A group of clinicians from the Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, US sought to determine if cancer patients with COVID-19 in the US have a poorer prognosis. In an article published in the Annals of Oncology, theyanalysed the electronic medical records of Mount Sinai Health System in New York City and found 334 patients (6%) with cancer among 5,688 patients diagnosed with COVID-19
A previous retrospective case study from China with 28 included cancer patients with COVID-19 showed a high mortality rate. However, these results cannot be applied to countries with different cancer epidemiology and clinical practice.
The group of clinicians extracted data from the electronic medical records in terms of sex, age, comorbidities, intubation, and mortality status for patients with COVID-19 RT PCR positive test from 1 March to 6 April 2020. Mortality was analyzed until 8 April. Among 334 patients with cancer, most had breast cancer (57 patients), prostate cancer (56 patients), lung cancer (23 patients), urothelial cancer (18 patients) and colorectal cancer (16 patients).
The authors wrote that without adjusting for age groups, patients with cancer were intubated significantly more frequently with relative risk (RR) 95% confidence interval (CI) 1.89, but the rate of death was not significantly different. By stratifying patients by age groups, they detected a significantly increased risk of intubation in patients with cancer aged 66 to 80 years (RR 95% CI 1.76). No significant difference in intubation risk was found in other age groups. However, patients with cancer younger than 50 years had a significantly higher mortality rate (RR 95% CI 5.01). But, the mortality rates of COVID-19 in cancer patients were lower than those in patients without cancer in age groups older than 50 years, although they were not statistically significant.
Patients with cancer have impaired immune systems.The authors commented that cytokine-associated pulmonary injury is a potential aetiology in cases with severe COVID-19 disease. In young population, whose mortality rate from COVID-19 is in general very low, baseline fragility among cancer patients may lead to a relatively higher rate of deaths.
The authors commented also the limitations of their data analysis, e.g. unclear causation between COVID-19 and intubation or death, as well as heterogeneity of cancer types and various stages of cancer.
Still it is the first report on the prognosis of COVID-19 in patients with cancer in the US. The relatively large number of patients in the study allowed for the adjustment of age, which is one of the strongest prognostic factors.
The authors concluded that further study based on the individual patients’ data is needed to better understand the risk of COVID-19 in patients with cancer.
Miyashita H, Mikami T, Chopra N, et al. Do Patients with Cancer Have a Poorer Prognosis of COVID-19? An Experience in New York City. Annals of Oncology (2020). DOI: https://doi.org/10.1016/j.annonc.2020.04.006