specific cancer diagnosis or treatment-related immunosuppression conveys in contracting and recovering from the COVID-19.
Further exploration is needed to analyze the impact of other chronic illnesses such as cardiac disease, diabetes, and renal disease in people with cancer in the setting of a coronavirus infection. However, this first data set reports that patients with a cancer diagnosis, regardless of disease status, appear to be at a higher risk for mortality and severe illness from a confirmed coronavirus infection. Given that and the need for ICU care, the data also underscore the priority for goals of care conversations throughout the disease trajectory.