Journal Club

Does Tumor Type Affect the Risk of Infection with and Death from SARS-CoV-2?

Reviewed by Razan El Ramahi, M.B.B.S.

Labeling all patients with cancer with equally elevated risk for SARS-CoV-2 infection and complications can be inaccurate. Higher risk in patients with hematologic malignancies and lung cancer has been suggested by reports in Leukemia, Cancer Discovery, and Lancet Oncology. In addition, there are non-oncology related factors that contribute to an individual’s COVID-19 risk.

To examine the association between tumor type, patient age and sex, and the prevalence and outcomes of SARS-CoV-2 infection, Lee and colleagues, also in Lancet Oncology, compared data from the UK Coronavirus Cancer Monitoring Project (UKCCMP) to a cohort of non-COVID-19 cancer patients from the UK Office for National Statistics (UKONS). They identified 1,044 patients in the UKCCMP group from March 18 to May 8, 2020. There were more men (56.9%) in the UKCCMP cohort compared to the UKONS cohort (51.3%; odds ratio [OR] 1.26, 95% confidence interval [CI] 1.12-1.43; P = 0.0002).

Patients with hematologic malignancies were represented more frequently in the UKCCMP cohort compared to the control group, implying that they were at increased risk for presenting with SARS-CoV-2 infection. Death occurred in 319 patients out of 1,044 (30.6%), and COVID-19 was reported as the cause of death in 295 (92.5%). All-cause case-fatality rates after a COVID-19 episode were significantly associated with increasing age and male sex. After correction for age and sex, patients with leukemia showed a significantly increased case-fatality rate compared to the rest of the UKCCMP cohort (OR 2.25, 95% CI 1.13-4.57; P = 0.023). Compared to patients with solid tumors, those with hematologic malignancies were more likely to experience a severe COVID-19 disease course and to have received chemotherapy within 4 weeks of SARS-CoV-2 infection. The authors developed a figure that stratified case-fatality rates after COVID-19 infection according to tumor type and patient age and sex.

Having data to support that patients with different demographics and underlying cancer types have variable susceptibility to SARS-CoV-2 infection and disease outcomes can aid in management decisions and prognosis discussions. The study was unique in comparing patients to a non-COVID-19 cancer cohort but was unable to analyze other factors such as tumor stages, variations in anti-cancer treatment, and patients’ performance scores or other comorbidities.

(Lee et al. Lancet Oncology. 2020;21(10):P1309-1316.)