Researchers in London, England, studied 2,634 patients in six European countries with solid cancer (abnormal cellular growths in “solid” organs such as the breast or prostate) or hematologic cancer (which begins in blood-forming tissue or in the cells of the immune system) and COVID-19.
They reviewed the outcomes of those patients between February 2020 and February 2021 to calculate death rates within the first two weeks after diagnosis and three months after diagnosis.
In total, 906 patients were diagnosed between February and March 2020, 720 between April and June 2020, 90 between July and September 2020, 696 between October and December 2020, and 222 between January 2021 and February 2021.
Researchers found that patients diagnosed in the first outbreak were more likely to experience complications of COVID-19 compared with those diagnosed in the second phase of the pandemic, and patients diagnosed with COVID-19 during the first outbreak had a significantly higher risk of death at 14 days and 3 months compared to those patients diagnosed during the second outbreak.
Similarly, patients diagnosed in the first outbreak were more likely to require hospitalization and COVID-19–specific therapy.
“Patients diagnosed at the peak of the first COVID-19 outbreak were characterized by a 30% unadjusted CFR (case-fatality rates) at 14 days, a figure that mirrors widely published data across COVID and cancer registries,” researchers wrote.
“We documented a downward trend in mortality reaching a nadir of 12.5% in July to September 2020, when community transmission of SARS-CoV-2 was at its lowest in Europe, with estimates of mortality remaining below 20% in the subsequent time periods. This downward trend was observed across tumor sites and countries, a point of greater consequence given the tumor-specific and geographic heterogeneity in outcomes from COVID-19,” researchers added.
“Despite a slight increase in overall and complicated COVID-19 cases reported from late 2020, as a consequence of the pan-European COVID-19 surge likely related to the new emerging variants, CFRs at 14 days and case-test ratios did not increase meaningfully, a finding that suggests enhanced capacity of health care systems,” they said.
Scientists believe that improved survival is related not only to better treatments but also to the improved availability of COVID-19 tests that allow for earlier diagnosis, as well as the introduction of asymptomatic screening.
They also credit the improved mortality rate to significant changes in the prescribing of anti-COVID-19 therapeutics, with the first phase of the pandemic being dominated by “off-label prescribing of drugs in the absence of clear evidence of benefit and the simultaneous withholding of therapies such as corticosteroids that would eventually be found to change the natural history of severe COVID-19.”
However, researchers note that the study has several limitations, including country-level changes in the incidence of COVID-19 during the pandemic which may have affected data reporting and clinical outcomes, with a trend toward improvement during low incidence phases.
Researchers summarized that large-scale population-based studies are needed to provide more definitive data to measure the success of improved therapies and vaccination campaigns against mortality rates in cancer patients with COVID-19.