ABSTRACT
Background: The COVID-19 pandemic has led to deteriorated outcomes among immunocompromised patients, significantly impacting cancer patients. However, little is known about the impact of the COVID- 19 pandemic on cancer patients in low and middle-income countries. Therefore, we sought to investigate the characteristics and clinical outcomes of cancer patients with COVID-19 treated at a single institution. Methods: A retrospective chart review was performed for cancer patients treated at King Hussein Cancer Center. Patients who were diagnosed with laboratory-confirmed SARS-CoV-2 infection by Real-time Polymerase chain reaction test between April 2020 and October 2020 were identified. Results: Overall, 327 COVID-19-infected cancer patients were included. At the time of COVID- 19 diagnosis, the median age was 55 years (range, 18-87 years), 146 patients (45%) were males. The most common neoplasms were breast cancer (n = 90, 27.5%), gastrointestinal cancers (n = 60, 18.3%), and lymphoma (n = 36, 11%). The majority of patients had comorbidities (n = 200, 61%), of which hypertension and diabetes mellitus were the most common. Testing reason was presence of symptoms in 183 (56%) patients, previous exposure in 10 (3.1%), and before elective procedure in 142 (43.4%). 118 patients (56.5%) were hospitalized and 18 patients (5.5%) required admission to the intensive care unit (ICU). At the time of the last follow-up, 76% (n = 249) remained alive, and 24% (n = 78) died, among which death was considered to be COVID related in 41 (52.5% of deaths). Mortality was significantly increased in patients with comorbidities (29%, vs 15.7 %;p = 0.008), the use of cardiac medications (34.3% vs. 18.1%;p = 0.001), active cancer status vs. remission (28.2% vs 11.6% p = 0.002), receiving chemotherapy in the last four weeks (27.6% vs 16.4%, p = 0.028), and when testing reason was the presence of symptoms vs exposure and elective (37.7% vs. 10% and 7.7% p = < 0.001) respectively. Chemotherapy was delayed in 109 (33.4%) patients and permanently discontinued in 57 (17.5%) patients. Among patients required hospitalization and needed ICU admission, mortality rates were 55.1% and 88.9% respectively. Conclusions: COVID-19 infection is associated with significant mortality and negatively affects treatment plans in cancer patients. A follow-up study will be needed to evaluate the effect of vaccination on the outcomes.
ABSTRACT
Introduction: The COVID-19 infection has a devastating clinical outcome among individuals with immunocompromised states, particularly those with malignancies. The impact of the coronavirus pandemic on patients with hematological malignancies in low and middle-income countries is not well studied. Herein, we sought to report the clinical outcomes of the COVID-19 infection in patients with hematological malignancies treated at a single institution. Methods: Electronic medical record charts of patients diagnosed with hematological malignancies (leukemia, lymphoma, and multiple myeloma) were reviewed. Patients who were diagnosed with laboratory-confirmed SARS-CoV-2 infection by Real-Time Polymerase Chain Reaction test between April 2020 and October 2020 were identified as the subjects of this study. The demographic data, including tumor characteristics, laboratory results, anti-cancer treatments, patient outcomes (need for hospitalization, ICU admission, complications, and mortality), were extracted and analyzed. Results: We identified 89 patients diagnosed with hematological malignancies who were infected with COVID-19 during the eligibility period. The median age at the time of diagnosis was 54 years (range, 19-80 years). Fifty-two patients (58%) were male, and 37 patients (42%) were female. Of the 89 cases, 41 patients (46%) were diagnosed with lymphoma, 27 patients (30%) had leukemia, 21 patients (24%) had multiple myeloma. 84 patients (94%) received prior anti-cancer treatment, such as: chemotherapy (n=47, 53%), immunotherapy (n= 4, 4%), chemoimmunotherapy (n=26, 29%), and tyrosine kinase inhibitors (n=3, 3%). At the time of COVID-19 diagnosis, 52 patients (58%) had active malignancy, while 37 patients (42%) were in remission. Fifty-nine patients (66%) had comorbidities, with hypertension (n=32, 36%) being the most commonly reported comorbidity, followed by diabetes mellitus (n=25, 28%) and ischemic heart disease (n=8, 9%). The most encountered presentations were: fever (n=32, 36%) followed by cough (n=31, 35%), shortness of breath (n=21, 23%), aches (n=6, 7%), fatigue (n=6, 7%), and ageusia (n=6, 7%). Forty subjects (45%) were hospitalized, 11 patients (12%) were eventually admitted to the intensive care unit (ICU). Notably, the hospitalization and ICU admission rates were higher among the people aged more than 53 years (n= 24, 59%;n=9, 82%, respectively). Among the 89 patients, complications were recognized in 36% of the patients (n=32), with sepsis (n=12, 13%), acute kidney injury (n=11, 12%), and cardiovascular complications (n=3, 3%) being the most prevalent complications. The median time interval between the date of COVID-19 diagnosis and the last follow-up date was 3 months (range, 2 days-6.4 months). At the time of the last follow-up, 64 patients (72%) remained alive, and 25 patients (28%) succumbed to COVID-related complications. Conclusion: The COVID-19 infection has deteriorated clinical outcomes among patients with hematological malignancies, which could be attributed to the high incidence of infections, increased risk of hospitalizations/ICU admissions, and other COVID-related complications. Such high morbidity and mortality rates necessitate future studies to outline the potential risk factors for COVID-related complications and modifications in the plan of care, including evaluation of the effect of vaccination on the outcome of these patients. Disclosures: No relevant conflicts of interest to declare.