COVID-19 Infection in a Lung Cancer Patient Population: Incidence, Presentation and Alternative Diagnostic Considerations

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

Introduction Lung cancer is associated with severe 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 lung cancer patients. Methods To determine an at-risk population for COVID-19, we retrospectively identified lung cancer patients receiving longitudinal care within a single institution in the 12 months (4/1/19 – 3/31/20) 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/radiographic findings, and outcomes of positive versus negative patients. Results Between 4/1/2019-3/31/2020, 696 patients received longitudinal care, including 406 (58%) in the active therapy population. Among 55 patients referred for COVID-19 testing, 24 (44%) were COVID-19 positive, representing a cumulative incidence of 3.4% (longitudinal population) and 1.5% (active therapy population). Compared to COVID-19-negative patients, COVID-19-positive patients were more likely to have a supplemental oxygen requirement (11% vs. 54%, p=0.005) and to have typical COVID-19 pneumonia imaging findings (5 vs. 56%, p=0.001). Otherwise, there were no significant differences in presenting symptoms. Among COVID-negative patients, alternative etiologies included treatment-related toxicity (26%), atypical pneumonia (22%), and disease progression (22%). Sixteen COVID-19-postive patients (67%) required hospitalization, and 7 (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 lung cancer patients presenting with acute symptoms.