Death rate among cancer patients with Covid-19 is over 270 times higher than others infected with virus: Study
Among those with cancer, being older than 65 years and being male are associated with increased risk of severe events from Covid-19
One in five cancer patients who get infected with coronavirus die, according to researchers who analyzed patient cases from the US, Canada, the UK, Europe, and Asia. The overall case-fatality rate was estimated at 22.4% in coronavirus patients with cancer, which is over 270 times higher than that of the Covid-19 patients without cancer at 5.9%. “Our analysis demonstrated that Covid-19 patients with cancer have a higher fatality rate when compared with that of Covid-19 patients without cancer. Our analysis confirmed that patients with cancer are at increased risk of severe illness due to Covid-19. Age and gender appear to be risk factors associated with a poorer prognosis,” write authors in the study published in the Journal of the National Cancer Institute. They add, “Best practice based on evidence will mitigate the impact of the Covid-19 pandemic on cancer patients and reduce the risk of morbidity or death from coronavirus.”
Cancer is one of the leading causes of death, with an estimated 9.6 million deaths worldwide in 2018. According to health experts, compared with the general population, cancer patients are more vulnerable to infection. “In addition to being in immunosuppressive states directly caused by cancer itself as well as cytotoxic treatments, this population presents an overall poorer health status, tends to be older, and has coexisting medical conditions. These are all risk factors that could contribute to severe Covid-19 infection and lead to a potentially poorer prognosis and an increased risk of death,” explain investigators.
The team says that the findings from this analysis will improve an understanding of the impact of the coronavirus pandemic on cancer patients and highlight the urgent need to provide “optimal clinical management” to this vulnerable patient population. It includes experts from New York University Langone Medical Center, Columbia University, University of Connecticut, and Imperial College London, among others.
Risk of dying from Covid-19 higher for blood, lung cancer patients
For the current analysis, the research team included 15 studies with 3,019 patients, of which 1,628 were men. An estimated 41% of patients were from the UK and Europe, followed by 35.7% from the US and Canada, and 23.3% from China. Among the patients with reported underlying health conditions, the three most common were hypertension (37.7%), diabetes (18.1%), and cardiovascular disease (13.1%).
The case fatality rate in Covid-19 patients with cancer in China was 20, which is similar to that of the rest of the world (Europe, the UK, and the US) at 24.1%. A subgroup analysis of clinical outcomes in different cancer types indicated that the case fatality rate was higher in lung or blood cancer in comparison to other solid cancer. “The overall case fatality rate in the lung cancer patients with Covid-19 was 32.9%, and the severe event rate was 57.2% In other types of solid cancer excluding lung, the overall case-fatality, and severe event rates were 17.2% and 59.7% respectively. In addition, the overall case fatality rate in hematological cancer patients was 34.2%. It is worth noting that the case fatality rate in lung cancer is comparable to that of hematological (blood) cancer patients with coronavirus, whereas it is lower in other types of solid cancer,” the findings state. A severe event is defined as the individual being admitted to the intensive care unit or requiring invasive ventilation, or death.
Cancer patients on chemotherapy or surgery, or other anticancer treatment, were not associated with increased risk of severe events from Covid-19 compared with those not on active treatment. In patients treated with chemotherapy, surgery, or immunotherapy, the case fatality rate was 25.6%, 27.6%, and 24.3% respectively. The case fatality rate for patients under treatment of radiotherapy or targeted therapy was 20.5% and 21.3% respectively. In comparison, the case fatality rate was similar among patients who were given different types of treatment.
“Based on our statistical analysis, we are not able to identify evidence supporting that cancer patients on cytotoxic chemotherapy are at an increased risk of severe events from Covid-19 disease compared with those not on active treatment. While awaiting further evidence, it might be beneficial to continue curative surgical resections, chemotherapy, and other cancer treatment, based on a comprehensive evaluation of individual cases with multidisciplinary team management,” recommend experts.
The analysis also reveals that being older than 65 years (odds ratio 3.57), being male (odds ratio 2.10), the presence of any comorbidity (odds ratio 2), single comorbidity hypertension (odds ratio 3.10), and diabetes (odds ratio 4.16) were associated with increased risk of severe events. However, in “multivariate analysis,” only age greater than 65 years and being male (odds ratio 2.29) were associated with increased risk of severe events.
“In summary, the occurrence of severe events including death in cancer patients with Covid-19 appears to be primarily accentuated by age, gender, and co-existing comorbidities. Based on these findings, we suggest that this high-risk cancer population should be evaluated and treated in a clinical setting equipped with comprehensive medical resources,” suggest authors.