ABSTRACT
Background: There is insufficient evidence to support clinical decision-making for oncology patients diagnosed withCOVID-19 due to the limited studies focusing on factors affecting COVID-19-associated disease severity/death incancer patients. Methods: We retrospectively analyzed data from KU Cancer Center to assess demographic/clinical characteristicsand ferritin levels of 40 cancer patients with a confirmed COVID19 diagnosis by viral RNA detection in anasopharyngeal swab between 3/1/20 through 6/9/20. Chi square test and Mann-Whitney U test were used toidentify whether demographic/clinical characteristics and ferritin were associated with COVID-19 severity/death. Results: Median age was 59.5 years, 16 (40%) were aged 65 years or older, and 18 (45%) patients were male. 31(77.5%) were non-Hispanic, 21 (52%) were Caucasians, 11 (27%) were African Americans, and 21 (52.5%) werecurrent/former smokers. 14 (35%) were obese. Breast cancer n=9 (22.5%) was the most prevalent malignancy. 28(70%) had ECOG of 0/1. 27 (67.5%) were on active anticancer treatment, and 13 (32.5%) had active (measurable)cancer. 12 (30%) had recent surgery. 6 (15%) were asymptomatic and 34 (85%) were symptomatic. Fever (47.5%), cough (57.5%), productive cough (50%), and shortness of breath (47.5%) were the most common symptoms. Atanalysis (June 9, 2020), 3 (7.5%) patients had died. 8 (38.1%) had mild/moderate COVID-19 illness and 13 (61.9%)had severe illness (ICU admission, intubation, death). Patients with mild/moderate illness were significantly younger(median age 56.5 years) vs. those with severe illness (median age 67.5 years), p=0.02. Sex, race and ethnicity, obesity, ECOG, cancer type, active cancer treatment, and recent surgery were not associated with COVID-19severity. However, productive cough (p=0.01) and shortness of breath (p=0.006) were associated with COVID-19severity. In 19 patients with available ferritin levels, asymptomatic patients (n=2) had a significantly lower ferritin(median 68.5 NG/ML) vs. symptomatic (n=17), who had higher ferritin (median 422 NG/ML) p=0.04. Conclusions: Age was associated with an increased risk of COVID-19-related disease severity/death in cancerpatients. This may possibly reflect the effects of more advanced malignant disease, anticancer treatment, andcomorbidities on the impact of this infection. Ferritin levels appear to have a role in screening and monitoring forCOVID-19 infection in cancer patients. Hence, our findings warrant validation in a larger cohort. A prospective studyis under way at the University of Kansas Cancer Center to validate the factors associated with COVID-19-relateddisease severity/death in cancer patients.
ABSTRACT
Background: The oncology community faces unprecedented challenges in balancing a delay in cancer treatmentagainst the risk for a potential COVID-19 infection and associated complications. An early retrospective analysisreported that cancer patients with COVID-19 infection have a much higher death rate than those infected but withouta cancer diagnosis, likely because of their immunocompromised disease from cancer and treatment. Even thoughCOVID-19 is known to have a long incubation period (∼14 days), there were no clear guidelines for screeningasymptomatic cancer patients who are planning to have and having antitumor treatment as of April 2020. Methods: We developed a protocol to screen asymptomatic cancer patients for COVID-19 who are scheduled toreceive cancer-directed treatment (i.e., chemotherapy, targeted therapy, immunotherapy, anticancer monoclonalantibody, endocrine therapy, or investigational agent). The protocol was developed and activated within 2 weeksthrough the Cancer Center Investigator Initiated Trial Program. FDA-authorized CDC 2019-Novel Coronavirus(2019-nCoV) Real-Time RT-PCR Diagnostic Panel EUA kit was performed at Sinochips Diagnostics. The primaryobjective was to determine COVID-19 status in participants prior to initiating anticancer treatment. The secondaryobjective was to evaluate COVID-19 related adverse events (AEs) in recovered COVID-19-positive participants for30 days after initiation of anticancer therapy. Results: We enrolled 507 patients and tested for COVID-19 from 4/28/20 to 5/8/20 through coordinated efforts within the CTO and Biospecimen Repository Core Facility. The research study was stopped when the KU HealthSystem was able to test this population as standard of care. Median age was 65 years, 110 patients (22%) wereaged 75 years or older, and 274 (54%) patients were female. 387 patients (76.3%) were Caucasians, 35 (6.9%)African American, 7 (1.4%) Asian, and 437 (86.2%) non-Hispanic. Based on the catchment of zip codes, 7% oftested patients came from more than 60 miles and 1.6% from more than 100 miles. Zero patients had a positiveCOVID-19 test. Conclusions: The prevalence of COVID19 in asymptomatic cancer patients is low, likely because of goodcompliance with the social distance policy. Screening for COVID19 may help reduce AEs related to COVID-19 inpatients receiving cancer-directed treatment. Studying COVID-19 test results in a larger patient pool is warranted. Asimilar study to test asymptomatic patient-facing oncology staff is pending.