PRE-ONCOVID-19 Study Findings Confirm High Cancer Patient Mortality Rates

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: The PRE-ONCOVID-19 study of cancer patients with suspicion of SARS-CoV-2 infection found that around 10% of patients died within 25 days of presentation.  

The analysis focused on 302 cancer patients who were admitted to the Comprehensive Cancer Center of Lyon in France between March and April 2020 with fever, dry cough, dyspnoea, dysgeusia, anosmia, diarrhoea, and/or suspicious images on computed tomography (CT), with or without contact with a suspected COVID-19 patient. 

Just 18.2% of the patients tested positive for SARS-CoV-19 on nasopharyngeal sample reverse transcriptase-polymerase chain reaction (RT-PCR) and people in this group were older than those who were negative, and more likely to have a haematological malignancy, respiratory symptoms and suspected COVID-19 pneumonia. 

Nevertheless, 38% of patients with a negative test had respiratory symptoms and 20% had CT findings indicative of COVID-19 pneumonia, report Jean-Yves Blay and co-workers from the cancer institute. 

Overall, 9.9% of patients died during a median follow-up of 25 days, including 21.0% of the patients who tested positive and 10.0% of those who had a negative test. 

The majority (80%) of patients who died had metastatic disease and there was no correlation between mortality risk and factors such as body mass index, histology, smoking history, comorbidity and receipt of cancer treatment in the month before admittance. 

“Importantly, the presence of a SARS-COV-2 RT-PCR-positive test was not significantly correlated to the risk of death in the overall population”, the investigators report in the European Journal of Cancer. 

However, multivariate analysis indicated that mortality risk was significantly and independently predicted by fever plus respiratory symptoms (hazard ratio [HR]=5.09), a Karnofsky performance status score of less than 60 (HR=4.87), relapsing cancer (HR=3.05), a lymphocyte count below 700 /µL (HR=3.05) and male sex (HR=2.75). 

Patients with respiratory symptoms or COVID-19 pneumonia had the highest mortality rates and this was true for patients who tested positive or negative for SARS-CoV-2, at 19.7% and 18.4%, respectively. 

But the team emphasizes that “[m]ost of the patients who succumbed during the observation period (22/30, 73%) were negative for SARS-COV-2 on RT-PCR.” 

“These observations strongly suggest an underdiagnosis of COVID-19 in this population of cancer patients and a major underestimation of SARS-COV-2 contribution as a cause of death in cancer patients”, write Jean-Yves Blay et al.

“The management of cancer patients with febrile respiratory symptoms in this period of epidemic should therefore be particularly careful even in the absence of SARS-COV-2 detection”, they say.

The researchers also recommend that “[s]pecific therapeutic procedures suggested to improve COVID-19 patient survival, e.g. anti-[interleukin-6 antibodies], chloroquine analogues, remdesivir, should be investigated also in this SARS-COV-2-negative cancer patient population presenting with severe symptoms suggestive of COVID-19.” 

Reference  

Assaad S, Avrillon V, Fournier M-L, et al. High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR. Eur J Cancer; Advance online publication 7 June 2020. https://doi.org/10.1016/j.ejca.2020.05.028