In a recent study published in the journal ELife, researchers investigate the persistent symptoms experienced by cancer patients who previously recovered from acute coronavirus disease 2019 (COVID-19) to assess post-acute sequelae of COVID-19 (PASC) in cancer patients.
Study: Long COVID in cancer patients: preponderance of symptoms in majority of patients over long time period. Image Credit: Ground Picture / Shutterstock.com
Extensive studies have been conducted on the chronic and persistent symptoms experienced by acute COVID-19 patients extending beyond the normal recovery period; however, there remains no final consensus on how to define PASC or long COVID.
One of the generally accepted definitions of PASC is persistent symptoms or the onset of delayed complications at least four weeks after recovering from acute COVID-19 requiring hospitalization. However, several studies have also reported the occurrence of PASC in outpatients who experienced mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Furthermore, the prevalence of PASC among the general population varies widely between 10% and 87%.
The association between the clinical outcomes of acute COVID-19 and risk factors in cancer patients such as cancer stage, type of therapy, comorbidities, and immunocompromised status are currently being examined. However, there remains a lack of information on PASC symptoms in patients with cancer, as well as the impact of these symptoms on the progression of this disease and the success of cancer therapies.
About the study
In the present study, researchers identified cancer patients receiving treatment at The University of Texas Cancer Center who had also been diagnosed with COVID-19 between March 2020 and September 2020 and were unvaccinated when they contracted the infection.
A longitudinal cohort assessment was conducted based on the remote monitoring of patient-reported outcomes and regular clinical care visits. Follow-ups continued until May 2021.
Questionnaires were sent to patients every day for two weeks following their COVID-19 diagnosis, then weekly for three months, and subsequently every month until the end of the study.
Clinic visits, hospital readmissions, and acute cancer care center visits were also analyzed from the charts. Based on the reasons for readmission and reported symptoms, hospitalizations were classified as COVID-19 related or non-COVID-19-related.
Persistent symptoms or the onset of new symptoms related to COVID-19 beyond one month from the initial COVID-19 diagnosis and extending up to 14 months were used to define long COVID or PASC. Symptoms included headaches, fever, fatigue, dysgeusia, anosmia, myalgia, cough, dyspnea, tightness in the chest, nausea, diarrhea, difficulty sleeping, and difficulty in performing daily activities.
Of the 312 cancer patients included in the study, 75% of whom had solid tumors, 60% reported experiencing PASC symptoms for up to seven months or beyond 14 months after their initial diagnosis of COVID-19. Fatigue was reported by 82% of patients, with other common symptoms including myalgias, sleep disturbances, and gastrointestinal disorders that were reported by 67%, 78%, and 61% of the patients, respectively.
Headaches, dysgeusia, anosmia, dyspnea, and cough were also reported by many patients. Persistent PASC symptoms were reported by a higher number of female patients than male patients at 63% and 37%, respectively.
Factors such as the type of cancer, age of the patient, lymphocytopenia, neutropenia, hypoxia, hospitalization during COVID-19, multiorgan failure, type of intervention, and severe disease were not associated with an increased risk of long COVID. Nevertheless, follow-up results showed that the no-PASC group exhibited a significant association with hypertension.
Furthermore, acute COVID-19 and higher mortality rates were observed in patients with relapsing and refractory cancer; however, this group did not show strong associations with long-term COVID-19 symptoms.
Additionally, all-cause hospital readmissions occurred in 31% of the patients, 27% of whom were readmitted due to COVID-19-related symptoms. This indicates that hospital readmissions due to PASC symptoms were seen in only 8.5% of the total patient cohort.
Many of the PASC symptoms commonly reported by cancer patients such as headaches, fatigue, gastrointestinal symptoms, cough, and dysgeusia also occur in cancer patients who are receiving radiotherapy, chemotherapy, or immunotherapy. Therefore, the prevalence of these symptoms in cancer patients could have been exaggerated or partly related to the cancer treatment.
Over 50% of cancer patients who had recovered from COVID-19 reported PASC symptoms persisting beyond seven months, and sometimes beyond a year. Female patients were more likely to report persistent PASC symptoms as compared to male patients.
The most commonly reported symptoms included fatigue, gastrointestinal problems, myalgia, and difficulty sleeping. Furthermore, the rate of hospital readmissions due to COVID-19-related symptoms was very low among cancer patients.
- Dagher, H., Chaftari, A.-M., Subbiah, I. M., et al. (2023). Long COVID in cancer patients: preponderance of symptoms in majority of patients over long time period. ELife. doi:10.7554/eLife.81182