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As doctors and scientists continue to learn more about the novel coronavirus, researchers are laboring to figure out exactly who is the most susceptible to the virus. One vulnerable group that has not yet been extensively researched is people with cancer -- but a new study is helping to change that.
Cancer patients face specific circumstances that may place them at higher risk for severe COVID-19 symptoms. Their immune systems may be weakened by anti-cancer treatment, additional supportive medications like steroids, and by cancer itself.
Unfortunately, cancer patients are also frequently older and have other underlying health conditions, putting them at additional risk for severe coronavirus symptoms. But there aren't many studies describing the fate of people with cancer who also develop COVID-19.
"As oncologists, we are accustomed to dealing with infectious complications, but the challenge with COVID-19 is that there is no specific treatment available at the time," said Dr. Wasif M. Saif, M.D., deputy physician-in-chief and medical director at Northwell Health Cancer Institute in Lake Success, New York.
It's a tricky situation as doctors must balance the risk of treating the cancer -- knowing it could put the patient at risk for worse COVID-19 symptoms or death -- versus delaying cancer treatment, which could allow the cancer to progress, resulting in worse cancer symptoms or death. In order to make the best decision, doctors needed more information.
Consequently, researchers from multiple institutions reviewed the records of more than 1,000 adult patients with cancer and confirmed COVID-19. The records were collected and cataloged by the COVID-19 and Cancer Consortium registry, a collaboration between academic and community oncology specialists in the United States and Canada. They investigated the association between numerous variables and death within 30 days of COVID-19 diagnosis. By the end of the study, 13% of the patients had died.
"The 30-day all-cause mortality was 13%, more than twice the mortality reported as the global average by Johns Hopkins," explained the co-lead author of the study, Dr. Toni K. Choueiri, director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute.
According to the study, if you're living with cancer, COVID-19 may be more dangerous for you than the average person. That means cancer patients should speak with their doctor about the risks of continuing treatment.
The researchers found several factors associated with an increased risk of death: older age, male sex, previous smoking history, having two underlying health conditions, active cancer, and treatment with azithromycin plus hydroxychloroquine. Of note, the researchers said they could not tell if hydroxychloroquine plus azithromycin gives any benefit or overall harm to the patients, because the study was not set up to look at that question, nor did it account for other potential variables.
Interestingly, race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with increased death.
These important findings will guide oncologists in treating their patients during this pandemic.
"Taken together, these results suggest that fit patients with cancer and few comorbidities can and should proceed with appropriate anti-cancer treatment," noted Choueiri, "whereas those with poor performance status or progressing cancer need to have thoughtful conversations with their oncology providers about risk versus benefit of anti-cancer treatment."
There is no doubt that the COVID-19 pandemic has placed cancer patients at a higher risk. But progress is being made on determining how to best protect these vulnerable patients.
"We are already at more than 2000 patients in our database and accumulating more granular data about specific therapies to be able to answer important questions relevant to patients with cancer," Choueiri said.
The only way forward is with continued rigorous scientific study, experts say.
"Until the pandemic has ended, we have to rely upon the principles of safety and evidence-based piers of priority in individualizing patients care," said Saif. "The fluidity of the situation mandates us to adapt and modify as we learn more about this disease and its impact."