The Impact COVID-19 Infection on Cancer Patients: A Tertiary Cancer Center Experience in Jordan

Kamal Al-Rabi; Fadwa Al-Qadi; Akram Al-Ibraheem; Khalid Halahleh; Samer Salah; Hazim Ababneh; Mohammad Akkawi; Maher Sughayer; Lana Tafesh; Layan Abu Abed; Mohammad Ma'koseh

doi:10.7759/cureus.51310

The Impact COVID-19 Infection on Cancer Patients: A Tertiary Cancer Center Experience in Jordan

Cureus. 2023 Dec 29;15(12):e51310. doi: 10.7759/cureus.51310. eCollection 2023 Dec.

Authors

Affiliations

¹ Medical Oncology, King Hussein Cancer Center, Amman, JOR.
² Internal Medicine, School of Medicine, University of Jordan, Amman, JOR.
³ Internal Medicine, King Hussein Cancer Center, Amman, JOR.
⁴ Nuclear Medicine, King Hussein Cancer Center, Amman, JOR.
⁵ Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, JOR.

Abstract

Background: Cancer patients are at higher risk of serious complications of COVID-19. Few studies evaluated the impact of COVID-19 on cancer patients in low- and middle-income countries. Our study aims to evaluate the outcomes of COVID-19 infection in cancer patients treated at our institution. Methods: Medical records of patients with a positive COVID-19 polymerase chain reaction (PCR) between April 2020 and October 2020 were reviewed. Fisher's exact test and logistic regression analysis were employed to correlate various variables with mortality. Survival estimates were generated using the Kaplan-Meier method.

Results: A total of 317 patients were included, with a median age was 55 years (range: 19-88). 82 (25.9%) had hematological neoplasms while the remainder had solid cancers. At the time of infection, 220 (69.4%) had active cancer, and 99 (31.2%) had received systemic anticancer treatment (SACT) within four weeks. Hospitalization was required for 101 (31.8%), 17 (5.3%) were admitted to the ICU and 50 (15.8%) died. Among patients with active cancer, SACT was delayed or discontinued in 140 (63.6%) patients. In the entire patient cohort, low albumin (p=<0.001) and leucocytosis (p=<0.001) correlated with mortality within six months of COVID-19 infection. The six-month mortality rate in patients with active cancer was significantly higher in patients with hypertension (p=0.024), no recent SACT (0.017), hematological cancer (p=0.029), low albumin (p=<0.001), leucocytosis (p=0.002) and lymphocyte count of less than 500/µL (p=0.004). Recent chemotherapy was associated with better 6-month survival rates (78.8% vs 89.9%, p=0.012) in patients with active cancer, patients with solid cancers (95.9% vs 82.2%, p=0.006) and was non-inferior in patient with hematological neoplasms (72% vs 65.4%, p=0.519). Conclusion: COVID-19 infection in our cancer patients was associated with significant morbidity and mortality and adversely affected their treatment. The decision to delay or discontinue SACT should be individualized, considering other risk factors for mortality.

Keywords: cancer; covid-19; jordan; mortality; systemic anitcancer treatment.