Factors Associated with Severity of COVID-19 Illness in Cancer Patients


  • Maimoona Nasir Department of Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Muhammad Nadeem Department of Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Amjad Department of Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Umair Department of Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Faisal Mehmood Department of Medicine, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Rawalpindi Pakistan




Cancer, COVID-19, Complications, Eastern cooperative oncology group (ECOG) performance status


Objective: To identify the various risk factors associated with severe COVID-19 complications in cancer patients.

Study design: Cross-sectional study.

Place and duration of study: Combined Military Hospital, Rawalpindi Pakistan, from Jun to Nov 2022.

Methodology: Seventy-one cancer patients with COVID-19 infection confirmed by PCR test on nasopharyngeal swab were
included in the study. They were assessed for their, ECOG status, smoking habit, comorbidity, vaccination status, cancer type, lung involvement and chemotherapy after written informed consent. COVID-19 symptoms were categorized.

Results: Out of 71 patients included in the study, 16(22.5%) cancer patients had asymptomatic COVID-19 infection, 34(47.9 %) patients had mild symptoms, 13(18.3%) had moderate disease, and 7(9.9%) had severe COVID-19 illness. A significant
association was found between severity of COVID-19 illness with age, gender, ECOG status, presence or absence of comorbid, vaccination status and type of malignancy (p-value<0.05).

Conclusions: Old, male, frail and unvaccinated patients with comorbidity more frequently developed serious COVID-19
disease. Patients with hematologic or lung malignancies had worse outcomes, while vaccinated ones were protected against
severe disease. Chemotherapy or smoking had no significant impact on the severity of COVID-19 illness.


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Nisar MI, Ansari N, Khalid F, Amin M, Shahbaz H, Hotwani A, et al.

Serial population-based serosurveys for COVID-19 in two

neighbourhoods of Karachi, Pakistan. Int J Infect Dis 2021; 106: 176-


Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. China

Medical Treatment Expert Group for COVID-19. Comorbidity and its

impact on 1590 patients with COVID-19 in China: a nationwide

analysis. Eur Respir J 2020; 55(5): 2000547.


Zhang JT, Zhong WZ, Wu YL. Cancer treatment in the coronavirus

disease pandemic. Lung Cancer 2021; 152(10): 98-103.


Saini KS, Tagliamento M, Lambertini M, McNally R, Romano M,

Leone M, et al. Mortality in patients with cancer and coronavirus

disease 2019: A systematic review and pooled analysis of 52 studies.

Eur J Cancer 2020; 139:43-50.


Fillmore NR, La J, Szalat RE, Tuck DP, Nguyen V, Yildirim C, et al.

Prevalence and Outcome of COVID-19 Infection in Cancer Patients: A

National Veterans Affairs Study. J Natl Cancer Inst 2021; 113(6): 691-


Yusuf A. Cancer care in the time of COVID-19-a perspective from

Pakistan. Ecancermedicalscience 2020; 14: 1026.

Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM, et

al. Estimating clinical severity of COVID-19 from the transmission

dynamics in Wuhan, China. Nat Med 2020; 26(4): 506-510.


Lee LY, Cazier JB, Angelis V, Arnold R, Bisht V. UK Coronavirus

Monitoring Project Team; Kerr R, Middleton G. COVID-19 mortality

in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet 2020; 395(10241): 1919-


Linehan A, Fitzpatrick O, Cowzer D, Hennessy MA, Coyne ZL,

Nolan A, et al. COVID-19-related mortality in cancer patients in an

Irish setting. Ir J Med Sci 2022; 191(5): 2013-2018.


Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender Differences

in Patients With COVID-19: Focus on Severity and Mortality. Front

Public Health 2020; 8(1): 152.


Luo J, Rizvi H, Preeshagul IR, Egger JV, Hoyos D, Bandlamudi C, et

al. COVID-19 in patients with lung cancer. Ann Oncol 2020; 31(10):

-1396. https://doi.org/10.1016/j.annonc.2020.06.007.

Ismail N, Hassan N, Abd Hamid MHN, Yusoff UN, Khamal NR,

Omar MA, et al. Association of Smoking And Severity of Covid-19

Infection Among 5,889 Patients In Malaysia: A Multi-Center

Observational Study. Int J Infect Dis 2022; 116: 189-196.


Rossato M, Russo L, Mazzocut S, Di Vincenzo A, Fioretto P, Vettor R,

et al. Current smoking is not associated with COVID-19. Eur Respir J

; 55(6): 2001290.


. Hu Y, Zhan C, Chen C, Ai T, Xia L. Chest CT findings related to

mortality of patients with COVID-19: A retrospective case-series

study. PLoS One 2020; 15(8): e0237302.


Rugge M, Zorzi M, Guzzinati S. SARS-CoV-2 infection in the Italian

Veneto region: adverse outcomes in patients with cancer. Nat Cancer

; 1(8): 784-788.


Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera

DR, et al. Clinical impact of COVID-19 on patients with cancer

(CCC19): a cohort study. Lancet 2020; 395(10241): 1907-1918.


Passaro A, Bestvina C, Velez Velez M, Garassino MC, Garon E, Peters

S, et al. Severity of COVID-19 in patients with lung cancer: evidence

and challenges. J Immunother Cancer 2021; 9(3): e002266.


Ben-Aharon I, Waldhorn I, Holland R, Peer A, Halberthal M, Goshen

- Lago TG, et al. 1559O Efficacy and toxicity of BNT162b2 vaccine in

cancer patients. Ann Oncol 2021; 32: S1130.


Robilotti EV, Babady NE, Mead PA, Rolling T, Perez-Johnston R,

Bernardes M, et al. Determinants of COVID-19 disease severity in

patients with cancer. Nat Med 2020; 26(8): 1218-1223.


Garassino MC, Whisenant JG, Huang LC, Trama A, Torri V, Agustoni

F, et al. TERAVOLT investigators. COVID-19 in patients with

thoracic malignancies (TERAVOLT): first results of an international,

registry-based, cohort study. Lancet Oncol 2020; 21(7): 914-922.


Jee J, Foote MB, Lumish M, Stonestrom AJ, Wills B. Chemotherapy

and COVID-19 Outcomes in Patients With Cancer. J Clin Oncol 2020;

(30): 3538-3546. https://doi.org/10.1200/jco.20.01307.




How to Cite

Nasir, M., Nadeem, M., Amjad, Umair, & Mehmood, F. (2023). Factors Associated with Severity of COVID-19 Illness in Cancer Patients. Pakistan Armed Forces Medical Journal, 73(6), 1777–1780. https://doi.org/10.51253/pafmj.v73i6.9847



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