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Table of Contents
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 113-116

Perceptions and realities about early mortality rates from COVID-19 in Indian patients with cancer

Medical Oncology, Ramaiah Medical College, Bangalore, Karnataka, India

Date of Submission23-Feb-2022
Date of Decision03-Oct-2022
Date of Acceptance03-Nov-2022
Date of Web Publication31-Mar-2022

Correspondence Address:
Vinayak V Maka
Vijay Kuteer, 47, 2nd Main, 3rd Cross, SMR Layout, Abbigere, Chikkabanawar Post, Bangalore - 560 090, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_90_22

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How to cite this article:
Maka VV, Devadas SK. Perceptions and realities about early mortality rates from COVID-19 in Indian patients with cancer. Cancer Res Stat Treat 2022;5:113-6

How to cite this URL:
Maka VV, Devadas SK. Perceptions and realities about early mortality rates from COVID-19 in Indian patients with cancer. Cancer Res Stat Treat [serial online] 2022 [cited 2022 May 28];5:113-6. Available from: https://www.crstonline.com/text.asp?2022/5/1/113/341258

The coronavirus disease 2019 (COVID-19) pandemic was responsible for a spike in the morbidity and mortality in patients with cancer.[1],[2] Even before the pandemic reached its first peak in August 2020, Indian patients with cancer faced enormous challenges due to poor accessibility to cancer care during the lockdown and isolation resulting from exposure and/or infection.[3–7] Dynamic guidelines[8–11] and communications from multiple national and international organizations for risk mitigation, avoiding treatment disruption, and management of COVID-19 in patients with cancer were published.[12],[13] COVID-19 infection in patients with cancer leads to early mortality (ranging from 15% to 28%).[14],[15] Data that were gathered during the first wave of COVID-19 showed that none of the COVID-19-directed treatment strategies were effective.[16],[17] Hence the assumption is that the 30-day mortality rate reflects the natural course of COVID-19 infection.

In this issue of the journal, Seshachalam et al.[18] have published their retrospective collaborative study conducted at multiple centers in southern India, which focused on the 30-day all-cause mortality in 206 patients with cancer who were diagnosed with COVID-19 infection, by COVID Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) (89.3%) or computed tomography (CT) scan of the thorax (10.7%) between March and December 2020. Predictors for severe COVID-19 in patients with cancer were incomplete disease remission (OR, 0.127; 95% CI, 0.015–1.067), and palliative intent of cancer-directed treatment (OR, 2.461; 95% CI, 0.299–20.243).

In this study, the 30-day all-cause mortality rate was 12.6% with a significantly higher mortality observed in patients with severe infection at presentation, COVID-19 that was diagnosed before August 2020, and who required mechanical ventilation. Four deaths were attributable to cancer progression and two deaths were reported in patients with cancer and asymptomatic COVID-19.

The authors have been forthcoming about the limitations of their study including the retrospective nature, small sample size, and lack of objective severity predictors of COVID- 19 infection like the c-reactive protein level, lymphopenia, and CT severity score index.[19] The postponement of cancer-directed treatment for patients on palliative chemotherapy was justified, in view of the increased incidence of severe COVID-19 infection and subsequent early mortality in patients with cancer. Achievement of early remission by effective cancer-directed therapy in patients with cancer would prevent severe COVID-19 infection and subsequent early deaths. The early mortality rate of 12.6% reported in this study is comparable to those reported in previous Indian studies, as well as in the French study which shares the same demographic pyramid.[14],[15],[20] The low death rate has been attributed to the younger median age of the cohort, small sample size, and milder virulence of the SARS-CoV-2 variants. A higher early mortality rate of 28% was noted in studies that recruited a predominantly older cohort of patients with cancer.[19] An unavoidable contributor to COVID-19 exposure is a visit to the hospital[21]; this is borne out by the finding that nearly 60% of the patients had received chemotherapy less than four weeks prior to the diagnosis of COVID-19.

A comparison of the mortality rate from COVID-19 infection among patients with cancer to that in the general population would be helpful to estimate the adverse impact of COVID-19 on patients with cancer. Pediatric patients were not adequately represented in the study, despite one unfortunate death, precluding any meaningful conclusions in this cohort of patients. Other authors have reported lower severity of COVID-19 infection in children with cancer.[22] There is limited information about cancer survivors who are at risk for COVID-19 and its outcomes.[23],[24] The impact of COVID-19 in specific types of cancer could be different and possibly more severe than that in other cancer types, which may be missed when a wide variety of malignancies are clubbed together and classified homogenously into solid and hematolymphoid malignancies, as was done in the present study. As an example, patients with multiple myeloma were reported to be at an increased risk of COVID-19 infection and had a higher mortality than non-myeloma patients.[25],[26] The time of diagnosis was a significant predictor of death due to COVID-19 in the adjusted model, but this may have been impacted by the availability of new information and subsequent decrement of the COVID-19 mortality rate in patients with cancer during the pandemic as seen in registry sources.[27] The concerns about the use of type of cancer treatments, that is, monoclonal antibodies and immunomodulators like rituximab or checkpoint inhibitors on the severity of COVID-19 have not been addressed in this study.[28]

The current study highlights that it is possible for multiple Indian institutes to collaborate and answer a particular research question. Even though this was a retrospective study, the findings are in line with the observations of Indian oncologists and reflect their experience during the first wave of COVID-19. We need to involve more cancer centers from various parts of the country to better understand the issues faced, and the outcomes of patients with cancer and COVID-19 during the delta variant and omicron surges. COVID-19 vaccines became available in India in early 2021, although high quality data about safety and efficacy were scarce among patients with cancer.[29] We should have more collaborative studies about the impact of early vaccine accessibility and vaccine hesitancy[30] among patients with cancer during the delta variant surge.[31],[32],[33]

The mortality of patients with cancer and COVID-19 is predominately driven by the severity of infection at initial presentation, in which the ongoing cancer remission status and intent of cancer treatment play a significant role.[6] Patients with cancer are seven times more likely to develop COVID-19 than patients without cancer, even after adjusting for age, race, sex, comorbidities, transplant status, and hospitalization.[13] Devising optimal and dynamic management strategies for both cancer and COVID-19 without compromising on cancer treatment would prevent early mortality and result in better outcomes.

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