CLINICAL ROLE –
Patients who had relapsed or treatment-resistant cancer at baseline, or those who had more severe acute COVID-19 infections, were less likely to develop long COVID-19.
More than 1 in 2 patients at a US cancer center experienced symptoms of long COVID-19 for more than 6 months after initial infection, according to new research published in eLife.
The findings are comparable with reported incidence of long COVID-19 in the general population, but also show that women undergoing cancer treatment seem to be at higher risk than men. In the general population, reports of the prevalence of long COVID-19, also called post-acute sequelae of SARS-CoV-2 infection, vary from 10% to 87%, with symptoms persisting beyond 30 days in patients who had severe initial COVID-19 symptoms or who were hospitalized.
“Although cancer patients fall into a higher COVID-19 risk group, there is limited data on PASC in cancer patients and how it affects their progression, care, and treatment,” said lead author Anne-Marie Chaftari, MD, an associate professor in the Department of Infectious Diseases at the University of Texas MD Anderson Cancer Center, in a press release. “In order to provide a better understanding of post-COVID-19 management among cancer patients, we sought to characterize the patterns of long COVID-19 specifically in these patients.”
In the study, investigators identified patients receiving care at the University of Texas MD Anderson Cancer Center who were diagnosed with COVID-19 between March and September 2020 and followed their progress for up to 14 months via remote symptom monitoring and their usual hospital visits. Questionnaires were sent out to patients daily for 14 days after initial COVID-19 diagnosis, then weekly for 3 months, and monthly after that.
Patients recorded symptoms such as fatigue, cough, chest tightness, difficulty breathing, headache, fever, altered sense of smell or taste, muscle aches, gastrointestinal (GI) symptoms, sleep disturbance, and any limitations with activities of daily living. Long COVID-19 was defined as COVID-19-related symptoms persisting beyond 30 days of diagnosis or the emergence of new COVID-19 symptoms.
Data were collected for 312 patients with cancer, of whom 60% developed long COVID-19. Those who had relapsed or had treatment-resistant cancer at baseline, or those who had more severe acute COVID-19 infections, were less likely to develop long COVID-19.
Among 188 patients with cancer who developed long COVID-19, 59 (31%) were readmitted to the hospital, but only 16 (8.5%) were readmitted for COVID-19-related reasons, with most having symptoms that could be managed by outpatient care.
Notably, the investigators also found that female cancer patients had a higher rate of long COVID-19 compared with male cancer patients (63% versus 51%). There was otherwise no difference in the characteristics of patients who developed long COVID-19 and those who did not. Risk factors such as depleted white blood cells, needing oxygen, being hospitalized for COVID-19 or multi-organ failure were similar in both groups. The most common long COVID-19 symptoms were fatigue, sleep disturbances, muscle pain, and GI symptoms.
Additionally, an intriguing discovery was that patients with high blood pressure were less likely to develop long COVID-19. According to the authors, this was surprising given that high blood pressure is a known risk factor for more severe acute COVID-19, but a similar finding was also seen in another study of long COVID-19 in immunocompromised patients.
The link between blood pressure and risk of severe acute COVID-19 is believed to be due to the binding of the COVID-19 spike protein to angiotensin-converting enzyme 2, the target of many blood pressure-lowering drugs. These findings might rule out this mechanism being important for the development of long COVID-19.
“Our study found that long COVID-19 occurred in the majority of our cancer patients and was more prevalent in women than men,” said senior author Issam Raad, MD, FACP, FIDSA, FSHEA, in the press release. “Even in this high-risk patient population, long COVID-19 was not associated with a high rate of hospital readmissions. We also found no underlying condition or severity of illness during acute COVID-19 that would predict long COVID-19.”
REFERENCE
One in two cancer patients may develop long COVID, with risk higher in women. News release. eLife; February 7, 2023. Accessed February 23, 2023. https://elifesciences.org/for-the-press/ecd6204e/one-in-two-cancer-patients-may-develop-long-covid-with-risk-higher-in-women#:~:text=Medicine-,One%20in%20two%20cancer%20patients%20may%20develop%20long%20COVID%2C%20with,could%20be%20managed%20as%20outpatients.
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