The long term consequences of COVID-19 infection for cancer patients include discontinuation of systemic treatment and an increased risk of long term complications and mortality, findings from a Europe-wide registry study have revealed.
Data on long term outcomes and post-COVID-recovery outcomes for 2795 cancer patients enrolled in the OnCOVID registry between January 2020 and February 2021 have been released ahead of the European Society of Medical Oncology virtual meeting (ESMO 2021) next week.
The results showed that almost one in six cancer patients (15%) who survived COVID-19 reported sequelae including respiratory symptoms (49.6%), fatigue (41%) and cognitive/psychological dysfunction (4.3%).
Persisting COVID-19 sequelae were more likely found in males, patients aged over 65 years people with two or more comorbidities, and among smokers.
Other factors that were significantly associated with post-COVID sequelae included a history of prior hospitalisation, complicated disease and receiving COVID-19 therapy.
Study lead investigator Dr Alessio Cortellini, a medical oncologist and researcher at Imperial College London, noted that cancer patients with COVID-19 sequelae had an increased risk of death (Hazard Ratio 1.76, 95%CI 1.16-2.66) at a median post-COVID-19 follow up of 128 days, compared to those without sequelae, after adjusting for factor such as age, comorbidities and tumour characteristics and COVID-19 severity .
It was also notable that a significant proportion of patients who were on systemic anticancer therapy at the time of COVID-19 diagnosis (62/473, 13.1%) permanently discontinued therapy. A further 16% had adjustment made to systemic anti-cancer therapy.
Therapy discontinuations were mostly due to worsening performance status (45%), disease progression (16.1%) and residual organ disfunction (6.3%).
The most frequent reasons for adjustments to systemic therapy included prevention of immunosuppression (57.3%), to avoid hospital attendance (40%) and adverse events (20%).
Permanent discontinuation of therapy was found to be associated with an increased risk of death (HR 4.2, 95%CI: 1.62-10.7), whereas therapy adjustments did not adversely affect survival.
Dr Cortellini said the findings had helped define the likelihood and nature of post-COVID-19 sequelae in patients with cancer and showed the potential to adversely influence survival and oncological outcomes after recovery.
“The fact that the cancer patients who most frequently suffered sequelae were those who survived severe forms of the disease leads us to imagine the beneficial effects that COVID-19 vaccination campaigns will have on these aspects,” he said .
Prevention, early recognition and treatment of COVID-19 sequelae would be an important step to prevent disruptions in the continuity of patients’ cancer care in the future, he added.
It was also reassuring to see that adjustments could be made to systemic therapy to preserve oncological outcomes in patients who remain eligible to treatment, said Dr Cortellini.