Safety of systemic anti-cancer treatment in oncology patients with non-severe COVID-19: a cohort study

Abstract

Background The viral pandemic coronavirus disease 2019 (COVID-19) has disrupted cancer patient management around the world. Most reported data relate to incidence, risk factors, and outcome of severe COVID-19. The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is an important matter in daily practice. Methods ONCOSARS-1 was a single-center, academic observational study. Adult patients with solid tumors treated in the oncology day unit with systemic anti-cancer therapy during the initial phase of the COVID-19 pandemic in Belgium were prospectively included. All patients (n = 363) underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serological testing after the first peak of the pandemic in Belgium. Additionally, 141 of these patients also had a SARS-CoV-2 RT-PCR test during the pandemic. The main objective was to retrospectively determine the safety of systemic cancer treatment, measured by the rate of adverse events according to the Common Terminology Criteria for Adverse Events, in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative patients. Results Twenty-two (6%) of the 363 eligible patients were positive for SARS-CoV-2 by RT-PCR and/or serology. Of these, three required transient oxygen supplementation, but none required admission to the intensive care unit. Hematotoxicity was the only adverse event more frequently observed in SARS-CoV-2 -positive patients than in SARS-CoV-2-negative patients: 73% vs 35% (P < 0.001). This association remained significant (odds ratio (OR) 4.1, P = 0.009) even after adjusting for performance status and type of systemic treatment. Hematological adverse events led to more treatment delays for the SARS-CoV-2-positive group: 55% vs 20% (P < 0.001). Median duration of treatment interruption was similar between the two groups: 14 and 11 days, respectively. Febrile neutropenia, infections unrelated to COVID-19, and bleeding events occurred at a low rate in the SARS-CoV-2-positive patients. Conclusion Systemic anti-cancer therapy appeared safe in ambulatory oncology patients treated during the COVID-19 pandemic. There were, however, more treatment delays in the SARS-CoV-2-positive population, mainly due to a higher rate of hematological adverse events.

Factors Associated With Cancer Treatment Delay Among Patients Diagnosed With COVID-19

“…One global systematic review that identified 38 different categories of delays and disruptions reported that clinician- or system-related variables, such as medicine stockouts or shortages of devices, personal protective equipment, and laboratorial or imaging tests, were the most frequently reported structural or process-related factors associated with delay . Several single-institution reports and surveys of physicians revealed that there were more treatment delays among patients infected with SARS-CoV-2 compared with patients who were not infected . Our analysis is the first study, to our knowledge, to identify systemic delays or cancellations in cancer treatment for a cohort of patients who were all diagnosed with SARS-CoV-2 infection.…”

“… 16 Several single-institution reports and surveys of physicians revealed that there were more treatment delays among patients infected with SARS-CoV-2 compared with patients who were not infected. 17 , 18 Our analysis is the first study, to our knowledge, to identify systemic delays or cancellations in cancer treatment for a cohort of patients who were all diagnosed with SARS-CoV-2 infection.…”

“…Summary results from multivariable logistic regression showed that the factors associated with surgical treatment delay included living in the South, compared with living in the Midwest, (OR, 9.66; 95% CI, 2. surveys of physicians revealed that there were more treatment delays among patients infected with SARS-CoV-2 compared with patients who were not infected. 17,18 Our analysis is the first study, to our knowledge, to identify systemic delays or cancellations in cancer treatment for a cohort of patients who were all diagnosed with SARS-CoV-2 infection.…”

Riesgo de infección por COVID-19 en pacientes oncológicos y asociación con el tratamiento recibido

“…En nuestra cohorte, aproximadamente 6% de los pacientes que realizaban tratamiento activo, desarrolló infección por COVID-19, consistente con la tasa reportada en otros estudios 9 . De este modo, la gran mayoría de los tratados en el Centro de Infusión durante la pandemia, transcurrieron el periodo de estudio sin desarrollar infección por COVID-19.…”

“…La QMT comprende un grupo diverso de fármacos con diversos mecanismos de acción, lo cual hace difícil obtener conclusiones inequívocas respecto a su rol en el riesgo de infección. Sin embargo, numerosos estudios han evaluado esta asociación y existe evidencia creciente que establece la falta de asociación entre QMT y mayor riesgo infección o de mortalidad por COVID-19, respaldando la seguridad de continuar la infusión de estos tratamientos durante la pandemia [7][8][9] .…”