Decline in Respiratory Functions in Hospitalized SARS-CoV-2 Infected Cancer Patients Following Cytotoxic Chemotherapy-An Additional Risk for Post-chemotherapy Complications.

Maha Ahmed Al-Mozaini,Abu Shadat M Noman,Walid A Farhat,Atm Rezaul Karim,Herman Yeger,Syed S Islam,Mihyar Islam

doi:10.3389/fmed.2022.835098

Abstract

BackgroundPatients recovering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection demonstrate impaired lung function and those requiring chemotherapy after recovering from SARS-CoV-2 infection have yet to be explored. In this study, we sought to investigate the possible pulmonary functional changes during and after administering chemotherapy in patients with prior SARS-CoV-2 infection.MethodsIn this study, a total of 37 SARS-CoV-2 infected patients with cancer who were discharged from hospital and received subsequent cytotoxic chemotherapy were enrolled and prospectively followed-up. The following parameters were prospectively measured before (P1), after first chemotherapy cycle (P2), and 10 weeks after the end of chemotherapy (P3), to assess their impact on respiratory complications in terms of diffusion capacity of the lungs for carbon monoxide (DLCO), forced expiratory volume in 1-s (FEV1), forced vital capacity (FVC), 6-min walking distance (6MWD) test and levels of key inflammatory markers.ResultsAll patients completed at least 2 cycles of chemotherapy without showing overt respiratory complications. Six patients (16%) complained about dyspnea during chemotherapy or at follow-up period. DLCO was significantly impaired during follow-up period [from P1 78 to P3 60% of predicted values; interquartile range (IQR) 55–89] and in 32 of 37 (86% of patients) from P1 to P2 (65% of predictive value; IQR 58–70; p < 0.001). Several patients experienced post-chemotherapy respiratory complications. As expected, all patients from control groups showed persistent improved pulmonary functions.ConclusionThe risk of pulmonary impairments due to cytotoxic chemotherapy in prior SARS-CoV-2 infected patients is linked to the loss of DLCO. Accordingly, we recommend that for patients with cancer requiring chemotherapy after recovering from prior SARS-CoV-2 infection, pulmonary tests to be performed routinely before and during chemotherapy treatment to monitor the pulmonary performance.

Highlights

Patients with cancers are more likely to have disproportionately vulnerable and severe outcome from coronavirus disease 2019 (COVID-19) and poor prognosis in the case of immunocompromise as a result of chemotherapy
All patients had tested negative for SARS-CoV-2, several patients age between 62 and 75 years had post-COVID19 symptoms, such as, difficulty of breathing, sleep problems, and cough
As this study was designed to assess the relationship between response to chemotherapy and respiratory function of recovered COVID-19 infected patients, we found that all patients had lower postchemotherapy DLCO predicted value

Summary

Introduction

Patients with cancers are more likely to have disproportionately vulnerable and severe outcome from coronavirus disease 2019 (COVID-19) and poor prognosis in the case of immunocompromise as a result of chemotherapy. Many studies have reported the effects of anti-cancer treatment in patients with COVID-19 with conflicting results [1, 2]. Emerging evidence demonstrate the symptoms and impairment of pulmonary function in patients who recover from severe COVID-19 infection [3–9]. Several recent reports demonstrated the severe impact of cancer treatment, such as chemotherapy, during the course of COVID-19 [1, 17–19]. It is pivotal to investigate whether administering chemotherapy can cause the additional risk of pulmonary impairments, performance, and tolerance in cancer patients with prior severe COVID-19 infection. Patients recovering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection demonstrate impaired lung function and those requiring chemotherapy after recovering from SARS-CoV-2 infection have yet to be explored. We sought to investigate the possible pulmonary functional changes during and after administering chemotherapy in patients with prior SARS-CoV-2 infection

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