JTO Clinical and Research Reports (Jan 2021)

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

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

Journal volume & issue
Vol. 2, no. 1
p. 100124

Abstract

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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.

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