The first study of the long term impact of COVID-19 in cancer patients has revealed that fatigue, respiratory symptoms and worsened oncological outcomes may be issues for many patients.
Also of concern is a finding that some COVID-19 survivors, particularly those with haematological malignancies, stopped or modified cancer treatment due to worsening performance or interval disease progression.
The study assessed medium-term impacts on 1,557 COVID-19 survivors at median 22 months from cancer diagnosis and 44 days from infection.
It found post-COVID sequelae affected up to 15% of patients, with half of those experiencing respiratory symptoms and 41%, residual fatigue, despite 90% of all patients having protective anti-SARS-CoV-2 antibodies.
A number of patients also experienced neurocognitive symptoms, weight loss, non-respiratory organ dysfunction and other complications post-infection (7%, 5%, 2% and 18% respectively).
Men and patients aged 65 years or older, with two or more co-morbidities and a history of smoking were particularly vulnerable to post-COVID sequelae versus women (P = 0.041), younger patients (P = 0.048), those with one or no co-morbidities (P = 0.0006) and non-smokers (P = 0.0004), the authors wrote in Lancet Oncology.
Affected patients had an increased risk of death after adjusting for time to post-COVID reassessment, sex, age, co-morbidities, tumour characteristics and infection severity (hazard ratio [HR]: 1.80), they noted.
Of 466 patients on systemic anti-cancer therapy, 15% permanently discontinued therapy and 38% resumed treatment with a dose or regimen adjustment.
While permanent discontinuations were independently associated with an increased risk of death (HR: 3.53), dose or regimen adjustments were not (HR: 0.84) and “can be safely pursued in treatment-eligible patients”, the authors wrote.
They attributed the “unsurprising” result to the patient group’s “higher clinical vulnerability to COVID-19 of this patient group and the higher intensity of treatment regimens, characterised by an increased risk of myelosuppression compared with those delivered in solid tumours”.
Most patients resumed cancer treatment after COVID-19 infection, with regimen adjustments ”reassuringly” not leading to worse survival.
“To our knowledge, this study provides for the first time a detailed account of clinical characteristics and outcomes from the largest European registry of patients with cancer and COVID-19, focusing specifically on SARS-CoV-2 infection survivors,” they wrote.
The study investigators said their findings add to a growing body of evidence suggesting that “[COVID-19-related] organ damage, of which symptomatic sequelae are a proxy, could contribute to a significant worsening of patients’ survival, irrespective of oncological prognosis”.
Notably, oncological characteristics, including tumour stage, activity and exposure to anti-cancer therapy prior to COVID-19 infection were not associated with viral sequelae development, the authors wrote.
This finding is “of paramount importance in understanding the natural course of recovery from SARS-CoV-2 infection in patients with cancer as it provides further data in support of the safe delivery of anti-cancer therapy in the context of an ongoing pandemic threat”.
However, the authors did stress that evaluating COVID-19 clinical status, and when/how to resume treatment, can be challenging in cancer patients, “given that constitutional symptoms (eg, fatigue and anorexia) are overlapping features of progressive malignancy and post-COVID-19 syndrome”.
Indeed, residual COVID-19-related fatigue is a “likely contributor of worsening performance” status in cancer patients and can last for more than 40 months in up to 40% of cancer patients.
Further, even with a variety of factors affecting treatment decisions, the authors described the proportion of permanent discontinuations as “non-negligible” and “concerning”.
They called for greater awareness, recognition and earlier COVID-19 sequelae treatment in clinics so they’d have better chances of tackling reversible factors, safely reintroducing systemic therapy and optimising oncological outcomes for infection survivors.