People whose cancer is progressing have an increased risk of dying if infected with COVID-19, according to research released May 28, 2020, in advance of the American Society of Clinical Oncology (ASCO) Virtual Scientific Program to be held May 29 to 31.
The findings are from the newly formed COVID-19 and Cancer Consortium (CCC19), which established a registry of patients on March 15 to quickly assembly and analyze data on how the worldwide outbreak of the SARS-CoV-2 virus is impacting patients with cancer, their care, and survival.
“The effects of COVID-19 on patients with cancer remain poorly understood,” said Jeremy L. Warner, MD, lead author of the study and an associate professor of medicine and biomedical informatics at Vanderbilt University Medical Center in Nashville, Tennessee.
“We wanted to collect a larger and more representative cohort to learn more about the impact of COVID-19 on cancer, with the anticipation that patients with cancer could be at greater risk,” he said.
RELATED: Cancer Experts Express Concern About How COVID-19 Is Impacting People With Cancer
Stratifying COVID-19 Risk for People With Cancer
The CCC19 analysis included 928 cancer patients diagnosed with COVID-19 with an average age of 66. Overall, 13 percent of the patients died within 30 days of being diagnosed with COVID-19.
Researchers found cancer that was actively progressive was linked to a 5.2 times higher risk of death after 30 days compared with patients who were in remission or who had no evidence of disease.
Warner’s study also showed that patients who had a diminished ability to perform basic daily-living skills were up to 4 times more likely to die of COVID-19, as were patients over age 75 (30 percent of the patients in the study). Men had an increased risk of death compared with women, and smokers had an increased risk of death compared with nonsmokers.
Of the 928 patients, one-half were hospitalized after COVID-19 diagnosis, and 14 percent required treatment in an intensive care unit.
RELATED: Cancer News From Day 2 of the AACR Virtual Meeting: COVID-19 Concerns Dominate
Controversial Drug Combo Risky for People With Cancer
In the study, the use of hydroxychloroquine and azithromycin to treat COVID-19 in patients with cancer was associated with a nearly threefold greater risk of death at 30 days compared with patients who were in remission or who had no evidence of disease and received the combination of drugs to treat COVID-19.
Azithromycin is a commonly used antibiotic. Hydroxychloroquine is a medication typically used to treat malaria. The latter drug has made headlines because President Donald Trump has championed its use and said he takes the medication prophylactically for COVID-19.
“Taking the combination gives you about a 3 times increased risk of dying within 30 days from any cause,” Dr. Warner said. “Carefully designed prospective trials are needed to see if there is a benefit or risk to these drugs alone or in combination.”
But, he noted, the CCC19 study results are similar to data published May 22 in The Lancet, which showed no benefit and an increased risk of ventricular arrhythmias from hydroxychloroquine given alone or in combination to hospitalized patients.
The study found no significant increased risk of death from using either drug alone.
RELATED: What You Need to Know About Remdesivir, the First FDA-Authorized COVID-19 Medication
A Rush to Understand How COVID-19 Affects Patients With Cancer
Understanding the impact of COVID-19 infection on cancer patients is a high priority in oncology now, said ASCO President Howard A. Burris III, MD, who was not involved in the study.
People with cancer are typically older and have other health problems or underlying conditions, making COVID-19 infection even more threatening. Moreover, these patients often have weakened or overburdened immune systems that are further taxed by the virus.
“The cancer care community urgently needs data on the effects of COVID-19, specifically in patients with cancer,” Dr. Burris said. “How we improve the care we provide these patients and reduce the number of deaths and severe consequences associated with this disease are among the top questions. The COVID-19 and Cancer Consortium registry is a great example of the community quickly coming together to identify and collect the data we need on a large scale.”
The CCC19 registry is open to oncologists in the United States, Canada, and several other countries and has 104 participating institutions. As of mid-April, about one-half of CCC19 registry patients were white, 16 percent black, 16 percent Hispanic, and 15 percent other races and ethnicities.
“Overall we need a larger sample size and longer follow-up to more completely understand the impact of COVID-19 on specific patient subsets, such as certain types of cancer, and what happens over time beyond this short initial period,” Warner said.
RELATED: How Will COVID-19 Impact Cancer Research?