In a retrospective study, a research team from New York City found that cancer patients undergoing chemotherapy were no more at risk for COVID-19 than those not on active treatment. Surprisingly, cancer patients receiving chemotherapy were even less likely to test positive for the disease, according to results presented at the AACR Virtual Meeting: COVID-19 and Cancer held in February.
"Perhaps patients with chemotherapy were more vigilant regarding social distancing, face masks, and hand hygiene compared to those in remission," said Monica Chen, MD, a third-year resident at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital in New York. "Another possibility is that patients undergoing chemotherapy were more actively screened. Regardless, it is reassuring to see that cancer patients receiving chemotherapy were not at increased risk of testing positive for COVID-19."
The results lend support to recent studies showing that cytotoxic chemotherapy is not associated with more severe COVID-19 outcomes and mortality, (The Lancet 2020; https://doi.org/10.1016/S0140-6736(20)31173-9; J Clin Oncol 2020; doi: 10.1200/JCO.20.01307), contradicting other findings that suggested otherwise (Cancer Discov 2020; doi: 10.1158/2159-8290.CD-NB2020-079; Lancet Oncol 2020; https://doi.org/10.1016/S1470-2045(20)30201-1.) The mixed results triggered concern among many patients worried about their perceived vulnerability to the disease, resulting in cancelled treatments and face-to-face consultations, as well as a decline in clinical trial participation, all causing disruptions in normal oncological care.
"COVID-19 has rapidly spread around the world and New York City was one of the epicenters of the disease in the United States," Chen said. "In concern that patients with cancer may be at increased risk for infection, there has been widespread changes in the practice of clinical oncology."
Studying COVID-19 & Cancer
To discern which factors among cancer patients are associated with increased risk for COVID-19 infection, Chen, her mentor Katherine Crew, MD, and colleagues conducted a retrospective study of cancer patients who tested positive for the disease between March 1, 2020, and June 6, 2020, at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center.
During this time, all hospitalized patients starting April 4, 2020, and all symptomatic cancer patients seen in the outpatient clinics were tested for COVID-19. Their primary interest was COVID-19 test results, defined as at least one positive test or no negative test.
Clinical data for the study included age, sex, race/ethnicity, body mass index, smoking status, time since cancer diagnosis, cancer type, current cancer status, most recent cancer treatment type within the past year, time since last cancer treatment prior to COVID-19 testing, and infusion center visits within the past year.
The median age in this cohort was 67 years (range 1-103), with 55.1 percent female. About 35.7 percent were non-Hispanic White, 32.5 percent Hispanic, 15.2 percent non-Hispanic Black, and 4 percent Asian. Some 27.2 percent had a recent cancer diagnosis, 56.7 percent had active disease, and 56.7 percent were on active cancer treatment within the past year.
Of the 1,174 cancer patients in the cohort, some 317 (27%) tested positive for COVID-19. Compared to non-Hispanic Whites, Black patients and Hispanic patients were more than 2.2 times and 2.7 times more likely to test positive for COVID-19, respectively. Older age and higher BMI were also associated with higher risks for COVID-19 infection.
A recent cancer diagnosis, active disease, and active cancer treatment were not associated with COVID-19. These results compare favorably with others suggesting the primary risk factors for COVID-19 among cancer patients are age, obesity, and race/ethnicity of Hispanic non-White and/or African-American-similar to the general population.
Consistent with prior studies, cancer patients who tested positive for COVID-19 had higher death rates than those who tested negative for the infection. Compared to cancer patients not on active treatment, those receiving chemotherapy were 35 percent less likely to develop COVID-19.
"Surprisingly, patients on active treatment, including chemotherapy, were not at increased risk for COVID-19," the researchers said in their abstract. "Therefore, delays in cancer diagnosis and treatment during the COVID-19 pandemic should be minimized."
Limitations of the study included the retrospective study design, Chen said. Results from a single academic urban medical center may not be generalizable to other study populations. While universal COVID-19 testing was implemented for all hospitalized patients, only symptomatic patients were tested in the outpatient setting, which may have introduced selection bias. The study was not adjusted for comorbid conditions and, while patients were followed for up to 6 months since COVID-19 diagnosis, long-term effects are still uncertain.
Warren Froelich is a contributing writer.
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