Abstract
PurposeWe aimed to determine the COVID-19 infection rate and determine the factors that affect hospitalization and prognosis in patients receiving systemic chemotherapy (CT), immunotherapy (IT) and molecular-targeted therapies at our hospital within three months after the onset of COVID-19 pandemic.Materials and methodsThe patients who received systemic treatment at chemotherapy unit with diagnosis of cancer between 11 March 2020 and 11 June 2020 were included. The clinical and demographic characteristics of patients, the systemic treatments that they received (CT, IT, targeted therapies), and the stage of disease were determined. For the parameters that affect the hospitalization of COVID-19 infected patients were also determined.ResultsAmong 1149 patients with cancer, 84 of them were infected with COVID-19, and the median age of infected patients was 61.0 (IQR: 21–84) and 60.7% of them were male. As a subtype of cancers lung cancer was more frequent in the patients who infected with COVID compared with non-infected ones and the difference was statistically significant when the underlying malignities were compared (32.1% vs 19.0%, p = 0.031). The hospitalization rate and receiving COVID-19 treatment were more frequent in metastatic patients who were receiving palliative therapy, and the difference was statistically significant (p = 0.01, p = 0.03). In our study, infection rate was similar among patients treated with CT, IT and CT plus targeted therapy; however, fewer COVID-19 infections were seen at patients who received only targeted therapy.ConclusionCOVID-19 infection is more frequent in cancer patients and tends to be more severe in metastatic cancer patients receiving anticancer treatment, and the continuation of palliative cancer treatments in these patients may cause increased cancer and infection-related morbidity and mortality.
Highlights
The coronavirus disease 2019 (COVID-19) announced by World health’s Organization as pandemics has increased the need for intensive care and invasive mechanical ventilator need in cancer patients
Eighty-four of 1149 patients with cancer were infected with COVID-19 had a median age of 61.0 (IQR: 21–84) while 1065 patients without COVID-19 infection had a median age of 59.0 (IQR: 22–86); 60.7% of COVID-19 infected patients were male and 39.3% were female; 34.5% of COVID-19 infected patients were still active smokers; but this ratio was 32.7% for patients who were not infected with COVID-19
The rate of lung cancer was 32.1%, breast cancer was 21.4% and the colorectal cancer was the most frequent underlying malignancy for COVID-19 infected patients while the rates were 30.9%, 19.0% and 18.6% for breast, lung and colorectal cancers, respectively, for non-COVID-19 infected patients; 67.9% of COVID-19 infected patients were at metastatic stage while 67.9% were receiving palliative therapy; 77.4% of COVID-19 infected patients received only chemotherapy (CT) as systemic therapy while 15.5% received CT plus molecular targeted therapy
Summary
The coronavirus disease 2019 (COVID-19) announced by World health’s Organization as pandemics has increased the need for intensive care and invasive mechanical ventilator need in cancer patients. Considering the emergency condition in management of cancer patients, the daily clinical practices have been rearranged.[2,3] Most of the chemotherapeutic agents prevent blood cell production at bone marrow and can cause anemia, thrombocytopenia and leukopenia/lymphopenia.[4,5] It was shown that the increased infection risk after chemotherapy depends on this reason.[6,7] Besides, the gastrointestinal side-effects like nausea, vomiting and poor diet, malnutrition can cause more immunosuppression As a result, it can bring patients of cancer a sensitive population for the pandemics factor COVID-19 infection. Some authors mentioned that the Tcell reactivation by IT does not increase COVID-19 infection risk in patients with cancer, it is rather preventive for them.[9]
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