In this study, the clinical characteristics and outcomes of 66 cancer patients with coronavirus disease-19 have been reported. The median age of participants was 61 years old and the main symptoms were fever, cough, and fatigue. Leukemia and lymphoma were the most prevalent cancer among patients followed by breast cancer. Our results showed that cancer patients had anemia, lymphopenia, and leukopenia. A quarter of our patients were admitted to the ICU and received HCQ and corticosteroids. About 71.4% of COVID-19-infected cancer patients received at least one antiviral drug, such as ganciclovir, lopinavir/ritonavir, arbidol, and ribavirin, while 32.1% were treated with two or more than two antiviral drugs. All patients with abnormal chest CT showed a GGO. The rate of mortality in cancer patients with COVID-19 was 23% and was not significantly different from among cancer COVID-19 patients with different stages.
Cancer patients have several risk factors that put them at higher risk for COVID-19 infection, such as suppressed immune systems, older age, increased comorbidities (e.g., diabetes, chronic lung disease, and cardiovascular disease), and need for frequent hospitalizations and referring to the hospital for chemotherapy. According to a study conducted in the USA, increased rate of mortality in cancer patients with COVID-19 is significantly linked with older age, need for ICU support, multiple comorbidities, and elevated levels of lactate dehydrogenase, D-dimer, and lactate. Three of these items including elevated levels of D-dimer, lactate dehydrogenase, and higher incidence of comorbidities were found in COVID-19-infected cancer patients in our study as well. Fatality rate in their study was 28%, which is almost similar to our result (23%). The double-arm meta-analysis by ElGohary et al. showed that cancer patients had a higher risk of mortality, ICU admission, severe/critical disease, and mechanical ventilation than noncancer patients, but the rate of ICU admission was not significantly different between groups in a case-control study performed in Iran (P > 0.05). This study also reported significantly higher rate of dry cough (75.0% vs. 29.2%, P = 0.01) and fever (72.7% vs. 45.8%, P = 0.02) in COVID-19 cancer patients, but these differences were not significant in our study between these groups. In their study, gastrointestinal cancer was the most frequent type of cancer followed by breast cancer and hematologic. Nine (37.5%) of their cancer patients were at stage 4, while in our study, only 20% were diagnosed with metastatic cancer. The prevalence of breast cancer in both studies was similar, 18.18% in our study versus 20.8% in study by Taghizadeh-Hesary et al.
In our study, 77.1% of COVID-19 cancer patients had anemia, which is higher compared to prevalence of anemia in general COVID-19 population (48.2%) reported by another study in Iran and 24.7% reported by Bellmann-Weiler in Austria. According to their results, the rate of death was almost twice in patients with anemia compared to the rest of COVID-19 population. It has been reported that the higher percentage of anemia in COVID-19 cancer patients may be the result of malnutrition and an immunosuppressive condition that leads to the increased susceptibility to respiratory pathogens. According to a cohort study in the USA, on admission, anemia was independently associated with increased risk of all-cause mortality in COVID-19 patients, but it was not significantly linked with severe outcomes during hospitalization. A recent study of 259 patients with COVID-19 by Bellmann-Weiler et al. also confirmed these results that anemia on admission but not iron deficiency is an independent predictor of COVID-19 related mortality.
For both cancer and general COVID-19 patients in our study, GGO was the most occurred feature of chest CT imaging followed by patchy consolidation, which has higher prevalence in COVID-19 cancer patients as a bilateral lung involvement than regular patients. These findings are in line with the results of study by Zhang et al., Vuagnat et al., and Taghizadeh-Hesary et al., named the GGO as the most common imaging result.
A nationwide analysis on cancer patients with coronavirus in China showed that patients undergoing chemotherapy or cancer-related surgery were more likely than general COVID-19 patients at the risk of severe clinical events. Our study showed an increased risk of mortality and serious clinical events due to the COVID-19 infection in cancer patients after surgery. However, the risk of side effects from cancer treatments does not appear to increase. The true effects of COVID-19 on cancer patients will be known in the near future. Evidence suggests that cancer is associated with worse clinical outcomes in patients with COVID-19. However, elderly patients with cancer may not be at risk of death if they develop COVID-19. These findings could potentially help physicians discuss with patients about their disease conditions to provide a prognosis and maybe, guide health policy. In the field of cancer, it is clear that the earlier the diagnosis of malignancy or cancer, the better the clinical outcome for the patient. Most health-care protocols have now follow safety guidelines and procedures, which have significantly reduced the risk of viral outbreaks when encountered in their health-care facilities. False negative results of COVID-19 test and incomplete information of some patients are the limitations of our study.