ABSTRACT
Introduction Little is known about the rates of asymptomatic COVID-19 carriers among cancer patients. The rate of asymptomatic carriers is important to understand in this population given the use of myelosuppressive and immunomodulating therapies and the risk of transmission to other patients in shared infusion centers. At UC San Diego, in June 2020, we implemented a COVID-19 asymptomatic screening protocol in which cancer patients receiving anti-cancer therapy in an infusion center must undergo symptom-based screening and then SARS-CoV-2 PCR testing prior to their infusion. Here, we describe the results of this asymptomatic screening protocol. Methods This was a single-center retrospective analysis of patients with active cancer receiving infusional anti-cancer therapy in 5 infusion centers who underwent at least 1 asymptomatic SARS-CoV-2 PCR test between 6/1- 12/1/2020. The primary endpoint was the rate of COVID-19 positivity among asymptomatic patients. Symptomatic patients were excluded. Secondary endpoints included COVID-19-related outcomes and patterns of oncologic management for asymptomatic COVID-19 positive patients. Results A cohort of 2,202 cancer patients received at least 1 asymptomatic SARS-CoV-2 PCR test prior to receipt of infusional anti-cancer therapy. 0.95% (N=21/2202) of patients were found to be PCR-positive on asymptomatic screening. Among positive patients, 9.5% (N=2/21) had hematologic malignancies and 90.5% (N=19/21) had solid tumors. In terms of therapy, 76.2% (N=16) were treated with cytotoxic chemotherapy, 9.5% (N=2) with targeted therapy, 4.7% (N=1) with immunotherapy, and 9.5% (N=2) were on a clinical trial. With a median follow-up of 122 days from positive PCR test (range: 8-186), only 2 of 21 (9.5%) of the cohort ultimately developed COVID-related symptoms. Both patients had a diagnosis of acute leukemia and 1 patient required hospitalization for COVID-related complications. No patients died from COVID-related complications. With regards to oncologic management, 95.2% (N=20/21) of patients had their therapy delayed or deferred with a median delay of 21 days (range: 7- 77 days). Only 1 patient proceeded with cytotoxic chemotherapy on schedule in the setting of adjuvant chemoradiation for oropharyngeal squamous cell carcinoma. Among the overall cohort, an additional 26 patients (1.2%) developed cases of symptomatic COVID-19 infection during the study period. Conclusions A strategy of asymptomatic screening of cancer patients receiving anti-cancer therapy in an infusion center detected an extremely low rate of asymptomatic carriers of COVID-19. This low rate of asymptomatic carriers may be due to a number of factors including multiple symptom-based screenings prior to infusion, behavior modification among patients, and/or differential immune responses to COVID-19 infection. Asymptomatic carriers in this cohort appeared to have favorable outcomes with few developing symptoms or requiring hospitalization, though the number of positive patients in our cohort is low, precluding definitive conclusions in this population.
ABSTRACT
Background Patients with cancer appear to have poor outcomes with COVID-19 infection. Cohort analyses of short-term outcomes of COVID-19 (C19)-infected cancer patients (pts) have reported mortality rates ranging from 10 to 30%. Little is known about the long-term outcomes of cancer pts infected with C19. Here, we present an analysis of long-term outcomes of a cohort of active cancer pts with C19 infection. Methods This was a single center retrospective analysis of active cancer pts who tested positive for SARS-CoV-2 virus between 3/1/20- 9/30/20. Key inclusion criteria included a positive SARS-CoV-2 PCR test and an active cancer diagnosis within 90 days of a positive C19 test. We examined the rates of hospitalization for C19 infection, readmission, and C19-related mortality at 30-, 60-, 90-, and 120-day follow-up. Rates of persistent symptoms and systemic complications of C19 infection were described. Results We identified 81 active cancer pts with PCR-confirmed SARS-CoV-2 infection. Among this cohort, the median age was 55 years (range: 19- 89). 77% (N=62) had solid tumors and 23% (N=19) had a hematologic malignancy. 75% (N=61) were receiving an anti-cancer therapy at the time of C19 diagnosis. Median follow-up time from C19 diagnosis to last follow-up was 4.8 months (range: 0.1-9.0 mos). 32% (N=26) of the cohort required hospitalization for C19-related complications within 30 days of C19 diagnosis. Among those hospitalized, 35% (N=9/26) died from C19-related complications. Of the 17 pts who were discharged, 2 pts required readmission with a median time to readmission of 37 days. For these 2 pts, readmission was due to persistent dyspnea and hypoxia and both were treated for pneumonia with presumed bacterial superinfection. There were no additional hospitalizations for C19-related complications at 60-, 90-, and 120-day follow-up. At 90- day follow-up, 6 pts (7.4%) had been diagnosed with PE/DVT. No long-term cardiac, neurologic, or renal complications were observed. With regards to C19-related mortality, 30-day mortality was 8.6% (N=7) and 90-day mortality was 11.1% (N=9). No further C19-related deaths were observed after 90 days. All pts who died were hospitalized within 30 days of initial C19 diagnosis and remained hospitalized at the time of death. Persistent C19-related symptoms were noted in 8.2% (N=6/73) of the cohort at 60-days and 2.8% (N=2/71) at 90-day follow-up. Dyspnea was the most common symptom. Conclusions Among a cohort of active cancer pts with C19 infection, these data suggest that much of the morbidity and mortality associated with C19 infection appears to occur early, with decreased incidence of late complications beyond 30 days. Cancer pts who do not require hospitalization early in their infection course appear to have a decreased rate of late complications. Readmissions for C19-related complications were low, but this analysis was limited by a low number of pts. Achieving a better understanding of long-term outcomes of C19 pts with cancer will help us to better approach oncologic care as the pandemic continues.