Delhi hospital highlights higher Covid fatality rate in cancer patients

A study conducted by the Rajiv Gandhi Cancer Institute and Research Centre here has highlighted the high rate of Covid-19 infection in cancer patients and also revealed that the fatality rate in such patients is 7.6 times more than the national average fatality rate for Covid-19.

Public health experts postulate that the severity and resulting mortality in cancer patients with Covid-19 is amplified due to their elderly and immunocompromised state which is further worsened by cancer treatment.

"Our study highlights the incredibly high rates of Covid-19 in cancer patients. More distressingly, the CFR is 7.6 times more than the national average CFR for Covid-19," six researchers from the Delhi-based cancer hospital noted, after conducting a study on 186 active cancer patients with confirmed infection between June 8 and August 20.

Dr Vineet Talwar, Director of Medical Oncology at Rajiv Gandhi Cancer Institute and Research Centre, said that this is the first study to show the case fatality rate and its clinical association in Covid-19 infected cancer patients.

A total of 3,101 cancer patients were treated at the indoor facility of the centre. 1,088 patients had developed signs and symptoms suspicious of Covid-19. Of these, 186 tested positive for Covid-19 and formed the study cohort. The infection rate among all cancer patients treated at the centre was 6 per cent.

Besides this, the Covid-associated fatality rate in the cohort was 14.5 per cent as against the national average of 1.96 per cent, i.e. 27 out of 186 patients succumbed to the disease.

"Although the incidence and CFR was 14.5 per cent against the national average in this study, this can be ascribed to patient factors, visitations and admission in health care facilities with high risk of contracting infection. This was also seen in the New York hospital system with CFR of 28 per cent," said Dr Talwar.

Cardiovascular diseases and diabetes posed a higher risk of death in this cohort. Co-morbid conditions like diabetes frequently co-occur with hypertension or coronary artery disease in cancer patients and can further weaken the immune response escalating the risk of death due to Covid-19.

Most cancer patients with coronavirus disease had solid malignancies (82.3 per cent); gastrointestinal cancer (21.5 per cent) was the common cancer type in such patients. About 17.7 per cent of cases presented with hematological malignancies, cancers that affect the blood, bone marrow, and lymph nodes.

More than a quarter of cases (26.9 per cent) were metastatic. Eighty-six patients (46.2 per cent) presented at least a single co-morbidity — hypertension (24.2 per cent) and diabetes (18.3 per cent) were most common.

About 60 per cent of cases were on active cancer treatment and had received cancer-directed treatment within a month before the onset of COVID-19 symptoms. Thirty-seven per cent of patients were on chemotherapy. No significant effect on mortality was noted in the patients who had received anti-cancer therapy in the past month.

The doctors of the tertiary cancer care centre managed Covid-infected cancer cases by treatments including corticosteroids, hydroxychloroquine, remdesivir, tocilizumab and convalescent plasma therapy.

According to the study, assisted ventilation had to be given to 12 patients (6.4 per cent), however, all of them eventually developed Covid-related complications like pneumonitis and associated respiratory failure, septic shock or sudden cardiac arrest and succumbed to the disease.

Two recent studies from the European continent have shown a far greater case fatality rate in cancer patients with Covid-19. In the United Kingdom's Coronavirus Cancer Monitoring Project, a case fatality rate of 30.6 per cent was observed. Similarly, high rates were noticed in the New York hospital system where a rate of 28 per cent was observed.

"Relatively, lower case fatality rate in the present study when contextualised to CFR in the general population shows the similar proportion to those observed elsewhere. This study once again establishes the far higher CFR in cancer patients with COVID-19," the researchers said..