Age, comorbidities, not cancer-related factors, raise COVID-19 risks with thyroid cancer
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Adults with differentiated thyroid cancer had greater likelihood for severe COVID-19 outcomes with older age and at least one comorbidity, but cancer-related factors did not increase risks, according to a study findings.
“Prior studies in general cancer patient populations from the U.S. and abroad showed very concerning rates of hospitalization and death among cancer patients compared to similarly aged patients without cancer,” Melissa G. Lechner, MD, PhD, assistant professor of medicine in the onco-endocrinology program, division of endocrinology, diabetes and metabolism at UCLA David Geffen School of Medicine, told Healio. “Contributors to severe COVID19 outcomes in cancer patients may be treatment-related effects, such as suppression of the immune system by chemotherapy, or cancer-related morbidity, such as metastatic disease in the lungs. Because thyroid cancer is treated with different modalities than many other solid tumors — ie, primarily surgery and radioactive iodine — and has excellent disease-specific survival, we felt that these COVID19 studies on general cancer patient populations may not be generalizable to differentiated thyroid cancer patients.”
Lechner and colleagues reviewed electronic medical records from 21 adults diagnosed with differentiated thyroid cancer who tested positive for COVID-19 from January to September 2020 in the UCLA Health System or the Los Angeles County-University of South California Medical Center Health System (median age, 56 years; 80% women). Demographic data, comorbidities, BMI and smoking status were extracted from a manual chart review. Researchers collected data on thyroid cancer history, including each person’s disease response within 6 months before the positive COVID-19 test. Information on COVID-19 outcomes, including hospitalization, supplemental oxygen administration, mechanical ventilation, vasopressor therapy, the use of renal replacement therapy and death, was also obtained.
All 21 adults in the study had been diagnosed with papillary thyroid cancer, eight were hospitalized for COVID-19, five needed supplemental oxygen, three required mechanical ventilation and vasopressor therapy, and one received renal replacement therapy. Two died from COVID-19 complications.
Four of the eight hospitalized patients had classic papillary thyroid cancer, including both who died. Only one hospitalized person was within 5 years of initial thyroid cancer diagnosis. Tumor size and recurrence risk were not associated with COVID-19 outcomes.
Patients who were older than 60 years were more likely to be hospitalized compared with those aged 60 years and younger (60% vs. 18%) and were more likely to need supplemental oxygen (40% vs. 18%), mechanical ventilation (20% vs. 9%) and vasopressor support (20% vs. 9%). Additionally, there were no deaths in adults aged 60 years or younger.
Of adults with differentiated thyroid cancer, those who also had diabetes, lung disease or cardiovascular disease were more likely to be hospitalized for COVID-19. Seven of eight patients who were hospitalized had at least one comorbidity, whereas only five of 13 people who were not hospitalized had at least one comorbidity.
Lechner said more research is needed on any association between radioactive iodine therapy and COVID-19 risks. She added future research could also examine patients with thyroid cancer with lung metastases, a subgroup that was not included in the study.
“While not a direct aim of our study, we did find that differentiated thyroid cancer patients had slightly higher rates of hospitalization and death from COVID-19 compared to similarly aged patients in the region,” Lechner said. “We would recommend vaccination and social distancing for patients with differentiated thyroid cancer to reduce their chance of COVID-19 as has been suggested by the CDC.”
For more information:
Melissa G. Lechner, MD, PhD, can be reached at mlechner@mednet.ucla.edu.
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