Coronavirus Disease 2019 Infection in a Patient Population with Lung Cancer: Incidence, Presentation, and Alternative Diagnostic Considerations

Andrew J Piper-Vallillo; Meghan J Mooradian; Catherine B Meador; Beow Y Yeap; Jennifer Peterson; Mustafa Sakhi; Andrew Do; Leyre Zubiri; Sara Stevens; Jeanne Vaughn; Kelly Goodwin; Alexander Gavralidis; Henning Willers; Adam Miller; Anna Farago; Zofia Piotrowska; Jessica J Lin; Ibiayi Dagogo-Jack; Inga T Lennes; Lecia V Sequist; Jennifer S Temel; Rebecca S Heist; Subba Digumarthy; Kerry L Reynolds; Justin F Gainor

doi:10.1016/j.jtocrr.2020.100124

Coronavirus Disease 2019 Infection in a Patient Population with Lung Cancer: Incidence, Presentation, and Alternative Diagnostic Considerations

JTO Clin Res Rep. 2021 Jan;2(1):100124. doi: 10.1016/j.jtocrr.2020.100124. Epub 2020 Nov 12.

Authors

Andrew J Piper-Vallillo^{1

2}, Meghan J Mooradian¹, Catherine B Meador¹, Beow Y Yeap¹, Jennifer Peterson¹, Mustafa Sakhi¹, Andrew Do¹, Leyre Zubiri¹, Sara Stevens¹, Jeanne Vaughn¹, Kelly Goodwin¹, Alexander Gavralidis¹, Henning Willers³, Adam Miller¹, Anna Farago¹, Zofia Piotrowska¹, Jessica J Lin¹, Ibiayi Dagogo-Jack¹, Inga T Lennes¹, Lecia V Sequist¹, Jennifer S Temel¹, Rebecca S Heist¹, Subba Digumarthy¹, Kerry L Reynolds¹, Justin F Gainor¹

Affiliations

¹ Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
² Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
³ Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.

Abstract

Introduction: Lung cancer is associated with severe coronavirus disease 2019 (COVID-19) infections. Symptom overlap between COVID-19 and lung cancer may complicate diagnostic evaluation. We aimed to investigate the incidence, symptoms, differential diagnosis, and outcomes of COVID-19 in patients with lung cancer.

Methods: To determine an at-risk population for COVID-19, we retrospectively identified patients with lung cancer receiving longitudinal care within a single institution in the 12 months (April 1, 2019 to March 31, 2020) immediately preceding the COVID-19 pandemic, including an "active therapy population" treated within the last 60 days of this period. Among patients subsequently referred for COVID-19 testing, we compared symptoms, laboratory values, radiographic findings, and outcomes of positive versus negative patients.

Results: Between April 1, 2019 and March 31, 2020, a total of 696 patients received longitudinal care, including 406 (58%) in the active therapy population. Among 55 patients referred for COVID-19 testing, 24 (44%) were positive for COVID-19, representing a cumulative incidence of 3.4% (longitudinal population) and 1.5% (active therapy population). Compared with patients who were COVID-19 negative, those who were COVID-19 positive were more likely to have a supplemental oxygen requirement (11% versus 54%, p = 0.005) and to have typical COVID-19 pneumonia imaging findings (5 versus 56%, p = 0.001). Otherwise, there were no marked differences in presenting symptoms. Among patients who were COVID-19 negative, alternative etiologies included treatment-related toxicity (26%), atypical pneumonia (22%), and disease progression (22%). A total of 16 patients positive for COVID-19 (67%) required hospitalization, and seven (29%) died from COVID-related complications.

Conclusions: COVID-19 was infrequent in this lung cancer population, but these patients experienced high rates of morbidity and mortality. Oncologists should maintain a low threshold for COVID-19 testing in patients with lung cancer presenting with acute symptoms.

Keywords: COVID-19; Lung cancer; NSCLC; SARS-CoV-2; SCLC; Thoracic oncology.