Outcomes of COVID-19 in Patients With Lung Cancer Treated in a Tertiary Hospital in Madrid

Abstract

Background: Cancer patients represent a vulnerable population for COVID-19 illness. We aimed to analyze outcomes of lung cancer patients affected by COVID-19 in a tertiary hospital of a high-incidence region during the pandemic. Methods: We annotated 23 lung cancer patients consecutively diagnosed with COVID-19 at our institution (HGUGM; Madrid, Spain) between March 4th, 2020 and May 12th, 2020. Only patients with a confirmatory SARS-CoV-2 RT-PCR were included in the study. Results: All patients had at least 1 COVID-19 related symptom; cough (48%), shortness of breath (48%), fever (39%), and low-grade fever (30%) were the most common. Time from symptoms onset to first positive SARS-CoV-2 PCR was 5.5 days (range 1-17), with 13% of cases needed from a 2nd PCR to confirm diagnosis. There was a high variability on thoracic imaging findings, with multilobar pneumonia as the most commonly found pattern (74%). Main lab test abnormalities were low lymphocytes count (87%), high neutrophil to lymphocyte ratio-NLR-(78%), and elevated inflammatory markers: fibrinogen (91%), c-reactive protein-CRP-(87%), and D-dimer (70%). In our series, hospitalization rate was 74%, 39% of patients developed acute respiratory distress syndrome (ARDS), and the case-fatality rate was 35% (8/23). 87% of patients received anti-viral treatment (87% hydroxychloroquine, 74% lopinavir/ritonavir, 13% azithromycin), 43% corticosteroids, 26% interferon-β, 4% tocilizumab, and 82% of hospitalized patients received anticoagulation. High-oxygen requirements were needed in 39% of patients, but only 1 pt was admitted for invasive MV and was discharged 42 days after admission. Multiple variables related to tumor status, clinical baseline conditions, and inflammation markers were associated with mortality but did not remain statistically significant in a multivariate model. In patients with lung cancer receiving systemic therapy (n = 242) incidence and mortality from COVID-19 were 4.5, and 2.1%, respectively, with no differences found by type of treatment. Calles et al. COVID-19 and Lung Cancer Conclusions: Lung cancer patients represent a vulnerable population for COVID-19, according to the high rate of hospitalization, onset of ARDS, and high mortality rate. Although larger series are needed, no differences in mortality were found by type of cancer treatment. Measures to minimize the risk of SARS-CoV-2 infection remain key to protect lung cancer patients.

COVID-19 and the multidisciplinary care of patients with lung cancer: an evidence-based review and commentary

“… Sha et al 78 The impact of the COVID-19 pandemic on lung cancer patients China Retrospective cohort study 161 patients Secondary care • Response evaluation criteria in solid tumour (RECIST 1) • Delayed admission 29.4% ( n = 47) patients had delayed admission during the epidemic and having to discontinue or delay their regular anticancer treatments. Of these 47 delayed patients, 33 were evaluated for tumour status using a computed tomography scan, 6 of these 33 cases (18.2%) were diagnosed as progressive disease (PD) and 5 cases did not return for visit Calles et al 79 Outcomes of COVID-19 in patients with lung cancer treated in a tertiary hospital in Madrid Spain Observational, retrospective cohort single-centre study 23 patients Secondary care • Clinical features, • Pathology, laboratory and Radiological data • Treatment schemes All patients had at least 1 COVID-19-related symptom; cough (48%), shortness of breath (48%), fever (39%) and low-grade fever (30%) were the most common. Time from symptoms onset to first positive SARS-CoV-2 PCR was 5.5 days (range 1–17), with 13% of cases needed from a second PCR to confirm diagnosis.…”

Evaluation of the susceptibility and fatality of lung cancer patients towards the COVID-19 infection: A systemic approach through analyzing the ACE2, CXCL10 and their co-expressed genes

“…As COVID-19 is a disease of the respiratory tract, previous studies have concluded that patients with lung cancer often experience severe manifestations when infected by SARS-CoV-2 and are at a higher mortality risk than patients with other cancer types ( Antonio et al, 2020 ). An investigation that took place in China suggested that 18 out of 1590 cases of COVID-19 patients had a cancer history.…”

Higher mortality in lung cancer patients with COVID-19? A systematic review and meta-analysis

“…According to the scales mentioned above, all included studies were of high quality, with no less than five points. For the above 13 studies, 10 studies ( [1] , [2] , [3] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ) reported the number of deaths in patients with lung cancer and other tumors, whereas the other 3(4-6) studies only reported on lung cancer populations and could not provide OR. Therefore, we included the first 10 studies in the meta-analysis and discussed all 13 studies in the systematic review for more information on the outcomes.…”