The Effect of Dexamethasone Treatment on COVID-19 Prognosis in Cancer Patients

Abstract

Background: Dexamethasone is used to treat cancer, relieve chemotherapy-induced nausea and vomiting, enhance cancer patients’ appetites, and treat COVID-19 patients. There is little evidence of the impact of a dexamethasone treatment plan on the severity of COVID-19 infections in cancer patients. This study explores whether dexamethasone treatment plan influences the severity of COVID-19 in dexamethasone-treated cancer patients. Methods: The medical records of 108 cancer patients receiving dexamethasone at King Hussein Cancer Center with a COVID-19 infection and 343 without corticosteroid treatment were reviewed. Patients on dexamethasone within seven days before infection, after infection, or both were included. Ventilation support, hospitalization, and mortality within 28 days of a COVID-19 diagnosis were key severity factors. Results: We found that dexamethasone before a COVID-19 infection increased the risk of requiring ventilation assistance and mortality within 28 days by a factor of 5.8 (2.8–12.0) relative to control (p < 0.005). Continuing dexamethasone treatment after a COVID-19 infection, or starting it after infection, had a risk factor equivalent to control. Conclusion: Our data showed that dexamethasone therapy protocol affected COVID-19 prognoses in cancer patients, and it is preferable to not discontinue therapy after infection. A rigorous prospective comparison between early and late dexamethasone dosing is needed to determine the best protocol for treatment.

Non-Dexamethasone Corticosteroid Therapy’s Effect on COVID-19 Prognosis in Cancer Patients: A Retrospective Study

“…Alternatively, switching the corticosteroid type to dexamethasone would be preferable, as the REMAP-CAP randomized study group [ 29 ] and the RECOVERY study group recommended [ 30 ]. This conclusion is similar to our previous study on COVID-19-infected cancer patients treated with dexamethasone, which found that it is preferable to continue the corticosteroid rather than stop it [ 27 ].…”

“…For this study, we analyzed data from the medical records of COVID-19-infected cancer patients at King Hussein Cancer Center (KHCC) who were between 18 and 91 years old. All KHCC patients were Middle Eastern (including Jordanians) and followed KHCC’s treatment protocols [ 27 ]. The KHCC Cancer Registry records were searched for PCR-positive COVID-19 patients (N = 1988).…”

“…To analyze the data of SARS-CoV-2 infected patients who were treated between September 2020 and January 2022, we followed the same methodology as in our previous publication [ 27 ]. Software “R” version R 4.1.2 (2021) was used for all data manipulation and statistical analysis [ 28 ].…”

“…The results showed that SARS-CoV-2 patients treated with dexamethasone had a reduced 28-day mortality than those receiving invasive mechanical ventilation or oxygen alone [ 12 ]. Furthermore, our previous published data showed that cancer patients who were already taking dexamethasone and continued the treatment after being infected with SARS-CoV-2 had higher survival rates and a better prognosis for COVID-19 than patients who stopped the medication after being diagnosed with COVID-19 [ 27 ].…”

“…As a follow-up to our previous work, we decided to investigate the effects of other corticosteroid management plans on cancer patients infected with the SARS-CoV-2 virus [ 27 ]. Therefore, this study aims to investigate if concurrent hydrocortisone and prednisone administration within seven days, particularly before, after, or both before and after a COVID-19 infection, influences the severity indicators of COVID-19 disease in cancer patients.…”