An Observational Study of Risk Factors for SARS-CoV 2 Infection in Patients with Cancer

Introduction: Cancer patients are regarded as a highly vulnerable population in Coronavirus Disease 2019 (COVID-19) pandemic due to their systemic immunosuppressive state. The aim of the study was to investigate the prevalence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in asymptomatic cancer patients attending the oncology clinic.

Methods: We conducted a retrospective observational study from May- November 2020. The patients who tested positive for SARS-CoV-2 RT PCR were followed up to study the risk factors, clinical presentation, and outcome. The ethical approval from institutional review board was done. Chi-square test was used to compare qualitative variables and logistic regression model was used to estimate the odds ratio (OR) of having COVID-19 infection.

Results: We included 334 cancer patients who were tested for COVID-19 infection. The prevalence of SARS-CoV-2 infection was 28.4%. COVID-19 infection was more common in solid organ malignancy than hematological cancer (29.2% vs. 26.1%). The risk of COVID-19 infection was associated with comorbidity (p = 0.002). Time since diagnosis of malignancy and the type of anticancer treatment received did not increase the risk of COVID-19 infection. However, patients receiving anticancer therapy in the last 4 weeks of testing positive for SARS-CoV-2 RT PCR had a higher risk for COVID-19 infection (p<0001). The oncological treatment was continued after resolution of symptoms and with negative RT-PCR. The multi variable regression model revealed that females, patients having both hypertension and diabetes mellitus and patients receiving chemotherapy within the last 4 weeks had higher odds of COVID-19 infection (p<0.05).

Conclusion: We observed that active oncologic treatment does not represent a risk factor for SARS-CoV-2 infection in cancer patients. However delaying anticancer treatment to avoid SARS-CoV-2 transmission may lead to malignancy related complications. The approach of routine COVID 19 testing in cancer patients seems preferable in detecting asymptomatic virus carriers.