Higher mortality and long-term consequences from SARS-CoV-2

Some cancer patients go through a SARS-CoV-2 infection, sometimes unnoticed. However, current registry studies indicate that the disease is more often fatal in them.

Individual reports do not help science in the fight against the corona pandemic. That is why researchers in oncology have come together internationally in order to be able to answer the specific risks and consequences Cancer patients from infection with SARS-CoV-2 threaten.

That Europe’s largest register of hospitalized COVID-19 patients was created in Great Britain: the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterization Protocol UK (CCP-UK). It takes into account all persons who were admitted to one of the 258 participating British clinics and entered in the CCP-UK with SARS-CoV-2 evidence. By August 12, 2021, those involved had deposited data from over 195,000 patients with full follow-up, including 15,250 participants with a history of cancer and 5,357 under active cancer therapy.1

And, like Dr. Tom Drake of the University of Edinburgh explained a higher risk of death. While about 38-39% of cancer patients suffering from COVID-19 died, it was just under 24% of the remaining patients. However, the cohorts did not differ in terms of mean age or comorbidities.

Mortality in affected cancer patients did not decrease

Therefore, Dr. Drake and colleagues die age-related mortality risks closer and found: Just for young people with tumors the infection reduces the chances of survival. 80-year-old corona patients with cancer were 1.15 times more likely to die than their peers without malignancy. That increased in the age group of 20-year-olds relative Risiko however by nine times. In addition, the researchers observed that the chance of intensive treatment for former cancer patients in the case of COVID-19 was 27% lower, with active therapy even by 32% (OR = 0.83, 95% CI 0.72-0, 95, p = 0.008 or OR = 0.68, 95% CI 0.62-0.74, p <0.001).

It was also noticed that the Mortality in Affected Cancer Patients unlike in the general population, did not decline during the pandemic. On the contrary, it even peaked in summer 2020 and spring 2021 in Maximum values. Why is so far unclear, said Dr. Drake too. But they want to get to the bottom of this in further investigations within the register.

In the OnCovid study with a good 2,600 (haemato-) oncological patients, no such developments were found, as can be seen from the presentation by Dr. David Pinato, Director of Studies at Imperial College London.2 According to this European register, the forecast for the cancer patients suffering from the pandemic. The 14-dayFall mortality – which served as an approximation for corona mortality – in this group from almost 30% in February / March 2020 to 12.5% ​​in the period from July to September 2020. At the beginning of 2021 it was 14.5%.

Time of illness as an independent prognostic factor

After considering several variables with a potential impact on mortality, the Time of illness exist as an independent prognostic factor – by the way, also for three-month mortality, which is more like the cancer-related deaths according to Dr. Pinato. The first wave was more dangerous than the second wave in this regard.

The extent to which better test capacities, clinical management, medication or even health policy had an influence over time can, if at all, only be determined retrospectively, the speaker pointed out. At least, however, his data indicated that larger test capacities would be a previous diagnosis of infection can facilitate. Because at the same time as the decrease in deaths, the researchers recorded an increase in test capacities, and the diagnosis also accelerated – from around three to four days after the onset of symptoms to only one day in the last quarter of 2020.

Long-term consequences associated with a higher risk of death

Dr. Pinato’s colleague Dr. Alessio Cortellini, also working at Imperial College London, drew attention in his lecture to another aspect that increases mortality among cancer patients: the Long-term effects of COVID-19.3 Of the 1,557 people from the OnCovid cohort, almost one in seven apparently struggled with it after recovering from the illness. This affected an above-average number of men, people over 65 years of age, (ex-) smokers, people with two or more comorbidities and people seriously ill with COVID-19. After a detailed analysis, the long-term consequences are with one 76% higher risk of death connected, said Dr. Cortellini (HR = 1.76, 95% CI 1.16-2.66, p <0.0001).

Also disadvantages for systemic cancer therapy

Most often occurred respiratory complaints such as dyspnea or chronic cough and fatigue, but also weight loss or neurocognitive deficits. However, the type of subsequent symptoms seemed to have less of an impact on survival than the number of persistent symptoms. The problem with this is that the complaints mentioned can actually be avoided regularly in cancer patients observe, even without SARS-CoV-2 infection. For Dr. However, Cortellini spoke of the fact that the symptoms occurred regardless of tumor stage and degree, that it is a consequence of the virus.

Incidentally, these also often had disadvantages for them systemic cancer therapy. Almost 15% of the patients who required a dose adjustment were affected by sequelae. In the group that had to permanently discontinue their therapy, the proportion was even 23%. According to the attending physicians, the therapy was stopped mainly because of the poor general condition of the patients during COVID-19, in three out of ten cases because of progressive cancer. And they reduced that Probability of survival especially for those affected.

Although the data are still to be regarded as provisional, according to the current status, discontinuing systemic therapy increased the risk of death by a factor of 3.5, according to Dr. Cortellini (HR = 3.53, 95% CI 1.45-8.59, p <0.0001). Dose adjustments, on the other hand, did not seem to have had any negative consequences, at least on this point.

Sources:
1.Drake T et al. ESMO Congress 2021; Abstract LBA60
2.Pinato DJ et al. ESMO Congress 2021; Abstract 1565MO
3.Cortellini A et al. ESMO Congress 2021; Abstract 1560O_PR
ESMO Congress 2021

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