Published on October 29, 2020
Cancer Patients on Immunotherapy & Chemotherapy Need to Be Extra Cautious
New research has added to our understanding of the risk of COVID-19 to cancer patients and underscores the importance of patients taking extra precautions to avoid infection.
Cancer patients who received treatment within three months of a COVID-19 diagnosis had the highest risk of death out of 3,600 cancer patients who contracted the novel coronavirus, according to a preliminary study by researchers at the University of Cincinnati (UC). Death rates were highest for patients treated with immunotherapy plus chemotherapy. Among patients on both therapies who contracted the novel coronavirus, 29 percent died. (The death rate for cancer patients who hadn’t received any treatment in the previous year was 14 percent.)
Monoclonal Antibodies and COVID-19
Anti-CD20 monoclonal antibodies, including rituximab (Rituxan) and obinutuzumab (Gazvya), deplete abnormal B cells common for certain lymphomas, according to study author Dr. Trisha Wise-Draper, an associate professor of medicine in the Division of Hematology and Oncology at the UC College of Medicine. The problem is B cells protect the body from infection.
"Any way you slice it, this is not good news for patients who are fighting cancer,” Dr. Wise-Draper said in a UC press release. She presented her findings at the European Society for Medical Oncology Virtual Congress 2020 last month. “Targeted therapies, especially those causing immune cell depletion, used one to three months before [the diagnosis of COVID-19] are associated with very high mortality, up to 50 percent. Also, death from any condition or reason in patients with cancer is higher than the general population, including those who have been in remission and have not received treatment in the last year.”
Impact of the Coronavirus on Cancer Patients
Dr. Wise-Draper and her colleagues analyzed 3,600 patients from 122 institutions in the COVID-19 and Cancer Consortium (CCC19) registry, which has been tracking the impact of the novel coronavirus on cancer patients. The registry is funded by the American Cancer Society, National Institutes of Health, and Hope Foundation of Cancer Research.
She said except for endocrine therapy, death was higher for those undergoing active cancer treatment compared to those who hadn’t been treated within a year prior to their COVID-19 diagnosis. Patients who received endocrine therapy had the lowest death rate after contracting COVID-19, at 11 percent.
Cancer patients in general are more susceptible to COVID-19 and subsequent complications. In the first analysis of about 1,000 patients in the registry in June, 13 percent died within 30 days of their COVID-19 diagnosis. The majority (37 percent) had a breast or prostate cancer diagnosis and 39 percent were undergoing cancer treatment when they contracted the coronavirus.
In a subsequent analysis of nearly 2,200 cancer patients in the registry, 16 percent died within 30 days, more than threefold greater than reported in the affected general population, noted Dr. Gary Lyman, co-senior author of the study and a medical oncologist-hematologist and researcher at Fred Hutchinson Cancer Research Center in Seattle. Lung cancer patients appeared especially vulnerable.
“I think it's clear our patients are having to deal with issues coming in and out of clinic for treatment, symptom management, and are on treatments that can make them most likely at higher risk [for COVID-19],” said Dr. Meredith McKean, a medical oncologist at Tennessee Oncology in Nashville, Tennessee, in an interview with Patient Power Co-Founder Andrew Schorr. “But that's something that's still evolving, and we're still learning what risk factors we can try to help mitigate.”
Keeping Cancer Patients Safe During the Pandemic
Cancer patients should not be deterred from getting lifesaving or life-prolonging treatment, Dr. Wise-Draper told HealthDay. However, the study reinforces the reasons cancer patients should be vigilant with mask-wearing, social distancing and other preventive steps: washing hands often with soap and water; avoiding touching the eyes, nose and mouth with unwashed hands; keeping extra distance — six feet is recommended — from people outside the household; regularly disinfecting frequently used surfaces; and avoiding unnecessary travel outside the home.
Monitoring cancer patients before, and during, treatment is also critical, according to Dr. Joshua Brody, director of the Lymphoma Immunotherapy Program at Mount Sinai in New York City. He told HealthDay that should include “routine COVID-19 screening plus a quick response if a patient does become sick — which could mean hospitalization and treatment with the drug dexamethasone.”
Dr. McKean emphasized the importance of working with your healthcare team. “The same team that's been helping take care of you either in the past or now for your cancer care, they're also there to help guide you and help try to keep you safe and help you make the best decisions,” she told Schorr. “So, don't feel alone. We're all in this together, and you've got a team around you that's ready to help.”
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- UC study sheds light on cancer treatment, COVID-19
- Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
- Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer
- The latest on how COVID-19 affects cancer patients
- Certain Cancer Treatments May Heighten Danger From COVID-19
- Common Questions About the COVID-19 Outbreak
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