Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China

Abstract

Background: Cancer patients are regarded as a highly vulnerable group in the current Coronavirus Disease 2019 (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain largely unknown.

Patients and methods: In this retrospective cohort study, we included cancer patients with laboratory-confirmed COVID-19 from three designated hospitals in Wuhan, China. Clinical data were collected from medical records from 13 January 2020 to 26 February 2020. Univariate and multivariate analyses were carried out to assess the risk factors associated with severe events defined as a condition requiring admission to an intensive care unit, the use of mechanical ventilation, or death.

Results: A total of 28 COVID-19-infected cancer patients were included; 17 (60.7%) patients were male. Median (interquartile range) age was 65.0 (56.0-70.0) years. Lung cancer was the most frequent cancer type (n = 7; 25.0%). Eight (28.6%) patients were suspected to have hospital-associated transmission. The following clinical features were shown in our cohort: fever (n = 23, 82.1%), dry cough (n = 22, 81%), and dyspnoea (n = 14, 50.0%), along with lymphopaenia (n = 23, 82.1%), high level of high-sensitivity C-reactive protein (n = 23, 82.1%), anaemia (n = 21, 75.0%), and hypoproteinaemia (n = 25, 89.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n = 21, 75.0%) and patchy consolidation (n = 13, 46.3%). A total of 15 (53.6%) patients had severe events and the mortality rate was 28.6%. If the last antitumour treatment was within 14 days, it significantly increased the risk of developing severe events [hazard ratio (HR) = 4.079, 95% confidence interval (CI) 1.086-15.322, P = 0.037]. Furthermore, patchy consolidation on CT on admission was associated with a higher risk of developing severe events (HR = 5.438, 95% CI 1.498-19.748, P = 0.010).

Conclusions: Cancer patients show deteriorating conditions and poor outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 coinfection.

Keywords: COVID-19; cancer; retrospective case study; severe clinical events.

Figure 1

Representative images of the chest computed tomography (CT) scan at different times throughout the disease course. (A–C) Axial CT scanning and (D–F) coronal scanning images are from a 70-year-old woman who was diagnosed with adenocarcinoma and received left upper lobectomy in 2010. As her adenocarcinoma recurred in 2012, she has so far received four courses of chemotherapy and targeted therapy (gefitinib). (A and D) Day 1 after symptom onset: left lung with reduced lung volume after left upper lobectomy and multifocal ground-glass opacities in the bilateral inferior lung lobes (arrows). (B and E) Day 10 after symptom onset: progressively diffused ground-glass opacities and consolidation (arrows) in bilateral subpleural regions. (C and F) Day 25 after symptom onset: improvement of ground-glass opacities and little fibrous stripe in the right lower lung (arrow). (G–I) Coronal CT scanning images are from a 47-year-old man who was diagnosed with nasopharyngeal carcinoma in 2016. Radiotherapy adjuvant chemotherapy was carried out. (G) Day 21 after symptom onset: diffused ground-glass opacities, obvious consolidation, mixed with reticular appearance in bilateral lungs. (H) Day 28 after symptom onset: decreased ground-glass opacity, consolidation, and interlobular septal thickening (arrow). (I) Day 32 after symptom onset: further improvement in appearance with predominant reticular patterns (arrows).

Figure 2

Kaplan–Meier curve of risk factors for developing severe events, adjusted by age and sex. (A) Cancer patients who received antitumour treatment within 14 days before Corona Disease 2019 (COVID-19) diagnosis or >14 days after its diagnosis. (B) Patchy consolidation in the first computed tomography scan on admission or its absence on admission.