Comparable outcomes but higher risks of prolonged viral RNA shedding duration and secondary infection in cancer survivors with COVID-19: A multi-center, matched retrospective cohort study*

Abstract

Abstract Objective To identify the differences in clinical features and outcomes between cancer survivors and non-cancer patients with coronavirus disease 2019 (COVID-19). Methods In this multicenter, retrospective, and observational cohort study from February 10, 2020 to March 31, 2020 in Wuhan, China, all cancer survivors infected with COVID-19 were screened, and statistically matched with non-cancer patients with COVID-19 using propensity score matching. Demographic, clinical, treatment, and laboratory data were extracted from a standardized medical recording system and underwent review and assessment. Results Sixty-one cancer survivors and 183 matched non-cancer patients were screened from 2,828 COVID-19 infected patients admitted to 4 hospitals in Wuhan, China. The median ages of the cancer survivor cohort and non-cancer patient cohort were 64.0 (55.0-73.0) and 64.0 (54.0-73.5), respectively (P = 0.909). Cancer survivors reported a higher incidence of symptom onset than non-cancer patients. Fever (80.3% vs. 65.0%; P = 0.026) was the most prevalent symptom, followed by cough (65.6% vs. 37.7%; P < 0.001), myalgia, and fatigue (45.9% vs. 13.6%; P < 0.001). The risks of the development of severe events (adjusted hazard ratio [AHR] = 1.25; 95% confidence interval [CI]: 0.76-2.06; P = 0.378) and mortality (relative risk [RR] = 0.90, 95% CI: 0.79-1.04; P = 0.416) in the cancer survivor cohort were comparable to those of the matched non-cancer patient cohort. However, the cancer survivor cohort showed a higher incidence of secondary infection (52.5% vs. 30.1%; RR = 1.47, 95% CI: 1.11-1.95; P = 0.002) and a prolonged viral RNA shedding duration (32 days [IQR 26.0-46.0] vs.24.0 days [IQR 18.0-33.0]; AHR = 0.54; 95% CI: 0.38-0.80; P < 0.05). Conclusion Compared to non-cancer patients, cancer survivors with COVID-19 exhibited a higher incidence of secondary infection, a prolonged period of viral shedding, but comparable risks of the development of severe events and mortality. It is helpful for clinicians to take tailored measures to treat cancer survivors with COVID-19.