Changing impact of COVID-19 on cancer patients and recovery

Two new papers from Imperial researchers have highlighted how the impact of COVID-19 on cancer patients has changed through the pandemic.

The work, based on the OnCovid registry, looked at thousands of cancer patients receiving treatment, who also had a confirmed COVID-19 infection.

In the first analysis, led by Dr David Pinato from the Department of Surgery and Cancer, researchers set out to answer the key question of whether COVID-19 mortality in patients with cancer improved during the course of the pandemic in Europe.

They found that there was a significant time-dependent improvement of both short- and medium-term clinical outcomes from COVID-19 in patients with a cancer diagnosis.

These findings suggest that enhanced testing capacity, improved disease management (e.g. COVID-19 specific therapy), health care system response and dynamic changes in community transmission have played an important role in this positive outcome.

Speaking about the findings, Dr Pinato said: “Early studies suggested that the mortality from COVID-19 in cancer patients exceeded 30%. We now know that the way we handled the pandemic in Europe has helped to reduce those numbers dramatically, leading to improved detection of cases and reduction in mortality from the onset of the pandemic well into 2021”.

Longer term impact 

The second paper, led by Dr Alessio Cortellini of the Department of Surgery and Cancer, looked at the medium- and long-term impact of COVID-19 in cancer patients, highlighting the prevalence of COVID-19 symptoms and their impact on oncological management and patient survival.

The study found post-COVID-19 symptoms (including shortness of breath, chronic cough and fatigue) affect up to 15% of patients with cancer and adversely influences survival and oncological outcomes after recovery. 

In addition, the study also looked at the continuity of cancer  care after COVID-19 infection, by depicting the systemic anticancer therapy (SACT) resumption pathways among those patients who were on SACT at COVID-19 diagnosis.

They found that 15% of patients permanently discontinued treatment (mainly due to clinical deterioration) and 38% resumed treatment after a dose/regimen adjustment. Reassuringly dose/regimen adjustments were not associated with worse post-COVID-19 outcomes. 

Speaking about the findings, Dr Cortellini said: "Our data about COVID-19 sequelae tells us something that was expected: the worse the COVID-19, the higher the chances of experiencing medium/long term effects. However, what is entirely new is the understanding of the impact of these sequelae on an especially vulnerable population, like those with cancer. This informative evidence allows us to recognise that the tremendous efforts of our health care systems in ensuring dedicated immunization campaigns in frail patients, will have a beneficial effect even on the prevention of the post COVID-19 syndrome and ensuring a prompter resumption of the oncological continuity of care."

Early recognition is key

According to the researchers, the findings suggest that early recognition of COVID-19 symptoms might be an important step forward in improving post-COVID-19 continuity of care in patients with cancer.

These two Imperial studies will be presented at the European Society for Medical Oncology (ESMO) Congress 2021, and are based on the pre-defined analysis of the OnCOVID registry, an active European observational study that since March 2020 has been collecting consecutive data of oncological patients (both solid and haematological malignancies, any stages) diagnosed with SARS-CoV-2 infection.

The OnCOVID registry was data locked on March 2021, with 35 European institutions across 6 countries (UK, Italy, Spain, France, Geramy and Belgium) entering 2795 patients diagnosed with COVID-19 between February 2020 and February 2021.

In the future, the OnCOVID team plan to collect similar data from after the advent of SARS-CoV-2 vaccines, which will allow them to estimate the likely multifaceted positive effects of the ongoing immunization campaign in patients with cancer.

Dr Pinato, Study Chief Investigator concludes: “OnCovid is an invaluable live resource that has led to important practice-informing findings in the management of COVID-19 and cancer. As the disease evolves we need to continue capturing data to adapt to the new challenges imposed by this unresolved pandemic threat”.

The research was supported by the NIHR Imperial BRC.