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The death and complication rates of the coronavirus disease 2019 (COVID-19) are significantly higher in older persons as compared to younger adults. In fact, due to the heterogeneous nature of aging, subsets of cancer patients of advanced age are likely to be at higher risk than others of acquiring adverse COVID-19-related side effects. Therefore, identifying those at an increased risk is critical in their clinical management.
In a recent The Lancet Healthy Longevity study, researchers developed a geriatric risk score for COVID-19 that included age, comorbidities, and performance status to accurately predict the risk of severe clinical outcomes in older cancer patients with COVID-19. The authors of this study were also interested in determining how COVID-19 presented in older cancer patients and how this disease could affect their cancer care after recovery.
A total of 5,671 patients over the age of 60 with a current or previous cancer diagnosis and a current or previously confirmed COVID-19 diagnosis were included in the present study.
The presentation of the patients included in the current study was categorized as typical, atypical, or none of the listed symptoms. A typical presentation of a patient was defined as individuals who experienced fever, cough, dyspnea, myalgia, arthralgia, headache, anosmia, ageusia, sore throat, rhinorrhea, nausea, vomiting, diarrhea, and abdominal pain.
Comparatively, an atypical presentation was reported when a patient experienced one or more atypical symptoms of fatigue, altered mental state, abdominal discomfort, conjunctivitis, and other symptoms that have not been classified by the United States Centers for Disease Control and Prevention (CDC) as a typical COVID-19 symptom.
The researchers then calculated a geriatric risk score, which they referred to as the COVID-19 and Cancer Consortium (CC19) index, based on several factors. For example, an individual younger than 75, those between the ages of 76 and 80, and those over the age of 80 years were given zero, one, and two points, respectively. The Charlson comorbidity index (CCI) was also used, a score given to individuals with several comorbidities to predict their 10-year survival.
A third component of the geriatric risk score used in the current study was the Eastern Cooperative Oncology Group (ECOG) performance status, which the healthcare providers assessed according to the patient’s chart. Patients with an ECOG grade of zero, one, or two were given zero, one, or two points, respectively, to reflect how the patient’s health conditions impacted their daily activities.
Within 30 days of a COVID-19 diagnosis, 920 patients died, including 161 of the 2,365 standard-risk patients, 409 of the 2,216 intermediate-risk patients, and 350 of the 1,089 high-risk patients. In addition, the researchers reported a significant correlation between COVID-19 and an increased CCC19 geriatric risk index and higher COVID-19 severity and higher odds of 30-day mortality.
The most prevalent symptoms reported in the study participants included cough, fever, weariness or malaise, and dyspnea. Patients aged 80 and older, in particular, had a higher rate of a disturbed mental state than younger patients.
Only 193 of the 2,360 standard-risk patients had severe COVID-19 at the time of examination as compared to 288 of the 2,210 intermediate-risk patients and 177 of the 1,084 high-risk patients. Most patients did not receive any form of treatment for their COVID-19-related symptoms. For all geriatric risk groups, the treatments administered were similar.
COVID-19 complications were prevalent throughout this study, with pulmonary issues being the most common. Complications were recorded more frequently in high-risk individuals than in intermediate and standard risk groups.
Approximately half of the patients whose cancer therapy was documented and were receiving anti-cancer treatments within three months of their COVID-19 diagnosis had their therapy modified. A delay in cancer therapy was the most prevalent adjustment among individuals with accessible data and was similar across all risk groups.
Taken together, the findings from the current study demonstrate that individuals with elevated geriatric profiles had more severe initial symptoms and are more likely to die from COVID-19-related complications than those with standard-risk profiles. However, it remains unclear how anti-cancer treatment adjustments affect cancer control and whether COVID-19-induced functional loss affects future capability to withstand cancer treatment in older individuals who may already be at significant risk for toxicity.
Based on publicly available clinical indicators, the CCC19 geriatric risk index may provide doctors with an easy-to-use risk prediction technique to identify most at-risk older persons for severe COVID-19 and mortality.