During one year, 60 cancer patients who had experienced Covid-19 disease were evaluated for symptoms. Most of the patients (60%) were infected with CVID-19 in the last three months of the study. While in the first trimester of the pandemic, the number of patients with Covid-19 was only 7, due to the observance of hygienic principles and adherence to self-care education [1].
Patients included 27 men (45%), 33 women (55%) with a mean age of 51.1 ± 13.8 years (range 24 to 77 years). There was no statistically significant difference in the prevalence of the disease between the two sexes. The mean age of the men was 52 ± 13 years, and women were 47 ± 13 years. There was a statistically significant difference in the age of infection between males and females (P < 0.05).
In terms of cancer type, patients were divided into two categories: patients with hematologic malignancy (including lymphoma, leukemia, myeloma, and Hodgkin) and patients with solid tumor (including the brain, breast, gastrointestinal tract, larynx, lung, ovary, pancreas, prostate, and skin cancers). Among all patients, 68% were in the solid tumor categories and 32% in the hematologic categories. In order of number, most cases of COVID-19 positive in solid tumor were breast cancer (24.4%), colon cancer (22%), gastric cancer (9.8%), lung cancer (7.3%), and ovarian cancer (7.3%). About hematological malignancy, most cases were observed in lymphoma (31.6%), chronic lymphocytic leukemia (CLL) (31.6%), and acute leukemia (21.1%) (Table 1). There was no statistically significant difference between the two categories in terms of age and gender.
The most clinical manifestations (70 − 60%) of COVID-19 were fever, tiredness, exhaustion, and dry cough. Other symptoms such as aches and pains, sore throat, headache, difficulty breathing or shortness of breath, and frailty (severe weakness) were observed in 40–55% of cases.
Less common symptoms (< 30%) were diarrhea, conjunctivitis, ageusia (loss of taste) and anosmia (loss of smell), dysarthria (difficulty speaking), confusion, and bewilderment (Table 2). The clinical manifestations of solid and hematological cancers are listed in Table 2. There was a statistically significant difference between the two groups in the incidence of frailty (P = 0.029) and dysarthria (P = 0.009) symptoms. Patients with solid tumor experienced the dysarthria (26%) and frailty more than patients with hematologic cancer.
About the blood findings and pulse oximetry results of patients, the percentage of saturated oxygen (SO2%) before oxygen therapy was in the range of 76–96%, and after oxygen therapy was 80–96%. According to the paired t-test, there was a significant difference between the mean of SO2 before and after treatment: 83.81 vs. 89.31 (P < 0.001). But there was no statistically significant difference between the two cancer groups (Table 3).
Other blood factors are listed in Table 3. Among hematologic factors, there was a statistically significant difference between the two groups only in the mean platelet count (P = 0.044).
Reverse transcription-polymerase chain reaction (RT-PCR) was the main laboratory technique in diagnosis Covid-19, in 33.3% of patients despite the symptoms, RT-PCR was negative. The relationship between cancer type and the RT-PCR test result was not significant.
In terms of pulmonary involvement in the computerized tomography (CT) scan report, 50.3% of patients had pulmonary involvement, of which16.7 % had unilateral involvement, 22% bilateral, and 8.3% had pleural involvement combined with unilateral or bilateral pulmonary involvement. There was no statistically significant difference between two groups in terms of pulmonary involvement parameters.
Patients were treated with chemotherapy based on the type of cancer (Table 4), and when they get Covid-19, the proposed therapies were used to control the disease. Overall, 40% of patients used single-dose or combination medications of ReciGen (interferon beta-1a) (36.7%), Remdesivir (21.7%), corticosteroids (2%), and Hydroxychloroquine (8.3%), and others used other medications or supportive proceedings to control the disease.
There was no significant relationship between the treatment options and the type of cancer.
A total of 68.3% of patients with severe symptoms were admitted to the intensive care unit (ICU), of which 13.3% needed a ventilator. There was no statistically significant relationship between the type of cancer and hospitalized in the ICU and the need for a ventilator.
In solid tumor, 9.8% and in hematological malignancy 15.8% of patients died. There was no statistically significant relationship between cancer type and patients’ survival status.
Among various types of cancer, only patients who were stage IV died of Covid-19 and in the other stages, there was no death report. There was a statistically significant difference between the stage of cancer and survival status (P = 0.043).
A total of 7 deaths were reported, of which 4 were related to solid tumor (two cases of lung cancer, one case of the brain, and one case of cholangiocarcinoma) and three cases were related to hematological malignancy (myeloma and refractory acute leukemia).
There were no statistically significant differences between hematologic and solid cancers in terms of survival, but there was a statistically significant difference between hematologic malignancy and life status (Table 5). The deceased patients had no comorbidity except cancer. All patients had a dry cough, but none had conjunctivitis, confusion, and bewilderment. The PCR test was positive in all patients and all required a ventilator. The deceased solid tumor patients had symptoms of fever, shortness of breath, chest pain, and frailty. Diarrhea was common in the deceased hematologic cancer patients, but none had pain, sore throat, ageusia and anosmia, dysarthria, or frailty.