Long COVID in cancer patients: preponderance of symptoms in majority of patients over long time period

Abstract

Background: An increasing number of observational studies have reported the persistence of symptoms following recovery from acute COVID-19 disease in non-cancer patients. The long-term consequences of COVID-19 are not fully understood particularly in the cancer patient population. The purpose of this study is to assess post-acute sequelae of SARS-CoV-2 infection (PASC) in cancer patients following acute COVID-19 recovery.Methods: We identified cancer patients at MD Anderson Cancer Center who were diagnosed with COVID-19 disease between March 1, 2020 and Sept 1, 2020 and followed them till May 2021. To assess PASC, we collected patients reported outcomes through questionnaires that were sent to patients daily for 14 days after COVID-19 diagnosis then weekly for 3 months, and then monthly thereafter. We also reviewed patients' electronic medical records to capture the persistence or emergence of new COVID19-related symptoms reported during any clinic or hospital encounter beyond 30 days of the acute illness and up to 14 months.Results: We included 312 cancer patients with a median age of 57 years (18-86). The majority of patients had solid tumors (75%). Of the 312 patients, 188 (60%) reported long COVID-19 symptoms with a median duration of 7 months and up to 14 months after COVID-19 diagnosis. The most common symptoms reported included fatigue (82%), sleep disturbances (78%), myalgias (67%) and gastrointestinal symptoms (61%), followed by headache, altered smell or taste, dyspnea (47%) and cough (46%). A higher number of females reported a persistence of symptoms compared to males (63% vs 37%; p=0.036). Cancer type, neutropenia, lymphocytopenia, and hospital admission during acute COVID-19 disease were comparable in both groups. Among the 188 patients with PASC, only 16 (8.5%) were readmitted for COVID-related reasons.Conclusions: More than one out of two cancer patients, and more likely females, report PASC that may persist beyond 6 months and even one year. The most common symptoms are non-respiratory and consist of fatigue, sleep disturbance, myalgia and gastro-intestinal symptoms. Most of the cancer patients with PASC were managed on outpatient basis with only 8,5% requiring a COVID-19 related re-admission.Funding: This research is supported by the National Institutes of Health/National Cancer Institute under award number P30CA016672, which supports the MD Anderson Cancer Center Clinical Trials Office. The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Course of fatigue among patients previously hospitalised due to COVID-19

“…Another study of 504 previously hospitalised patients from Saudi Arabia followed-up three months after the onset of infection showed that the presence of post-COVID syndrome, with fatigue constituting its most common presentation, was associated with female sex, three or more comorbidities, steroid treatment, and symptoms of nasal congestion and depression during the acute phase of disease [33]. Female predominance among subjects with persistent post-COVID symptoms, with the most common being fatigue, sleep disturbances, and myalgia, was also confirmed in a cohort of 312 patients with cancer observed up to 14 months post-infection [34]. In a large cohort of more than 12,000 adult patients from Sweden who were hospitalised due to COVID-19, it was found that post-COVID symptoms, with the prevalence of fatigue being 22%, were more common in women of middle age, and association with asthma and mental health disorders was less prominent compared to non-hospitalised individuals [35].…”

Disentangling the relationship between cancer mortality and COVID-19 in the US

“…Another limitation of our study is the reliance on mortality as an outcome, while it may be important to consider the risk of COVID-19-related hospitalization and morbidity, and Long COVID in cancer patients. A small US study reported that 60% of cancer patients suffered Long COVID symptoms (Dagher et al, 2023). Future analyses using hospitalization data and electronic medical records may provide additional insights on how different cancer stages or other comorbidities may contribute to increased risk of severe COVID-19 outcomes.…”

“…In a large cohort study of ~500,000 COVID-19 inpatients, only cancer patients under recent treatment were at increased risk of COVID-19 related deaths (OR=1.7) relative to non-cancer patients (Chavez-MacGregor et al, 2022). Conversely, a smaller European study of 3,000 COVID-19 inpatients found that cancer was not a risk factor (Rüthrich et al, 2021), as did an international, multicenter study of 4,000 confirmed COVID-19 inpatients (Raad et al, 2023). More recently a meta-analysis of 35 studies from Europe, North America, and Asia found a 2-fold increased risk of COVID-19 mortality among cancer patients (Di Felice et al, 2022).…”

MULTIMORBIDITY, MORBIDITIES, AND LONG COVID – findings of the Sulcovid longitudinal study

“…Regarding cancer [35], they found that 60.0% of people with neoplasms reported symptoms of long COVID, with an average duration of 7-14 months after infection; fatigue (82%), sleep disturbances (78%), myalgia (67%), and gastrointestinal symptoms (61%), followed by dyspnea (47%), and cough (46%) were the most reported symptoms [35].…”