Factors Associated with Severity of COVID-19 Illness in Cancer Patients
DOI:
https://doi.org/10.51253/pafmj.v73i6.9847Keywords:
Cancer, COVID-19, Complications, Eastern cooperative oncology group (ECOG) performance statusAbstract
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.
Downloads
References
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-
https://doi.org/10.1016/j.ijid.2021.03.040
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.
https://doi.org/10.1183/13993003.00547-2020.
Zhang JT, Zhong WZ, Wu YL. Cancer treatment in the coronavirus
disease pandemic. Lung Cancer 2021; 152(10): 98-103.
https://doi.org/10.1016/j.lungcan.2020.12.012.
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.
https://doi.org/10.1016/j.ejca.2020.08.011.
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-
https://doi.org/10.1093/jnci/djaa159.
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.
https://doi.org/10.1038/s41591-020-0822-7.
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-
https://doi.org/10.1016/s0140-6736(20)31173-9.
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.
https://doi.org/10.1007%2Fs11845-021-02815-9.
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.
https://doi.org/10.3389%2Ffpubh.2020.00152.
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.
https://doi.org/10.1016/j.ijid.2022.01.011.
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.
https://doi.org/10.1183/13993003.01290-2020.
. 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.
https://doi.org/10.1371/journal.pone.0237302.
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.
https://doi.org/10.1038/s43018-020-0104-9.
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.
https://doi.org/10.1016/s0140-6736(20)31187-9.
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.
https://doi.org/10.1136%2Fjitc-2020-002266.
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.
https://doi.org/10.1016%2Fj.annonc.2021.08.1552.
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.
https://doi.org/10.1038/s41591-020-0979-0.
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.
https://doi.org/10.1016%2FS1470-2045(20)30314-4.
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.