Cancer patients have a higher risk of severe infection with COVID -19 than non-cancer patients

Patients with inactive cancer who are not currently undergoing treatment are also at a significantly higher risk of serious illness from COVID-19, a new study from Penn Medicine published online today in JNCI Cancer Spectrum shows.

Previous reports have established an increased risk of serious illness and death in sick or hospitalized cancer patients with COVID-19 compared to patients without cancer, but less is known about patients in the general population.

The results underscore the importance of COVID-19 mitigation, such as social distancing and wearing masks, and vaccinations for all patients, not just those recently diagnosed or with active disease.

“Cancer patients should be careful not to be exposed during this time,” said senior author Kara N. Maxwell, MD, Ph.D., assistant professor of hematology-oncology and genetics at the Perelman School of Medicine at the University of Pennsylvania and member of the Abramson Cancer Center and the Basser Center for BRCA.

“This message has been broadcast, but these latest findings show us that it is not just for patients hospitalized or under treatment for their cancer. All oncology patients must take important precautions during the pandemic to protect themselves.”

The researchers analyzed the charts of more than 4,800 patients who had been tested for COVID-19 from Penn Medicine BioBank, a centralized sample bank, and linked data from the health system’s electronic health records, to study the association between cancer status and COVID -19 results.

Of the 328 positive cases up to June 2020, 67 (20.7%) had a diagnosis of cancer in their medical history (80.6% with a solid malignant tumor and 73.1% with an inactive cancer).

Patients with COVID-19 – including those with active cancer (18) and inactive cancer (49) – had higher hospitalization rates than non-cancer patients (55.2% vs. 29 %), ICU admissions (25.7 percent vs. 11.7 percent), and 30-day mortality (13.4 percent vs. 1.6 percent).

While the worst outcomes were more strongly associated with those with active cancer, patients in remission also faced an overall increased risk of more severe disease compared to COVID-19 patients without cancer.

Notably, the proportion of black patients – who represent 20% of biobank patients – was significantly higher in COVID-19 positive cancer and non-cancer patients (65.7% and 64.1%, respectively) compared to all patients tested for SARS-CoV-2.

The findings parallel previous reports showing the disproportionate impact of COVID-19 on minority communities.

We really have to think of race as a big factor in trying to get people vaccinated as soon as possible. “

Kara N. Maxwell, MD, Ph.D, study lead author and Assistant Professor of Hematology-Oncology and Genetics, Perelman School of Medicine, University of Pennsylvania, Fellow of the Abramson Cancer Center, Basser Center for BRCA

Studies show cancer patients have a higher risk of complications from COVID-19, in part due to factors such as advanced age, higher smoking rates, co-morbidities, frequent health care exposures and the effects of cancer therapies. These latest findings also suggest that cancer itself and its impact on the body may play a role in exacerbating COVID-19 infections.

“Our finding that cancer patients with COVID-19 were more likely than non-cancer patients to be hospitalized and die even after adjusting for patient-level factors supports the hypothesis that cancer is a factor of independent risk of poor COVID-19 outcomes, ”they wrote.

In another related study published in the bioRxiv preprint database and not yet peer reviewed, researchers at Penn Medicine report that cancer patients receiving in-person care at a facility with aggressive mitigation efforts have an extremely low probability of infection with COVID-19.

Of 124 patients in the study receiving treatment at Penn Medicine, none tested positive for the virus after their clinical visits (an average of 13 per patient).

The results suggest that these efforts, when combined with social distancing outside of the healthcare setting, may help protect vulnerable cancer patients from exposure and infection to COVID-19, even when Current immunomodulatory cancer treatments and frequent exposure to healthcare are needed, the authors said.