COVID-19 Disrupts Cancer Care and Increases Hospitalizations

COVID-19, the virus caused by SARS-CoV-2, has a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death, according to data from the National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) published in JAMA Oncology.¹

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Cancer Puts Patients at Serious Risk for COVID-19

It has been established that older age and comorbidities are associated with severe presentations of COVID-19, along with heightened mortality rates. Patients who are immunocompromised are considered a high-risk group, putting a greater spotlight on patients with cancer as health care professionals seek to prevent infection with SARS-CoV-2.^1,2

Patient undergoing active therapy for cancer often have a weakened immune system, both due to their disease and because of the therapy they are receiving. Patients with cancer also frequently present with additional comorbidities—including those that may have contributed to their underlying cancer, such as age and smoking. Previous research has affirmed that multiple factors, including the treatment received, age, and the type of cancer, all contribute to the severity of COVID-19 in patients with cancer.^1,3

These aspects combine to increase the risk of complications for patients with cancer who contract COVID-19. Beyond direct clinical implications stemming from infection, there is also the possibility that patients experience treatment disruptions that impact their treatment. Patients may have to navigate a severe, prolonged course of COVID-19, which may necessitate dose adjustments or delays. Individuals who harbor profound immunosuppression may experience protracted viral shedding, leading to longer delays or even cessation of cancer treatment.^1,4,5

Comprehensive long-term data are critical to better understanding the impacts of COVID-19 on patients with cancer, especially now that the COVID-19 pandemic has become endemic in the population. The current investigators led the NCCAPS study, which enrolled individuals with cancer and a recent positive COVID-19 test result and prospectively followed them for 2 years to characterize aspects of their health, including any cancer treatment modifications and the short- and long-term outcomes of COVID-19.¹

Risk Factors for Severe COVID-19 Include Lung Cancer, Chemotherapy

Patients were screened and enrolled between May 2020 and February 2022, recruited from sites participating in 3 National Cancer Institute clinical trial networks. In total, 2040 patients were screened by the authors, with 1572 ultimately being deemed eligible and included in the analysis. There were significant baseline comorbidities observed, including overweight/obesity (72.8%), hypertension (41.7%), diabetes (19.9%), and asthma or chronic obstructive pulmonary disease (14.9%). Critically, most patients (64.4%) were unvaccinated against COVID-19 at the time of their diagnosis.¹

Across the enrolled patients, a total of 1439 (91.5%) had at least 1 symptom related to COVID-19 within 14 days of their positive SARS-CoV-2 result. The most common baseline symptoms were respiratory in 229 patients (66.6%) and constitutional in 239 patients (69.5%), according to the investigators, while loss of taste or smell was reported in 358 patients (22.8%). In a positive development, COVID-19 symptoms generally declined over time.¹

At 90 days, COVID-19-related mortality was 3.0%, without observed increases at subsequent time points. Accordingly, cancer-related mortality was 2.9% at the same time point, increasing to 6.6% at 6 months. Regarding specific cancer types, cumulative incidence of COVID-19-specific death throughout the first 90 days was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and the lowest in individuals with other cancers, according to the study authors.¹

Hospitalizations due to COVID-19 were observed for 290 patients (18.4%) within 90 days of enrollment, of which 68 (23.4%) were admitted to the intensive care unit (ICU). The highest incidence of COVID-19-specific death in hospitalized individuals was among patients with lung cancer, while those with solid, non-lung tumors and other hematologic cancers were least likely to require hospitalization. The investigators determined multiple key risk factors for hospitalization, including receiving chemotherapy (hazard ratio [HR], 1.97 [95% CI, 1.52–2.54]) and a baseline history of stroke, pulmonary embolism, or atrial fibrillation (HR, 1.87 [95% CI, 1.33–2.38]).¹

Finally, treatment disruptions were detailed by the investigators over 2 years of follow-up. During this time, there were 1739 disruptions, of which 881 (50.7%) were attributed to COVID-19. Notably, most disruptions occurred within the first 30 days. The most reported disruption was experiencing a schedule change of cancer treatment or clinical care.¹

Data Present Critical Insights for Oncology Pharmacists

It’s essential to investigate the factors that may put patients with cancer at higher risk of developing severe COVID-19. In addition, researchers must continue to shed a light on the related complications of COVID-19 in this population, which could include hospitalization. Pharmacists should be aware of these possibilities and counsel patients with cancer—especially those receiving active treatment—on their risks and responsibilities to keep themselves protected, which could include receipt of a COVID-19 vaccine.¹

Beyond the direct risks of severe illness, the investigators characterized the impact of treatment disruptions on this population. Pharmacists should ensure to the best of their ability that patients with cancer infected with COVID-19 do not experience any delays in treatment and educate and aid patients on how to manage both their cancer treatment and COVID-19 illness.¹

“The data from this prospective cohort study confirm and expand previous retrospective case series that have found factors, including hematologic cancers, chemotherapy receipt, and lung cancer, as associated with COVID-19 severity,” the study authors concluded. Populations at extreme risk should be carefully followed up as SARS-CoV-2 transitions from a pandemic to an endemic illness.¹

REFERENCES

1. Rini BI, Best AF, Bowman MD, et al. Risk Factors for COVID-19–Related Hospitalization and Death in Patients With Cancer: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS). JAMA Oncol. 2025. Published Online July 17, 2025. doi:10.1001/jamaoncol.2025.2010

2. Zhang Ji, Dong X, Liu G, et al. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clinic Rev Allerg Immunol. 2023;64:90-107. doi:10.1007/s12016-022-08921-5

3. Khoury E, Nevitt S, Madsen WR, et al. Differences in Outcomes and Factors Associated With Mortality Among Patients With SARS-CoV-2 Infection and Cancer Compared With Those Without Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(5):e2210880. doi:10.1001/jamanetworkopen.2022.10880

4. Grivas P, Khaki AR, Wise-Draper TM, et al. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. ESMO Annals of Oncol. 2021;32(6):787-800. doi:0.1016/j.annonc.2021.02.024

5. Aydillo T, Gonzalez-Reiche AS, Aslam S, et al. Shedding of viable SARS-CoV-2 after immunosuppressive therapy for cancer. N Engl J Med. 2020;383(26):2586-2588. doi:10.1056/NEJMc2031670