Long COVID appears to ‘impair’ survival of cancer patients

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More than one in six cancer patients have long-term sequelae after infection with SARS-CoV-2, putting them at increased risk of discontinuing cancer treatment or dying, registry data shows European.

Given the “high lethality” of COVID-19 in cancer patients and the risk of long-term complications after infection in the general population, Alessio Cortellini, MD, consulting medical oncologist at Hammersmith Hospital and Imperial College of London, London, UK, and colleagues wanted to explore the “prevalence and clinical significance of the sequelae of COVID-19 in cancer patients and their continuity of cancer care”.

Cortellini presented the research on the OnCovid registry on September 21 at the 2021 annual meeting of the European Society for Medical Oncology (ESMO). cancer care.

Data from the OnCovid registry showed that the 15% of cancer patients who had long-term complications from COVID-19 were 76% more likely to die than those without sequelae. Cancer patients with COVID-19 sequelae were significantly more likely to permanently discontinue systemic cancer treatment, and they were more than 3.5 times more likely to die than those who continued treatment as planned. In terms of long-term complications, almost half of the patients experienced dyspnea and two-fifths reported chronic fatigue.

“These data confirm the need to continue prioritizing cancer patients,” commented Antonio Passaro, MD, PhD, Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy, in a press release . “In the fight against the pandemic, it is of the utmost importance not to neglect to study and understand the curves of incidence and mortality from cancer.

Asked to discuss the results, Anne-Marie C. Dingemans, MD, PhD, pulmonologist and professor of thoracic oncology at Erasmus Medical Center in Rotterdam, the Netherlands, said COVID-19 remains a “very important” problem for cancer patients.

Interestingly, Dingemans noted that the sequelae of COVID-19 in cancer patients appear to occur somewhat less frequently compared to estimates in the general population – which range from 13% to 60% – although patients with cancer tend to have more breathing problems.

However, Dingemans added, the difficulty in comparing sequelae rates between cancer patients and the general population is that cancer patients “probably already have a lot of symptoms” associated with a long COVID, such as dyspnea and fatigue, and may not be aware that they are suffering from the after-effects of COVID.

The results of the registry

To study the long-term impact of COVID-19 on survival and continuity of care, the team looked at data from the OnCovid registry, which was established at the start of the pandemic to study consecutive 18-year-old patients. and more with confirmed SARS-CoV. -2 infection and a history of solid or hematologic malignancies.

By the data cut-off date of March 1, 2021, the registry included 35 establishments in six European countries. The institutions collected information on patient demographics and comorbidities, cancer history, cancer treatment, COVID-19 investigations, and COVID-19-specific therapies.

For the current analysis, the team included 1,557 of 2,634 patients who had undergone clinical reassessment after recovering from COVID-19. Sufficient information to perform multivariate analysis was available for 840 of these patients.

About half of the patients were under 60 and just over half were women. The most common cancer diagnoses were breast cancer (23.4%), gastrointestinal tumors (16.5%), gynecological / genitourinary tumors (19.3%), and hematological cancers (14 , 1%), with a uniform distribution between local / locoregional and advanced disease.

The median interval between recovery from COVID-19 and reassessment was 44 days, and the average post-COVID-19 follow-up period was 128 days.

Fifteen percent of patients have experienced at least one long-term sequela from COVID-19. The most common were dyspnea / shortness of breath (49.6%), fatigue (41.0%), chronic cough (33.8%) and other respiratory complications (10.7%).

Cortellini noted that cancer patients with sequelae were more likely to be males, aged 65 or older, to have two or more co-morbidities and to have a history of smoking. Additionally, cancer patients who experienced long-term complications were significantly more likely to have had complications from COVID-19, needed treatment for COVID-19, and been hospitalized for disease.

Taking into account gender, age, comorbid burden, primary tumor, stage, receipt of anti-cancer and anti-COVID-19 treatment, complications of COVID-19 and hospitalization, the team found that the sequelae of COVID-19 were independently associated with an increased risk of death. (risk ratio, 1.76).

Further analysis of systemic cancer treatment regimens in 471 patients revealed that 14.8% of COVID-19 survivors permanently discontinued treatment and that a dose or regimen adjustment occurred for 37.8 %.

Patients who permanently discontinued cancer treatment were more likely to be former or current smokers, to have had complications from COVID-19 or to have been hospitalized for COVID-19, and to have suffered after-effects from COVID-19 during reassessment. Researchers found no association between stopping treatment permanently and the stage of cancerous disease.

Cortellini and colleagues reported that stopping systemic cancer treatment permanently was associated with an increased risk of death. A change in dose or regimen did not affect survival.

The most common reason for permanent discontinuation was deterioration in patient performance (61.3%), followed by disease progression (29.0%). Dose or regimen adjustments were generally made to avoid immune suppression (50.0%), hospitalization (25.8%), and intravenous drug administration (19.1%).

Cortellini concluded his presentation by emphasizing the importance of increasing awareness of long-term COVID in cancer patients as well as early treatment of the sequelae of COVID-19 to improve patient outcomes.

The study was funded by the Imperial College Biomedical Research Center. Cortellini maintains relationships with MSD, BMS, Roche, Novartis, AstraZeneca, Astellas, Sun Pharma. Dingemans has relationships with Roche, Eli Lilly, Boehringer Ingelheim, AstraZeneca, Jansen, Chiesi, Amgen, Pfizer, Bayer, Takeda, Pharmamar and Sanofi.

European Society for Medical Oncology (ESMO) 2021 Annual Meeting: Summary 1560O. Presented September 21, 2021.

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