Don’t Stop the Process

Session: COVID‐19 Outcomes Of Patients With Gynecologic Cancer In New York City: An Updated Analysis

 Speaker: Olivia Lara, MD, MS, gynecologic oncology fellow, New York University (NYU) Langone Health, New York City

Immunotherapy or chemotherapy does not increase risk of hospitalization or death due to COVID-19

While several studies indicate that cancer patients have a greater risk of health complications from coronavirus disease 2019 (COVID-19), a new study reports that recent chemotherapy or immunotherapy for gynecologic cancer does not increase a patient’s risk of hospitalization or death due to COVID-19. In addition, there was no association between cancer type or stage on COVID-19-related outcome.

The study results were reported during SGO 2021’s first focused plenary session, Practicing During a Pandemic: Lessons from COVID-19. “We can reassure women with gynecologic cancer that they can continue anticancer therapy,” said the study’s presenting author, Olivia Lara, MD, MS, gynecologic oncology fellow, New York University, Langone Health, New York City.

During the flurry of activity to figure out what COVID-19 meant in terms of cancer treatments and therapies, Dr. Lara and her colleagues spotted a gap in studies specific to gynecologic cancer. This prompted their study: COVID19 Outcomes Of Patients With Gynecologic Cancer In New York City: An Updated Analysis.

In addition to answering oncologists’ questions, Dr. Lara wanted a study that addressed patients fears as to whether chemotherapy would further weaken their already immunocompromised state and increase COVID-19 symptom severity—if they did catch the virus.

The researchers analyzed data from 193 patients, all diagnosed with and treated for COVID-19 between March and May 2020 and at eight New York City area hospitals. In addition, all patients had gynecologic cancer, primarily endometrial/uterine, ovarian, and cervical cancers. Overall, 106 patients (54.9 percent) required hospitalization.

When the investigators analyzed risk for these patients to experience death or hospitalization due to a COVID-19 diagnosis, they found that a patient’s recent cytotoxic chemotherapy did not predict increased risk for either.

The same negative increased risk held true for immunotherapy, although in a similar but considerably smaller study conducted by the same research team, immunotherapy did appear to be a risk factor for increased COVID-19-related deaths in women with gynecologic cancer. Again, this did not hold true in the second, larger study.

The need for hospitalization due to COVID-19 was reportedly associated with age 65 years or older, Black race, and having three or more additional, coexisting, long-term health conditions. Additionally, women who had a low performance status score, indicating their ability to independently perform activities of daily living, had an increased risk of hospitalization compared with those with better performance status.

Thirty-four of the 193 patients in this study, or 17.3 percent, died of COVID-19. Dr. Lara said this fatality rate is similar to that of age-matched women with COVID-19 who did not have cancer. She added that fatality rates may be lower now, since this study was conducted in the pandemic’s earlier days.  

Taking a step back and evaluating the study’s strengths and possible loose ends, Bhavana Pothuri, MD, professor at New York University Grossman School of Medicine, brought up a few points. A solid strength, Dr. Pothuri said, was the fact that these findings came from a collaborative, multicenter study with a multivariable analysis.

The doctor did, however, raise a few questions for the study authors. “I would like to know if Dr. Lara and her colleagues think their findings are generalizable to other parts of the country—or world?” she asked. “And, given that this study was conducted during the initial COVID-19 surge, do you think the outcomes are different now?”

Dr. Pothuri also expressed concern about racial disparity. “Black race was associated with a two-and-a-half-fold increase in hospitalization. Can you comment on your work in racial disparity in gynecologic cancer and COVID-19 outcomes?”

Interesting questions. And although the world appears to be turning a final pandemic corner, answering these queries might help gynecologic oncologists better deal with future concerns concerning how chemotherapy for gynecologic cancer relates to other diseases.