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Risk Factors for Adverse COVID-19 Outcomes in Patients With Cancer
A study on chemotherapy and COVID-19 outcomes in cancer patients has shown that although cytotoxic chemotherapy treatment is not associated with adverse COVID-19 outcomes, hematologic and lung malignancies, peri–COVID-19 lymphopenia, and baseline neutropenia are (J Clin Oncol. 2020;38[30]:3538-3546).
“[COVID-19] mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized,” wrote Justin Jee, MD, PhD, Memorial Sloan Kettering Cancer Center (MSKCC), New York, and colleagues.
A total of 309 patients at MSKCC who have cancer and concurrent COVID-19 were reviewed by researchers until the end of March 2020, and clinical end points were observed until mid-April 2020.
Although Dr Jee et al had hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis would lead to an increased hazard ratio (HR) of severe or critical COVID-19, there was no significant association found between the 2 (HR, 1.10; 95% CI, 0.73-1.60).
However, there was an association between patients with hematologic malignancies and increased COVID severity (HR, 1.90; 95% CI, 1.30-2.80). Lung cancer patients also exhibited higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20-3.30).
Also associated with higher rates of severe or critical illness were patients with lymphopenia at COVID-19 diagnosis (HR, 2.10; 95% CI, 1.50-3.10) and patients with baseline neutropenia 14 to 90 days before COVID-19 diagnosis (HR, 4.20; 95% CI, 1.70-11.00).
Furthermore, patients in a time-matched population with cancer but without COVID-19 had a lower rate of adverse events. The findings of these analyses remained consistent in a multivariable model and multiple sensitivity analyses.
“Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes,” wrote Dr Jee et al.
“Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation,” they concluded.—Alexandra Graziano
