23 February 2022

Cancer treatment not linked to increased covid mortality

Cancer Clinical COVID-19

While patients with cancer have poorer covid outcomes than other individuals, these are more likely to be associated with age, sex, comorbidities, and cancer subtype rather than anticancer treatments, a new study has found. 

Published in the JAMA, the study found recent chemotherapy was not associated with all-cause mortality, and recent immunotherapy was actually associated with less severe covid symptoms and lower mortality. 

The findings have been welcomed by Associate Professor Kate Burbury, consultant haematologist and Deputy Chief Medical Officer at the Peter McCallum Cancer Centre in Melbourne. 

But she said it also served as a reminder that covid was just one of a number of viruses that pose a risk to cancer patients, including influenza and even salmonella.  

“All infectious diseases and viruses are an important cause of morbidity (for cancer patients),” she told Oncology Republic. 

“We’ve put a microscope on one virus (covid) but it’s not the only virus in the community.”  

While covid had presented huge challenges for managing patients with cancer, and delays in diagnosis had seen a reduction in new diagnosed, clinicians have now had two years to develop ways of safely and effectively adapting therapies to the pandemic landscape to protect their patients while still continuing their treatment. 

“We’ve all gone through this rationalisation of therapy, and we’ve learnt a lot,” Professor Burbury said. “Cancer doesn’t wait for anyone or anything or any virus.” 

She said while the study was useful in allaying patients’ fears that cancer treatment could cause increased mortality risk if they contracted covid, it was important for clinicians to reassure them that appropriate care could still be delivered safely. 

“There has been a fear across the population about starting treatment, and we need to educate patients and show them that starting therapy is in their best interests,” she said. 

“We need to learn to live with the virus not wrap ourselves in cotton wool.” 

As part of the study, researchers looked at 2515 unvaccinated patients in the UK between 18 March and 1 August, 2020, and evaluated whether systemic anticancer treatments (SACTs), tumour subtypes, patient demographic characteristics (age and sex), and comorbidities were associated with covid mortality. 

More than half of the participants (58%) were men; and the median (IQR) age was 72 (62-80) years. A mortality rate of 38% was observed (966 patients); 1108 patients (44%) presented with mild covid symptoms; 701 (28%) with severe symptoms; and 539 (21%) with critical symptoms; while 119 (5%) presented with no symptoms. A total of 131 patients (5%) were admitted to intensive care. 

The data suggested an association between higher mortality in patients with haematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher covid–related mortality (OR, 1.58; 95% CI, 1.11-2.25).  

No association between higher mortality and receiving chemotherapy in the four weeks before covid diagnosis was observed. An association between lower mortality and receiving immunotherapy in the four weeks before covid diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). 

“The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection,” the authors concluded. 

“This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers.” 

JAMA Network Open 2022, online 21 February 

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