Patients with Cancer Experiencing COVID-19 Symptoms at Increased Risk of Death Despite Negative SARS-CoV-2 Tests

July 20, 2020

“These observations strongly suggest an underdiagnosis of COVID-19 in this population of cancer patients and a major underestimation of SARS-CoV-2 contribution as a cause of death in cancer patients,” the authors wrote. “The management of cancer patients with febrile respiratory symptoms in this period of the epidemic should, therefore, be particularly careful even in the absence of SARS-CoV-2 detection.”

The death rate among patients with cancer presenting with symptoms of COVID-19 is high 30 days after diagnosis, regardless of if the results of a SARS-CoV-2 infection test came back positive or negative, according to results of the PRE-ONCOVID-19 study recently published in the European Journal of Cancer.

To come to this conclusion, the retrospective study examined the cases of 302 patients with cancer who were admitted to the Comprehensive Cancer Center of Lyon in France between March and April 2020 with suspected COVID-19. This meant patients may or may not have come into contact with someone who also had COVID-19, and also presented with one or more of the widely reported symptoms of the virus: fever, dry cough, shortness of breath, altered sense of taste, altered ability to smell, diarrhea, and/or suspicious images on computed tomography (CT).

Out of this group, 55 patients (18.2%) had detectable SARS-CoV-2, the virus that causes COVID-19, with reverse transcription-polymerase chain reaction (RT-PCR) in nasopharyngeal samples. Of note, 72.7% of those with a positive test were 60 years or older and had more frequent hematological malignancies, respiratory symptoms, and suspected COVID-19 pneumonia.

Conversely, the 247 patients who were found to be SARS-COV-2 RT-PCR-negative were younger (with a mean age of 56.9 years). Thirty-eight percent of these patients presented with similar respiratory symptoms, and 20% presented with similar CT scan images.

Both patient populations had similar comorbidities, including smoking history, obesity, COPD, diabetes, and hypertension, and the biological characteristics of both groups were also similar. Both populations presented with similar major lymphopenia and a major inflammatory syndrome with increased CRP levels, as well as an accurate surrogate of circulating interleukin (IL)-6 levels found to be increased in cases of severe COVID-19.

During the observation period, 30 patients (9.9%) died, including 24 (80%) with advanced cancer. At a median follow-up of 25 days after the first symptoms were reported, the death rate was 21% in RT-PCR-positive patients and 10% in RT-PCR-negative patients.

A multivariate analysis found that the risk factors of death included fever plus respiratory symptoms, a Karnofsky performance status score of less than 60, relapsing cancer, lymphopenia (a lymphocyte count below 700/µL), and male sex.

The researchers concluded that a positive result of SARS-CoV-2 on RT-PCR was not correlated with an increased death rate, and that none of the treatments administered to the study cohort within the previous month (including cytotoxics, PD1 Ab, anti-CD20, and VEGFR2 therapies) correlated with better or worse survival.

Additionally, the death rate at day 25 was 18.4% in RT-PCR-positive patients and 19.7% in RT-PCR-negative patients with respiratory symptoms and/or COVID-19-type pneumonia on CT scan. However, the researchers noted, most patients with cancer dying during this period (22 of 30, 73%) were negative for the virus.

“These observations strongly suggest an underdiagnosis of COVID-19 in this population of cancer patients and a major underestimation of SARS-CoV-2 contribution as a cause of death in cancer patients,” the authors wrote. “The management of cancer patients with febrile respiratory symptoms in this period of epidemic should therefore be particularly careful even in the absence of SARS-CoV-2 detection.”

The researchers went on to note that further study is needed in this patient population.

“Specific therapeutic procedures suggested to improve COVID-19 patient survival, e.g. anti-IL-6 Ab, chloroquine analogues, remdesivir (Veklury), should be investigated also in this SARS-CoV-2-negative cancer patient population presenting with severe symptoms suggestive of COVID-19.”

A version of this story originally appeared on Cancer Network as “SARS-CoV-2 RT-PCR-Positive Test Not Significantly Correlated with Risk of Death


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