Outcome of COVID-19 Infection in Cancer Patients in Pune

Abstract

Introduction We document our data on the course of the coronavirus disease 2019 (COVID-19) infection in cancer patients in an attempt to help optimize their management in India and globally. Material and Methods Between February 2020 and January 2021, participating oncologists from Pune (members of the Oncology Group of Pune) documented effect of COVID-19 infection in their cancer patients. Binomial logistic regression analysis as well as correlation analysis was done using Pearson Chi-square test to determine significance of clinical factors. Results A total of 29 oncologists from 20 hospitals contributed their data involving 147 cancer patients who developed COVID-19 infections. COVID-19 infection resulted in higher deaths (likelihood ratio of 4.4) amongst patients with hematological malignancies (12/44 = 27.2%) as compared with those with solid tumors (13/90 = 14.4%, p = 0.030). Patients with uncontrolled or progressive cancer (11/34 = 32.4%) when they got infected with COVID-19 had higher mortality as compared with patients whose cancer was under control (14/113 = 12.4%; p = 0.020). Complication of thromboembolic episodes (seen in eight patients; 5.4% cases) was associated with higher risk (25.6 times) of death (five-eighths; 62.5%) as compared with those who did not develop it (20/139;14.4%; p <0.001). Discussion Patients with cancer should be advised to take strict precautions to reduce the risk of being infected with COVID-19. They should also be given priority for COVID-19 vaccination. If infected with COVID-19, patients with hematological malignancy and uncontrolled cancer are at higher risk of morbidity and mortality. When they are being treated (OPD or inpatient basis), additional precautions are necessary to ensure their exposure to potential COVID-19 virus is minimized. If they get infected with COVID-19, they should be given aggressive treatment to prevent complications, especially thromboembolic episodes. If they develop any thromboembolic complication, their risk of dying are significantly higher, and management should be modified accordingly.

COVID-19 in cancer patients: patient characteristics and outcomes in the post-COVID-19 vaccination period

“…Studies have indicated that malignancy in comparison to other comorbidities is associated with a higher risk of admission to the ICU, invasive ventilation, and death from COVID-19 [ 10 ].It has been reported that mortality rates secondary to COVID-19 in cancer patients are approximately 30% (reported as around 40% in the first wave of COVID-19 and around 25% in subsequent waves),whichis at least 5times higher than inpatients without malignancy [ 1 , 7 , 11 ]. When studies evaluating COVID-19 in patients with solid organ cancers were examined,in a multicenter study from India,the COVID-19-related CFR was determined as 14.4% in solid cancer patients(likelihood ratio of 4.4,p= 0.030), while in a study from Belgium,the 30-day in-hospital COVID-19-related mortality rate was reported as 31.7% in patients with solid cancer and 20.0% in patients without cancer [ 12 , 13 ]. In patients with hematological cancer, a study from Türkiye stated that the rates of severe/critical illness and CFR were significantly higher in hematological cancer patients in comparison withnoncancerous patients (18.9% vs. 11.5% and 13.8% vs. 6.5%, respectively) [ 14 ].…”

“…Studies have also shown that severe diseasewith the needed forhospitalization/ICU admission and COVID-19-related mortality rates were higher in hematological cancer patients in comparison to solid organ cancer patients [ 12 , 16 , 17 ]. The overall COVID-19-related CFR in the cancer patients in the current study was 15.4% and the rates of hospitalization, ICU admission, and CFR were higher in the hematological cancer patientscompared to thesolid organ cancer patients.…”

“…Considering the comorbidities that may affect the COVID-19 course and outcome, studies have shown that older age, male sex, cardiovascular and metabolic comorbidities, specially diabetes mellitus, and active or uncontrolled malignancy represent the main risk factors in both hematological and solid organ cancer patients [ 12 , 19 ]. In the European Hematology Association Survey (EPICOVIDEHA),conducted by Pagano et al[ 11 ], it was found thatage, active malignancy, chronic cardiac, liver, and renal diseases, smoking history, and ICU stay were correlated with mortality in COVID-19 patients with hematological malignancy.…”

“…An elevated blood D-dimer level has been shown to predict a higher risk of VTE. D-dimer has the potential to also serve as a risk stratification tool in COVID-19 [ 7 , 12 ].Aworse prognosis was detected in the hematological cancer patients compared to those with solid organ cancer, as well as lower WBC, lymphocyte, neutrophil, and platelet counts at the time of COVID-19 diagnosis in these patients. In the analysis of the relationship between these laboratory findings and poor prognosis,it wasfound thatpatients with COVID-19-related mortality had significantly higher rates oflymphocytopenia, leukocytosis, and neutrophilia, and higher levels of D-dimer, troponin, CRP, procalcitonin, and ferritin levels than the survivors.…”