COVID-19 mortality risk higher among older patients with B-cell malignancies
Older patients with B-cell malignancies diagnosed with COVID-19 had a substantially higher risk for death than their counterparts aged 60 years or younger, according to study results published in JCO Oncology Practice.
Researchers observed no such association between survival and age among patients with metastatic solid tumors.
The study of patients with cancer in ASCO’s COVID-19 registry also showed those diagnosed with COVID-19 in the early months of the pandemic had greater risk for mortality than those diagnosed later in 2020.
In addition, previous or current tobacco users had an increased risk for death if they tested positive for COVID-19, which represents another opportunity to encourage, educate and provide resources for patients on smoking prevention and cessation, Kathryn F. Mileham, MD, FACP, chief of thoracic medical oncology and associate professor at Atrium Health’s Levine Cancer Institute, told Healio.
“COVID-19 treatments are more available now than in the early months of the pandemic, with therapeutic antibodies and soon-to-be-available oral therapies, which should diminish risk for severe outcomes going forward,” Mileham said.
Researchers initiated the ASCO Survey on COVID-19 in Oncology Registry cohort study in April 2020 to identify which patients with cancer have an increased risk for severe COVID-19 and to examine the impact of COVID-19 on cancer care or outcomes.
The study included 453 patients (median age, 64 years; 62% regional or metastatic solid tumors; 43% current or previous tobacco users) receiving care across 38 oncology practices between April and October 2020. Thirty-day and 90-day mortality rates and changes over time served as the primary outcomes.
“We wanted to provide evidence for patients and their clinicians to determine which patients needed more stringent strategies to avoid exposure to the virus and realistic expectations for what it meant to have a COVID-19 infection as a patient with cancer,” Mileham said. “We also wanted to share our findings of the change in mortality in patients with cancer and COVID-19 infection in 2020 — comparing the early part of the pandemic to later in 2020 — as diagnostic testing and treatment strategies improved and the risk for severe outcomes decreased.”
Results showed that among patients with B-cell malignancies, those aged between 61 and 70 years had a twofold higher mortality risk (HR = 2.1; 95% CI, 1.3-3.3) and those aged older than 70 years had a 4.5-fold (95% CI, 1.8-11.1) higher mortality risk than patients aged 60 years or younger.
“We advise patients with cancer to get vaccinated against COVID-19,” Mileham said. “Specific to patients with B-cell malignancies, antibody response to the vaccines in these patients has been shown to be poor, so the three-dose rather than two-dose series is particularly important.”
Compared with an 11% 30-day mortality estimate among patients who never-smoked, tobacco users had a 21% estimate (P = .005).
Moreover, patients diagnosed with COVID-19 before June 2020 had a 30-day mortality rate of 20% (95% CI, 14-25) and 90-day mortality rate of 28% (95% CI, 21-34) vs. 13% (95% CI, 8-18) and 21% (95% CI, 13-28) for those diagnosed in or after June 2020.
“The benefit of the ASCO registry is the ability to provide long-term assessments and determine how things change over time based not just at the community level but down to the individual,” Mileham said. “Since we are still collecting data on patients with cancer infected with COVID-19 and vaccination both prior to and after infection, we plan to compare outcomes among patients with cancer and breakthrough infections vs. those in patients with cancer who were unvaccinated when infected.
“We are collecting up to 2 years of follow-up data per patient since the time of a COVID-19 positive test,” she added. “Because many unknowns remain about how the virus affects patients with cancer, we are encouraging others to use the ASCO registry database for important research questions.”
For more information on the registry, visit www.asco.org/covid-resources/asco-registry.
For more information:
Kathryn Mileham, MD, FACP, can be reached at Atrium Health – Levine Cancer Institute, 1021 Morehead Medical Drive, Bldg. 2, Suite 30500, Charlotte, NC 28204.