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New research from China suggests cancer patients are at greater risk of severe outcomes and death from COVID-19, specifically those with lung and hematologic malignancies, or late-stage disease.

In a multicenter study of over 600 COVID-19 patients, those with cancer had significantly higher risks for death (OR 2.34), intensive care unit (ICU) admission (OR 2.84), severe or critical symptoms (OR 2.79), and invasive mechanical ventilation (OR 2.71) compared with age-matched controls (P<0.05 for all), reported Hongbing Cai, MD, PhD, of Zhongnan Hospital of Wuhan University in China.

According to the findings, presented at the American Association for Cancer Research (AACR) virtual meeting, 11.4% of the 105 cancer patients died versus roughly 5% of the non-cancer patients. The highest mortality rates were in patients with hematologic malignancies (33.3%), and those with lung (18.1%) and esophageal (16.7%) tumors.

And while those with early-stage cancers had outcomes similar to non-cancer controls, those with metastatic disease had the highest risks for severe outcomes from COVID-19:

• Death (OR 5.58, 95% CI 1.71-18.23, P=0.01)
• ICU admission (OR 6.59, 95% CI 2.32-18.72, P<0.01)
• Severe symptoms (OR 5.97, 95% CI 2.24-15.91, P<0.01)
• Invasive ventilation (OR 55.42, 95% CI 13.21-232.47, P<0.01)

"Patients who received surgery had high risk of severe events," Cai added during her presentation. "These findings indicate that cancer patients appear more vulnerable."

The findings, which were simultaneously published in , showed that cancer patients with COVID-19 had overall ICU admission rates of 19%, and that 34% had critical symptoms and 9.5% required invasive mechanical ventilation.

Severe symptoms were reported in six of the nine patients with hematologic malignancies, 11 of the 22 lung cancer patients and three of the six with esophageal tumors. Severe immunosuppression was present in 55.6% of the hematological cancer patients, which may have contributed to the group's poor outcomes, the researchers noted.

"We can't generalize cancer as a whole," said Marina Chiara Garassino, MD, of the Istituto Nazionale dei Tumori in Milan, Italy, who also presented during AACR's "COVID-19 and Cancer" session. "We have to divide the type of cancers."

Garassino suggested that comorbidities as well as presence of disease within the lungs may play a role in the worse outcomes seen in lung cancer patients with COVID-19. However, she added that it's unclear whether cancer patients in general have any higher risk of infection from the COVID-19 coronavirus.

For their study, Cai's group looked at 1,014 adults diagnosed with COVID-19 from January 1 to February 24, 2020, who were admitted to 14 hospitals in Hubei province. The cancer patients were randomly paired with 536 age-matched controls.

No patients with breast (n=11), thyroid (n=11), or cervical cancers (n=6) died or required invasive mechanical ventilators. Among the 13 gastrointestinal cancer patients, 7.7% died, 23% were admitted to the ICU, and 7.7% required ventilators.

Cancer patients were more likely to have in-hospital infections compared with non-cancer patients (19.0% vs 1.5%, P<0.01) and were more likely to be smokers (34.3% vs 8.6%, P<0.01), Cai reported. No other significant differences were seen with regard to baseline characteristics between the cancer and control groups.

For presenting signs and symptoms, cancer patients were significantly more likely to report chest distress (14.3% vs 6.2%) and slightly less likely to present with fever (64.8% vs 74.8%). In general, the cancer group was more often treated with invasive mechanical ventilation (10.5% vs 2.8%), continuous renal-replacement therapy (3.8% vs 0.6%), and extracorporeal membrane oxygenation (2.9% vs 0.4%) than non-cancer patients.