Patients with Gynecologic Cancer May Not be at Increased Risk of COVID-19

A study published in Cancer indicated that women in New York City receiving standard treatment for gynecologic cancer are not at increased risk of being hospitalized for or dying from coronavirus disease 2019 (COVID-19) due to their cancer.¹

In addition, researchers also found that neither having cancer nor receiving treatment for it worsened COVID-19 outcomes.

“Our study should be reassuring for women with gynecologic cancers who are worried that having cancer increases their risk of becoming seriously ill if they go to the hospital because of COVID-19," study lead investigator Olivia Lara, MD, an oncology fellow in the Department of Obstetrics and Gynecology at Perlmutter, said in a press release.²

Looking at patients from 6 New York City area hospital systems with known gynecologic cancer and a COVID-19 diagnosis, researchers reviewed the medical records of women treated between March 1 and April 22, 2020. Ultimately, the records of 121 patients with gynecologic cancer and COVID-19 were extracted.

Overall, 66 of the 121 patients (54.5%) required hospitalization and of those, 45 (68.2%) required respiratory intervention, 20 (30.3%) were admitted to the intensive care unit, and 9 (13.6%) underwent invasive mechanical ventilation. Moreover, 17 patients (14.0%) died of COVID-19 complications; no patient requiring mechanical ventilation survived.

On multivariable analysis, hospitalization was found to be associated with an age ≥64 years (risk ratio [RR], 1.73; 95% CI, 1.18-2.51), African American race (RR, 1.56; 95% CI, 1.13-2.15), and 3 or more comorbidities (RR, 1.43; 95% CI, 1.03-1.98). Importantly, only recent immunotherapy use (RR, 3.49; 95% CI, 1.08-11.27) was associated with death due to COVID-19 – treatment with chemotherapy and recent major surgery were not predictive of COVID-19 severity or mortality.

Notably, these results are comparable to recent outcomes for all patients hospitalized in New York City, which reported a 21% death toll rate among 5700 hospitalized patients with COVID-19. Of this cohort, females represented 39.7% of cases and 6% had cancer as a comorbidity.

“These data are important for counseling patients with gynecologic cancer that standard cancer treatments do not seem to increase the risk of hospitalization or death due to COVID-19,” the authors wrote.

Importantly, the investigators raised an additional concern regarding myelosuppressive regimens and the risk of lymphopenia and neutropenia. Though the exact role of lymphopenia and neutropenia is not well understood, lymphopenia has been associated with poor outcomes and severity in patients with COVID-19. However, in this particular cohort, no association between lymphopenia and disease severity was observed.

Overall, the study findings support the safety of continued cancer treatment during the pandemic, though the researchers indicated that immunotherapy treatment should be administered with discretion.

“Because the COVID-19 pandemic is not expected to subside for some time, this may help to alleviate patients’ fears and allow them to feel safe in continuing critical cancer treatments, including surgery and cancer-directed therapy,” the authors wrote. “Further evaluation in immunotherapy in larger cohorts is needed; caution and extensive counseling regarding immunotherapy use should be exercised.”

References:

1. Lara OD, O’Cearbhaill RE, Smith MJ, et al. COVID-19 Outcomes of Patients with Gynecologic Cancer in New York City. Cancer. doi: 10.1002/cncr.33084.

2. Most Women Treated in New York City for Gynecologic Cancers Are Not at Increased Risk of Death From COVID-19 [news release]. New York. Published July 30, 2020. prnewswire.com/news-releases/most-women-treated-in-new-york-city-for-gynecologic-cancers-are-not-at-increased-risk-of-death-from-covid-19-301102808.html. Accessed August 3, 2020.