Author: By Lynda Williams, Senior medwireNews Reporter
medwireNews: Around one in seven patients with cancer experience long-term symptoms after SARS-CoV-2 infection that may impact on cancer treatment and survival, analysis of the OnCovid registry has found.
“Our data argue for improved awareness, recognition, and early treatment of COVID-19 sequelae in patients with cancer as an important step towards the promotion of optimal oncological outcomes in COVID-19 survivors”, write David Pinato, from Imperial College London in the UK, and co-authors in The Lancet Oncology.
The current analysis of the European registry includes 2634 patients with solid or haematological malignancy from Belgium, France, Germany, Italy, Spain and the UK who were diagnosed with SARS-CoV-2 infection between February 2020 and February 2021.
In all, 1557 of the patients underwent a formal clinical assessment a median of 22.1 months after being diagnosed with cancer and 44 days after COVID-19 diagnosis, at which time 15.0% reported one or more COVID-19 sequelae, including respiratory symptoms (49.6%), fatigue (41.0%), neurocognitive symptoms (7.3%), weight loss (5.5%), nonrespiratory organ dysfunction (1.7%) and other complications (18.4%).
The investigators found that patients with COVID-19 sequelae were significantly more likely than those without to have developed COVID-19 complications (54.3 vs 20.9%) and required COVID-19 treatment (65.9 vs 52.6%) or hospitalisation (72.2 vs 41.2%).
Patients with COVID-19 sequelae were also significantly more likely than those without to be male (54.5 vs 47.2%), to be aged 65 years or older (55.1 vs 48.1%) and to have at least two comorbidities (48.3 vs 36.4%) or a history of smoking (55.9 vs 42.3%).
“Oncological characteristics, including tumour stage, presence of active cancer, and, most importantly, exposure to anti-cancer therapy before COVID-19 were not associated with the emergence of SARS-CoV-2 sequelae”, David Pinato and co-authors report.
They describe this finding as being “of paramount importance in understanding the natural course of recovery from SARS-CoV-2 infection in patients with cancer as it provides further data in support of the safe delivery of anti-cancer therapy in the context of an ongoing pandemic threat.”
Following up the patients for a median 128 days after COVID-19, the team found that patients with COVID-19 sequelae had a significantly higher risk of dying than those without, with a hazard ratio (HR) of 1.80 after considering a range of confounding factors such as time to assessment, age, sex, comorbidity burden, tumour characteristics, anticancer treatment and COVID-19 severity.
Of the 466 patients who had been receiving systemic anticancer therapy within 4 weeks of COVID-19 diagnosis, 15.0% permanently discontinued treatment because of a deterioration in performance status (61.3%), disease progression (29.0%) or residual organ dysfunction (9.7%).
A further 38.2% of these patients resumed anticancer therapy after a dose or regimen adjustment to avoid potential immune suppression (50.0%), reduce the need for hospital visits (25.8%) or avoid adverse events (19.1%).
David Pinato et al highlight that discontinuation or adjustment of anticancer therapy was significantly predicted by COVID-19 complications, hospitalisation and sequelae, as well as former or current smoking.
Of concern, patients who permanently discontinued systemic anticancer treatment had a significantly greater risk of death than those who continued with therapy (HR=3.53), although the researchers say it “seems to be reassuring” that adjustments to dose or regimen did not significantly alter survival.
“Taken together, our data underscore the clinical significance of post-COVID syndrome in patients with cancer, a newly emerging prognostic domain that should be promptly identified in the clinic”, the OnCovid registry investigators conclude.
“Further research should prioritise the discovery of viral and host factors that are linked to the development of sequelae to allow for an improved diagnosis and for the implementation of better tailored treatment strategies to improve survival and quality of life of COVID-19 survivors with cancer”, they write.
Pinato DJ, Tabernero J, Bower M, et al. Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study. Lancet Oncol; Advance online publication 3 November 2021. DOI:10.1016/S1470-2045(21)00573-8
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