Lin Dong D, Wu Yunhong, Toom Sudhamshi, Sheth Niki, Becker Kevin, Burdette-Radoux Susan, D'Silva James, Huang Yiwu, Lipshitz Jay, Meghal Trishala, Mo Lan, Murthy Pooja, Rubin Philip, Natarajan Vijaya, Donahue Bernadine, Xu Yiqing
Department of Volunteers and Student Services, Maimonides Medical Center, Brooklyn, NY, United States.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Front Med (Lausanne). 2021 Feb 16;8:604221. doi: 10.3389/fmed.2021.604221. eCollection 2021.
Cancer patients may carry a worse prognosis with SARS-CoV-2 infection. Most of the previous studies described the outcomes of hospitalized cancer patients. We aimed to study the clinical factors differentiating patients requiring hospital care vs. home recovery, and the trajectory of their anti-cancer treatment. This study was conducted in a community cancer center in New York City. Eligible patients were those who had cancer history and were diagnosed of SARS-CoV-2 infection between March 1 and May 30, 2020, with confirmatory SARs-CoV-2 virus test or antibody test. Four groups were constructed: (A) hospitalized and survived, (B) hospitalized requiring intubation and/or deceased, (C) non-hospitalized, asymptomatic, with suspicious CT image findings, close exposure, or positive antibody test, and (D) non-hospitalized and symptomatic. One hundred and six patients were included in the analysis. Thirty-five patients (33.0%) required hospitalization and 13 (12.3%) died. Thirty (28.3%) patients were asymptomatic and 41 (38.7%) were symptomatic and recovered at home. Comparing to patients who recovered at home, hospitalized patients were composed of older patients (median age 71 vs. 63 years old, = 0.000299), more who received negative impact treatment (62.9 vs. 32.4%, = 0.0036) that mostly represented myelosuppressive chemotherapy (45.7 vs. 23.9%, = 0.0275), and more patients with poorer baseline performance status (PS ≥ 2 25.7 vs. 2.8%, = 0.0007). Hypoxemia (35% in group A vs. 73.3% in group B, = 0.0271) at presentation was significant to predict mortality in hospitalized patients. The median cumulative hospital stay for discharged patients was 16 days (range 5-60). The median duration of persistent positivity of SARS-CoV-2 RNA was 28 days (range 10-86). About 52.9% of patients who survived hospitalization and required anti-cancer treatment reinitiated therapy. Ninety-two percent of the asymptomatic patients and 51.7% of the symptomatic patients who recovered at home continued treatment on schedule and almost all reinitiated treatment after recovery. Cancer patients may have a more severe status of SARS-CoV-2 infection after receiving myelosuppressive chemotherapy. Avoidance should be considered in older patients with poor performance status. More than two thirds of patients exhibit minimal to moderate symptoms, and many of them can continue or restart their anti-cancer treatment upon recovery.
癌症患者感染新冠病毒后可能预后更差。此前大多数研究描述的是住院癌症患者的情况。我们旨在研究区分需要住院治疗与居家康复患者的临床因素，以及他们的抗癌治疗轨迹。本研究在纽约市的一家社区癌症中心开展。符合条件的患者是有癌症病史且在2020年3月1日至5月30日期间被诊断为新冠病毒感染，且新冠病毒检测或抗体检测呈阳性的患者。构建了四组：（A）住院且存活；（B）住院需要插管和/或死亡；（C）未住院、无症状，但CT影像有可疑发现、有密切接触或抗体检测呈阳性；（D）未住院且有症状。106例患者纳入分析。35例患者（33.0%）需要住院治疗，13例（12.3%）死亡。30例（28.3%）患者无症状，41例（38.7%）有症状且居家康复。与居家康复的患者相比，住院患者年龄更大（中位年龄71岁对63岁，P = 0.000299），接受有负面影响治疗的更多（62.9%对32.4%，P = 0.0036），其中大多是骨髓抑制性化疗（45.7%对23.9%，P = 0.0275），且基线体能状态较差（PS≥2）的患者更多（25.7%对2.8%，P = 0.0007）。就诊时低氧血症（A组35%对B组73.3%，P = 0.0271）对预测住院患者死亡率有显著意义。出院患者的中位累计住院天数为16天（范围5 - 60天）。新冠病毒RNA持续阳性的中位持续时间为28天（范围10 - 86天）。约52.9%住院存活且需要抗癌治疗的患者重新开始了治疗。92%的无症状患者和51.7%居家康复的有症状患者按计划继续治疗，几乎所有患者康复后都重新开始了治疗。接受骨髓抑制性化疗后的癌症患者可能新冠病毒感染状况更严重。对体能状态差的老年患者应考虑避免。超过三分之二的患者症状轻微至中度，其中许多人康复后可继续或重新开始抗癌治疗。
