27th August 2020 // Sarah McDonald
You may have seen some of the recent news reports referring to a publication in The Lancet looking at how COVID-19 affected patients with different types of cancer during the peak of the pandemic.
The data shows that blood cancer patients, including those with myeloma, had a higher susceptibility to COVID-19 and were more likely to be seriously ill due to COVID-19 than patients with other cancer types.
A news article in The Independent highlighted the figures reported in the study which stated that 36% of blood cancer patients had died due to COVID-19, and that myeloma patients were 65% more likely to die from COVID-19. This is pretty dark reading and it’s really important that we unpick some of this to understand the stark numbers.
Let’s start by looking at who was included in the study. The people in the study had cancer, were on active treatment and under the care of their clinical teams, and had a positive test for COVID-19. This means the study focused on patients who were being treated, monitored and managed in a hospital setting, rather than looking at every myeloma patient.
The group in the study were exclusively cancer patients, so it is also important to consider why blood cancer might lead to a higher risk of dying due to COVID-19 than other cancers. There are several factors relating to myeloma which would contribute to this data. Myeloma patients being looked after in a hospital setting are likely to be having intensive chemotherapy, be immunocompromised, have increased frailty, or have other co-morbidities which contribute to the increased risk factors associated with COVID-19.
It is also important to look at the timing of the study. This patient data was collected between the18 March and the 8 May – in other words, at the peak of the COVID-19 infective period. Testing for COVID-19 was not widely available for people with milder symptoms at this time, and was used mainly for patients on admission to hospital. Moreover, the world was still in the process of finding the right way to treat and care for COVID-19 patients. This means that the numbers quoted represent the situation between March and May and don’t necessarily represent the status today.
I would encourage all myeloma patients reading this to reflect on the results of our COVID-19 survey. This was open from the 20 May for two weeks and began two weeks after the data for the Lancet study was collected. We had over 1100 respondents very few of whom had COVID-19 or were even tested for it. The overwhelming conclusion from the Myeloma UK survey is that shielding was successful for minimising COVID-19 risk for myeloma patients in the community. Shielding has now been suspended and we are keen to understand what this change means for myeloma patients. The next phase of our COVID-19 survey launches next week and we hope you will complete this so we can what life looks like for you all in this period.
There have been further changes since the study was published in The Lancet that also influence today’s picture for myeloma patients. We have seen several temporary changes to treatment access which enable myeloma patients to continue treatment whilst seeking to lower their risk of COVID-19 infection. We all know that living with myeloma carries an element of risk: back in March to May, the risk to your health was greater from COVID-19 as infection rates within the community were so high. As we look towards September, the community infection rate is much lower, there are alternative treatments available, many clinicians have resumed high-dose therapy and stem cell transplants, and so the priority for your health is back to treating myeloma.
It is also important to remember that the majority of people in the study recovered, and that the figures quoted represent the average for the groups of patients in the study and not individuals.
So, I would urge patients and carers not focus on the numbers and the headline “65% more likely to die from COVID-19”.
It’s tricky when results like these are published as the instinct is always to look at the worst-case scenario. There is a lot we don’t know yet about COVID-19. It has been around for less than a year and we need to know more about the disease and how it affects different groups. Most importantly, we need a vaccine. More research will find answers and, hopefully, an effective vaccine soon. As that work progresses, Myeloma UK will be ready to respond to any changes and keep the clinical and care needs of myeloma patients at the forefront of decision-makers’ minds.
If you are worried about the results of this study or have questions about COVID-19 you can contact our Myeloma Information Specialist through the Myeloma Infoline (0800 980 3332 (UK) or 1800 937 773 (Ireland)) or the AskTheNurse email service.