Largest Study of Cancer Patients with COVID-19 Provides Guidance on How to Protect This Vulnerable Population
(Bronx, NY) People with cancer who develop COVID-19 are much more likely to die from the disease than those without cancer, according to physician-researchers at Montefiore Health System and Albert Einstein College of Medicine. The study, published today in the online edition of Cancer Discovery, is the largest so far to assess outcomes for patients with cancer who have also been infected with COVID-19.
“Our findings emphasize the need to prevent cancer patients from contracting COVID-19 and—if they do—to identify and closely monitor these individuals for dangerous symptoms,” said Vikas Mehta, M.D., M.P.H., a co-lead author of the study, a surgical oncologist at Montefiore and associate professor of otorhinolaryngology—head and neck surgery at Einstein. “We hope that our findings can inform states and communities that have not yet been so severely struck by this pandemic about the unique vulnerability cancer patients face.”
The study involved 218 cancer patients who tested positive for COVID-19 from March 18 to April 8, 2020 at Montefiore Medical Center in the Bronx, New York City, one of the regions in the United States hit hardest by the pandemic. A total of 61 cancer patients died from COVID-19, a dramatically high case-fatality rate of 28%. (The mortality rate for COVID-19 in the United States is 5.8%, according to the World Health Organization.)
“A key element is that mortality appears to be more closely related to frailty, age, and co-morbidities than to active therapy for cancer,” said co-senior author Balazs Halmos, M.D., M.S., director of the Multidisciplinary Thoracic Oncology Program at Montefiore and professor of medicine at Einstein.
"Our data suggest that we should not stop lifesaving cancer therapies, but rather develop strategies to minimize potential COVID-19 exposures and re-evaluate therapies for our most vulnerable cancer populations,” explained co-senior author Amit Verma, M.B.B.S., director of the division of hemato-oncology at Montefiore and professor of medicine and of developmental and molecular biology at Einstein.
The time period during which these patients were treated was earlier in the epidemic when testing was almost exclusively done in sicker, symptomatic patients who required hospitalization. This may partially explain the high fatality rate within the study’s cancer population. However, even when compared to mortality rates in non-cancer patients at Montefiore and across New York City during the same time period, cancer patients demonstrated a significantly higher risk of dying from COVID-19.
As a group, COVID-19 patients with hematologic (blood) cancers, such as leukemia and lymphoma, had the highest mortality rate: 37% (20 of 54 patients). For patients with solid malignancies, the mortality rate was 25% (41 of 164). Striking differences were observed among specific solid cancers: the mortality rate for patients with lung cancer was 55% and colorectal cancer was 38%, compared with mortality rates of 14% for breast cancer and 20% for prostate cancer.
Certain underlying conditions—older age, hypertension, heart disease, and chronic lung disease—were significantly associated with increased mortality among cancer patients with COVID-19.
A detailed analysis of patients with cancer who died from COVID-19 shows that more than half of these individuals—37 of 61—had been in places with a higher risk of exposure to COVID-19, such as nursing homes, hospitals or emergency departments within the 30 days before being diagnosed with COVID-19. This was before widespread social distancing had been implemented.
Montefiore has already changed clinical practice as a result of the study’s findings, by using telemedicine and early and aggressive social distancing for cancer patients, and by opening a dedicated cancer outpatient and inpatient clinical service. It has also instituted bilingual peer counseling and deployed social workers and food deliveries to its at-risk population.
Montefiore is able to quickly identify patients with a known history of cancer who test positive for COVID-19 based on a daily collection and collation of data across the health system. This allows the care team to act immediately to ensure appropriate care for these individuals and track outcomes.
Additional Montefiore-Einstein authors are: Daniel Cole, M.D., Mendel Goldfinger, M.D., Ana Acuna-Villaorduna, M.D., Kith Pradhan, Ph.D., Raja Thota. M.S., Stan Reissman, M.S.W., Joseph A Sparano, M.D., Benjamin A. Gartrell, M.D., Richard V. Smith, M.D., Nitin Ohri, M.D., Madhur Garg, M.D., Andrew D. Racine, M.D., Ph.D., Shalom Kalnicki, M.D. and Roman Perez-Soler, M.D.
This study was supported in part by the Albert Einstein Cancer Center (P30CA013330).
About Montefiore Health System
Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 11 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and more than 200 outpatient ambulatory care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.
About Albert Einstein College of Medicine
Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2019-20 academic year, Einstein is home to 724 M.D. students, 158 Ph.D. students, 106 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,800 full-time faculty members located on the main campus and at its clinical affiliates. In 2019, Einstein received more than $178 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.