Outcome of COVID-19 Infection in Cancer Patients in Pune

Abstract

Introduction We document our data on the course of the coronavirus disease 2019 (COVID-19) infection in cancer patients in an attempt to help optimize their management in India and globally.

Material and Methods Between February 2020 and January 2021, participating oncologists from Pune (members of the Oncology Group of Pune) documented effect of COVID-19 infection in their cancer patients. Binomial logistic regression analysis as well as correlation analysis was done using Pearson Chi-square test to determine significance of clinical factors.

Results A total of 29 oncologists from 20 hospitals contributed their data involving 147 cancer patients who developed COVID-19 infections. COVID-19 infection resulted in higher deaths (likelihood ratio of 4.4) amongst patients with hematological malignancies (12/44 = 27.2%) as compared with those with solid tumors (13/90 = 14.4%, p = 0.030). Patients with uncontrolled or progressive cancer (11/34 = 32.4%) when they got infected with COVID-19 had higher mortality as compared with patients whose cancer was under control (14/113 = 12.4%; p = 0.020). Complication of thromboembolic episodes (seen in eight patients; 5.4% cases) was associated with higher risk (25.6 times) of death (five-eighths; 62.5%) as compared with those who did not develop it (20/139;14.4%; p <0.001).

Discussion Patients with cancer should be advised to take strict precautions to reduce the risk of being infected with COVID-19. They should also be given priority for COVID-19 vaccination. If infected with COVID-19, patients with hematological malignancy and uncontrolled cancer are at higher risk of morbidity and mortality. When they are being treated (OPD or inpatient basis), additional precautions are necessary to ensure their exposure to potential COVID-19 virus is minimized. If they get infected with COVID-19, they should be given aggressive treatment to prevent complications, especially thromboembolic episodes. If they develop any thromboembolic complication, their risk of dying are significantly higher, and management should be modified accordingly.

Keywords

pandemic - thromboembolism - mortality - complications - risk - oncology - solid tumors - hematological malignancies - SARS-CoV-2

Publication History

Article published online:
21 August 2021

• References

• 1 Worldometer. Coronavirus. Available at: https://www.worldometers.info/coronavirus/. Accessed April 14, 2021
• 2 Purvish P, Prashant M, Shyam A. Important COVID-19 update—new life-threatening syndrome in pediatric patients?. Int J Mol Immuno Oncol 2020; 5 (02) 42-43
• 3 Parikh PM, Mehta P, Krishna MM, Babu GK. Clinical trials facing serious adverse events during the ongoing COVID-19 Pandemic. Indian J Med Paediatr Oncol 2020; 41: 127-131
• 4 Kuderer NM, Choueiri TK, Shah DP. et al; COVID-19 and Cancer Consortium. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet 2020; 395 (10241) 1907-1918
• 5 Liang W, Guan W, Chen R. et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21 (03) 335-337
• 6 Parikh PM, Bapna A, Krishna MV, Mehta P, Aggarwal S, Gulia A. COVID-19 testing in India in comparison to the rest of the world. If Indian testing strategy was replicated in the other top 15 COVID-19 affected countries in the world, the status would be startlingly different. Indian J Med Sci 2020; 72 (02) 107-109
• 7 Ackermann M, Verleden SE, Kuehnel M. et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med 2020; 383 (02) 120-128
• 8 Parikh P. COVID-19 pandemic: contrast between SAARC countries and western world. 2020. Available at: https://www.m3india.in/contents/editor_pick/136721/covid-19-pandemic-contrast-between-saarc. Accessed April 12, 2020
• 9 Parikh P, Mehta P, Bansal S. et al. Protecting health-care professionals and workers (other than COVID-19 management facilities) from contamination during COVID-19 pandemic. Indian J Med Sci 2020; 72: 3-4
• 10 Mehta P, Parikh P, Aggarwal S. et al. Has India met this enemy before? From an eternal optimist’s perspective: SARS-CoV-2. Indian J Med Sci 2020; 72: 8-12
• 11 Parikh P, Singh R. Hot race for COVID-19 vaccines—light at the end of the tunnel just got brighter. Int J Mol Immuno Oncol 2021; 6 (01) 1-3
• 12 ESMO. Cancer Patient Management During the COVID-19 Pandemic. Available at: https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic. Accessed April 10, 2021
• 13 The Hindustan Times. Mumbai News. Available at: https://www.hindustantimes.com/mumbai-news/covid-19-death-rate-among-mumbai-s-cancer-patients-stands-at-9-8-tata-memorial-hospital/story-vp6l1ppcX3pr2ju1cgMVqI.html. Accessed April 14, 2021
• 14 Ciceri F, Beretta L, Scandroglio AM. et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc 2020; 22 (02) 95-97
• 15 Kollias A, Kyriakoulis KG, Dimakakos E, Poulakou G, Stergiou GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol 2020; 189 (05) 846-847
• 16 Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. Published: March 25, 2020. Available at: https://clotconnect.wpcomstaging.com/2020/03/26/covid-19-and-coagulopathy-two-management-guidance-documents-for-health-care-professionals/. Accessed April 14, 2021
• 17 COVID-19 and VTE/Anticoagulation. Frequently asked questions. Available at: https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation. Accessed April 10, 2021
• 18 Tartarone A, Lerose R. COVID-19 and cancer care: what do international guidelines say?. Med Oncol 2020; 37 (09) 80
• 19 Gundavda MK, Gundavda KK. Cancer or COVID-19? A review of guidelines for safe cancer care in the wake of the pandemic. SN Compr Clin Med 2020; 2: 2691-2701
• 20 Miyashita H, Mikami T, Chopra N. et al. Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City. Ann Oncol 2020; 31 (08) 1088-1089
• 21 Battisti NML, Mislang AR, Cooper L. et al. Adapting care for older cancer patients during the COVID-19 pandemic: recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group. J Geriatr Oncol 2020; 11 (08) 1190-1198