Are childhood tumor survivors at higher risk of severe illness once infected with COVID-19?

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Are childhood tumor survivors at higher risk of severe illness once infected with COVID-19?

Journal of Clinical Oncology: Are childhood tumor survivors at higher risk of severe illness once infected with COVID-19?

Cancer survivors in children, adolescents, and young adults often face long-term effects of their cancer. These survivors are at significantly higher risk of being affected by chronic disease than the general population due to the original tumor or subsequent treatment.

Statistics show that cancer survivors are severely affected by an average of 4.7 conditions at the age of 50, including conditions that lead to disability and even life-threatening conditions.

Among the long-term disease risks faced by cancer survivors are the increased risk of death from various infectious diseases.

Since the outbreak of the COVID-19 epidemic, tumor survivors and related caregivers and medical teams have worried that survivors may be at higher risk of infection or severe illness.

However, data on the actual risks faced by cancer survivors in the epidemic have so far been very limited.

Therefore, some international medical organizations and associations cannot provide targeted risk analysis for survivors, and such uncertainty makes survivors deeply anxious.

On February 28, 2022, a joint research group led by Dr. Sumit Gupta from The Hospital for Sick Children in Canada published a report in the Journal of Clinical Oncology entitled Risk of COVID-19 Infections and of Severe Complications Among Survivors of Childhood, Adolescent, and Young Paper in Adult Cancer: A Population-Based Study in Ontario, Canada .

The study analyzed the medical records of children, adolescents and young adult cancer survivors in Ontario, Canada’s most populous province, and found that compared with the general population, these cancer survivors had a higher risk of COVID-19 infection, emergency room admission or hospitalization due to infection. There was no significant increase. This study is of great significance for providing more rational risk assessment counseling for cancer survivors.

Are childhood tumor survivors at higher risk of severe illness once infected with COVID-19?

The study used a retrospective cohort analysis design. Cohorts of pediatric, adolescent, and young adult tumor survivors were drawn from two databases: POGONIS and IMPACT.

POGONIS has collected medical data on all patients under the age of 18 at five Ontario Children’s Oncology Centres since 1985; IMPACT collected data on all six major cancer diagnoses in Ontario between 1992 and 2012 on all patients aged 15-21 (including acute leukemia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, soft tissue sarcoma, osteosarcoma, testicular cancer).

Among the patients included in POGONIS and IMPACT, as long as they survived more than 5 years after the initial tumor diagnosis, on January 1, 2020 (the study start time, the first case of COVID-19 infection in Ontario occurred on January 25, 2020) was still alive and in All of Ontario’s Medicare for All were included in the study’s cohort of cancer survivors.

For each survivor, 10 age-, sex-, and residence-matched controls were screened from the general population.

After screening, a total of 12,721 tumor survivors met the criteria and were included in the survivor-related analysis. Excluding the 10 control populations for which 311 survivors could not find a match, the remaining 12,410 survivors and their corresponding 124,100 general population controls were used for the comparative analysis of survivors and the general population.

At study initiation, the median age of the tumor survivor cohort was 24 years, and the median time since initial tumor diagnosis was 14.3 years. Compared with controls, survivors had a higher risk of underlying conditions such as asthma, high blood pressure, diabetes and congestive heart failure.

In the two years prior to study initiation, 25.2% of survivors had at least one hospitalization, up from 9.9% in the control cohort. 8.5% of survivors had a recurrence before the study start time, and 1.6% encountered a second tumor.

Are childhood tumor survivors at higher risk of severe illness once infected with COVID-19?

Comparison of characteristics of tumor survivors and control populations

(The partial data of the table is intercepted here, see the original text at the end of the article)

The researchers analyzed and compared the three aspects of COVID-19 detection, vaccination and infection severity.

During the observation period from January 1, 2020 to May 31, 2021, tumor survivors were more likely to be tested for COVID-19 than controls. 41.6% of the survivors and 35.4% of the control group were tested for the COVID-19 during the observation period.

However, the positive detection rates were similar in both cohorts, 3.1% and 3.2%, respectively.

The median age at which the survivors tested positive was 22, younger than the 24-year-old in the control group, but there were no differences in gender, living environment, etc.

Analyzing the survivor cohort separately, survivors who were younger, had diabetes, and lived in poorer areas of the city had a higher risk of testing positive.

In terms of vaccination, the earliest vaccination date in both cohorts was December 15, 2020.

As of July 31, 2021, 52.8% of those who met the vaccination age criteria in the survivor cohort had been fully vaccinated and 10.8% had been partially vaccinated (the first dose of the two-dose vaccine). The two proportions in the control group were 47% and 11.4%, respectively.

Inoculation rate analysis by time of vaccination, survivors completed part or all of their vaccinations at a rate 20% higher than controls.

Are childhood tumor survivors at higher risk of severe illness once infected with COVID-19?

Cumulative partial vaccination (A) to full vaccination ratio (B) of survivors (blue) and controls (red)

Tumor survivors were also not significantly different from controls in terms of infection severity, and survivors did not have a higher risk of emergency room visits and hospitalizations.

The median time from infection to emergency department visit was 3 days in both cohorts.

Because very few people were vaccinated before infection occurred, these disease severity analyses were not adjusted for vaccination status.

In an analysis of underlying conditions in the survivor cohort, only hypertension was associated with a higher risk of emergency room visits.

To sum up, from the research results, compared with the general population, tumor survivors do not have a higher risk of COVID-19 infection, and infected people do not have a higher risk of serious disease.

The study is the first population-based big data analysis of COVID-19 infection among children, adolescents and young adult cancer survivors.

Similar studies in the past tend to focus on cancer patients undergoing treatment, and the conclusions may not be generalized to the young cancer survivors involved in this study, making the latter face great uncertainty.

The cancer survivor and his or her caregivers are also deeply affected by anxiety during the epidemic. More accurate risk assessment and communication is essential, and this study provides the basis for this.

The study leveraged Canada’s well-established medical information records and analyzed population big data to not only identify the risk of COVID-19 infection, but also analyze data related to the severity of infection, such as emergency room visits and hospitalizations.

However, due to the follow-up period, the study did not involve mutant strains such as Delta and Omicron, and only six types of tumors were covered in young adults.

This study is based only on Canadian patients, and may not be applicable in regions with different demographic characteristics such as ethnic composition.

While this study provides a data basis for COVID-19 risk assessment in young cancer survivors, further analysis is needed in older survivors and in survivors of specific tumors.

Reference:

DOI: 10.1200/JCO.21.02592

Are childhood tumor survivors at higher risk of severe illness once infected with COVID-19?

(source:internet, reference only)

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