Characteristics and Outcome of SARS-CoV-2 Infection in Cancer Patients

Abstract

Background: Concerns have emerged about the higher risk of fatal coronavirus disease 2019 (COVID-19) in cancer patients. In this article, we review the experience of a comprehensive cancer center.

Methods: A prospective registry was set up at Institut Curie at the beginning of the COVID-19 pandemic. All cancer patients with suspected or proven COVID-19 were entered and actively followed for 28 days.

Results: Among 9842 patients treated at Institut Curie between March 13 and May 1, 2020, 141 (1.4%) were diagnosed with COVID-19, based on reverse transcription polymerase chain reaction testing and/or computerized tomography scan. In line with our case mix, breast cancer (40.4%) was the most common tumor type, followed by hematological and lung malignancies. Patients with active cancer therapy or/and advanced cancer accounted for 87.9% and 68.9% of patients, respectively. At diagnosis, 78.7% of patients had COVID-19-related symptoms, with an extent of lung parenchyma involvement inferior to 50% in 95.8% of patients. Blood count variations and C-reactive protein elevation were the most common laboratory abnormalities. Antibiotics and antiviral agents were administered in 48.2% and 6.4% of patients, respectively. At the time of analysis, 26 patients (18.4%) have died from COVID-19, and 100 (70.9%) were cured. Independent prognostic factors at the time of COVID-19 diagnosis associated with death or intensive care unit admission were extent of COVID-19 pneumonia and decreased O₂ saturation.

Conclusions: COVID-19 incidence and presentation in cancer patients appear to be very similar to those in the general population. The outcome of COVID-19 is primarily driven by the initial severity of infection rather than patient or cancer characteristics.

Figure 1.

Flow chart. Figure showing how patients were selected for the present analysis. CT = computed tomography; RT-PCR = reverse transcriptase polymerase chain reaction.

Figure 2.

Baseline COVID-19–related findings on chest CT scan according to main baseline characteristics in 80 patients. Distribution of the initial extent of pulmonary parenchymal lesions is displayed according to cancer-related (A), patient-related (B), or COVID-19 diagnosis-related (C) parameters. Numbers indicate the percentage of each imaging pattern according to the 5-class classification we retained: absent/minimal (0% to <10%); moderate (10%-25%); extensive (26%-50%); severe (51%-75%); critical (>75%). The longest spokes indicate the highest frequency of the corresponding pattern. CT = computerized tomodensitometry.

Figure 3.

Patient trajectory from baseline to day 28. Diagram showing the changing status of cancer patients with COVID-19, based on individual follow-up. At baseline, patients were either immediately discharged home (dark blue bars) or hospitalized (light blue bars), including patients already hospitalized at the time of COVID-19 diagnosis (hospital-acquired infection). The patient’s status may have changed on days 7, 14, and 28 to one of the following 4 modalities: discharged home (dark blue bars), hospitalized (light blue bars), admitted to the intensive care unit (ICU, dark orange bars), and deceased (light orange bars). The grey flows between bars are proportional to the number of patients at each step.