Uncovering the Clinical Impact of COVID-19 on Cancer Patients
At the start of the COVID-19 pandemic, cancer patients were advised to stay home and isolate in order to minimize risk of infection. There was little known at the time about the novel SARS-CoV-2 virus that leads to the disease COVID-19, including its causes and clinical outcomes, particularly across patients with different underlying conditions, like cancer. What was undeniable was its precipitous spread and the devastating health effects.
While cases of COVID-19 infiltrated all five boroughs of New York City in the spring, claiming the city as an epicenter of the pandemic in March, a grassroots effort was underway by hospitals and cancer centers to collect real-time patient data to study the clinical impact of COVID-19 on patients with cancer.
Recently published in Lancet, the study, led by the COVID-19 & Cancer Consortium (CCC19), which includes the Herbert Irving Comprehensive Cancer Center (HICCC), found that cancer patients with COVID-19 are twice as likely than the general patient population to die or become severely ill from COVID-19. The study also suggests that patients with cancer who have a higher fitness level and few underlying conditions can and should proceed with appropriate anti-cancer treatment, whereas those with poor fitness health or progressing cancer need to carefully consider—with their treating oncologist—whether the benefits outweigh the risk for continuing anti-cancer treatment during the COVID-19 pandemic.
The overall rate of complications for this cohort was high, regardless of whether the patients had active cancer, were undergoing treatment for their cancer, or both. The ongoing study is being led by a consortium of more than 100 participating institutions and identified potential predictive factors for mortality and severe illness.
“Our main finding underscores the notion that patients with cancer are at increased risk of poor outcomes related to the illness and that extra precautions to care for and bring patients back to clinic and back to their treatment are essential,” says Jessica Hawley, MD, assistant professor of medicine at the Columbia University Vagelos College of Physicians & Surgeons, the physician-researcher representing the HICCC in the new consortium.
The researchers collected de-identified data on COVID-19 patients with active cancer or prior cancer, aged 18 years and older (median age was 66 years), from the period between March 17 and April 16, 2020; data was generated from participating institutions in the U.S., Canada, and Spain. The study analyzed data of 928 international cancer patients with COVID-19 and found the 30-day all-cause mortality was 13%, more than double the mortality reported as the global average by Johns Hopkins Coronavirus Resource Center’s report. Patients with advanced cancer had a five-fold relative risk of dying within 30 days, compared to those in remission. The study suggest that cancer patients who were male, were former smokers, above 66 years old, and who had two or more comorbidities were at a higher risk of becoming severely ill or dying from COVID-19.
The CCC19 grew from a “call-to-action” via Twitter by oncologists and cancer researchers motivated to better understand the novel coronavirus’ impact on the cancer patient population. Advised by Drs. Dawn Hershman, Gary Schwartz, and Jason Wright, Dr. Hawley, who was re-deployed to treat COVID-19 patients at NewYork-Presbyterian in the height of the New York City surge, began contributing data to the consortium within 10 days of that “call”. The CCC19’s registry was conceived and developed in less than a month.
As a result of the data being generated by the CCC19, several research projects are now underway to analyze the data by various treatment subgroups. One project, led by CCC19, is investigating whether cancer immunotherapy protects this cohort of patients or further puts them at risk, and another is examining whether outcomes vary per patient tumor type; for instance, are lung cancer patients with COVID-19 more susceptible to poor outcomes? Dr. Hawley is currently participating in a disparities working group that is investigating data by different racial and ethnic groups, as well as by regional variability, and also, a different study is looking into biological factors to explore whether blood types of cancer patients predispose to worse outcomes.
“Additionally, we hope to mitigate poor outcomes if a second wave of infections occurs,” adds Dr. Hawley, “and use the data to make meaningful change for patients relative to treatment interventions and closer attention to those known to be at higher risk, as we determined in our findings.”