The burden of severe COVID19 tends to be high in people with lung cancer, with patient-specific factors having the greatest impact on severity, indicates a chart review from a single center.
The study highlights “both the urgent vulnerability of patients with lung cancer during this pandemic as well as the persistently critical need to continue, and drive improvements in, optimal cancer care,” write the researchers in the Annals of Oncology.
Study looks at COVID19 severity and lung cancer
They analyzed data from 102 patients (median age, 68 years) who were receiving treatment for lung cancer at the Memorial Sloan Kettering Cancer Center in New York, USA, and tested positive for SARS-CoV-2 between 12 March and 6 May 2020.
Over a median follow-up of 25 days, nearly two-thirds (62%) of the patients were hospitalized, 21% needed intensive care, and 25% died.
Matthew Hellmann (Memorial Sloan Kettering Cancer Center) and co-researchers note, however, that the confirmed COVID-19 deaths represented just 11% of all deaths among patients with lung cancer at the institution.
And despite the high burden of severity, just over half (52%) of the participants had recovered and 13% were improving at the time of analysis. The study authors highlight that the recovered patients included “a small (but important) fraction of patients initially requiring intubation and invasive mechanical ventilation.”
“This finding amplifies the importance of maintaining urgent focus on the needs of patients with cancer,” they say.
The study authors also found that patient-related features were “the greatest determinants” of COVID-19 severity in this cohort. For instance, people who smoked a median of 23.5 pack–years had a significant threefold increased risk for death from COVID-19 versus never smokers, while the presence of chronic obstructive pulmonary disease was associated with a nearly fourfold increased risk.
Similarly, older age and hypertension were both significantly associated with an elevated risk for hospitalization and severe COVID-19 (defined as intensive care unit admission, intubation, and/or transition to do not intubate status), with odds ratios ranging from 1.63 to 2.68.
By contrast, there was no significant association between COVID-19 severity and cancer-specific factors, such as the presence of active or metastatic disease, histology, and PD-L1 expression levels, nor between severity and recent (within 1–6 weeks of the SARS-CoV-2 test) immunotherapy, chemotherapy, or targeted therapy.
“Our findings suggest that risk factors leading to lung cancer and its related chronic medical conditions, rather than cancer itself or cancer-directed treatments, are the primary drivers of severity of COVID-19 in patients with lung cancers,” conclude Hellmann and colleagues.