Difference in SARS-CoV-2 Antibody Status Between Patients With Cancer and Health Care Workers During the COVID-19 Pandemic in Japan | Oncology | JAMA Oncology | JAMA Network
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WHO. Coronavirus Disease (COVID-19) Dashboard 2021. Accessed February 1, 2021. https://covid19.who.int
Patel  A, Jernigan  DB; 2019-nCoV CDC Response Team.  Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak—United States, December 31, 2019-February 4, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(5):140-146. doi:10.15585/mmwr.mm6905e1PubMedGoogle ScholarCrossref
Deeks  JJ, Dinnes  J, Takwoingi  Y,  et al; Cochrane COVID-19 Diagnostic Test Accuracy Group.  Antibody tests for identification of current and past infection with SARS-CoV-2.   Cochrane Database Syst Rev. 2020;6(6):CD013652.PubMedGoogle Scholar
Liang  W, Guan  W, Chen  R,  et al.  Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.   Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6PubMedGoogle ScholarCrossref
Berghoff  AS, Gansterer  M, Bathke  AC,  et al.  SARS-CoV-2 testing in patients with cancer treated at a tertiary care hospital during the COVID-19 pandemic.   J Clin Oncol. 2020;38(30):3547-3554. doi:10.1200/JCO.20.01442PubMedGoogle ScholarCrossref
Yu  J, Ouyang  W, Chua  MLK, Xie  C.  SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China.   JAMA Oncol. 2020;6(7):1108-1110. doi:10.1001/jamaoncol.2020.0980PubMedGoogle ScholarCrossref
Bertuzzi  AF, Marrari  A, Gennaro  N,  et al.  Low incidence of SARS-CoV-2 in patients with solid tumours on active treatment: an observational study at a tertiary cancer centre in Lombardy, Italy.   Cancers (Basel). 2020;12(9):2352. doi:10.3390/cancers12092352PubMedGoogle ScholarCrossref
Rogado  J, Obispo  B, Pangua  C,  et al.  COVID-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid.   Clin Transl Oncol. 2020;22(12):2364-2368. doi:10.1007/s12094-020-02381-zPubMedGoogle ScholarCrossref
Fillmore  NR, La  J, Szalat  RE,  et al.  Prevalence and outcome of COVID-19 infection in cancer patients: a national Veterans Affairs study.   J Natl Cancer Inst. 2020;djaa159. doi:10.1093/jnci/djaa159PubMedGoogle Scholar
Wang  Q, Berger  NA, Xu  R.  Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection.   JAMA Oncol. 2021;7(2):220-227. doi:10.1001/jamaoncol.2020.6178PubMedGoogle ScholarCrossref
Miyashita  H, Mikami  T, Chopra  N,  et al.  Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City.   Ann Oncol. 2020;31(8):1088-1089. doi:10.1016/j.annonc.2020.04.006PubMedGoogle ScholarCrossref
Mehta  V, Goel  S, Kabarriti  R,  et al.  case fatality rate of cancer patients with COVID-19 in a New York hospital system.   Cancer Discov. 2020;10(7):935-941. doi:10.1158/2159-8290.CD-20-0516PubMedGoogle ScholarCrossref
Dai  M, Liu  D, Liu  M,  et al.  Patients with cancer appear more vulnerable to SARS-CoV-2: a multicenter study during the COVID-19 outbreak.   Cancer Discov. 2020;10(6):783-791.PubMedGoogle Scholar
Anelli  F, Leoni  G, Monaco  R,  et al.  Italian doctors call for protecting healthcare workers and boosting community surveillance during covid-19 outbreak.   BMJ. 2020;368:m1254. doi:10.1136/bmj.m1254PubMedGoogle ScholarCrossref
Moscola  J, Sembajwe  G, Jarrett  M,  et al; Northwell Health COVID-19 Research Consortium.  Prevalence of SARS-CoV-2 antibodies in health care personnel in the New York City area.   JAMA. 2020;324(9):893-895. doi:10.1001/jama.2020.14765PubMedGoogle ScholarCrossref
Garcia-Basteiro  AL, Moncunill  G, Tortajada  M,  et al.  Seroprevalence of antibodies against SARS-CoV-2 among health care workers in a large Spanish reference hospital.   Nat Commun. 2020;11(1):3500. doi:10.1038/s41467-020-17318-xPubMedGoogle ScholarCrossref
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053.Google ScholarCrossref
Noda  K, Matsuda  K, Yagishita  S,  et al.  A novel highly quantitative and reproducible assay for the detection of anti-SARS-CoV-2 IgG and IgM antibodies.   Sci Rep. 2021;11(1):5198. doi:10.1038/s41598-021-84387-3PubMedGoogle ScholarCrossref
Park  R, Lee  SA, Kim  SY, de Melo  AC, Kasi  A.  Association of active oncologic treatment and risk of death in cancer patients with COVID-19: a systematic review and meta-analysis of patient data.   Acta Oncol. 2021;60(1):13-19. doi:10.1080/0284186X.2020.1837946PubMedGoogle ScholarCrossref
Solodky  ML, Galvez  C, Russias  B,  et al.  Lower detection rates of SARS-COV2 antibodies in cancer patients versus health care workers after symptomatic COVID-19.   Ann Oncol. 2020;31(8):1087-1088. doi:10.1016/j.annonc.2020.04.475PubMedGoogle ScholarCrossref
Lumley  SF, O’Donnell  D, Stoesser  NE,  et al; Oxford University Hospitals Staff Testing Group.  Antibody status and incidence of SARS-CoV-2 infection in health care workers.   N Engl J Med. 2021;384(6):533-540. doi:10.1056/NEJMoa2034545PubMedGoogle ScholarCrossref
Verma  R, Foster  RE, Horgan  K,  et al.  Lymphocyte depletion and repopulation after chemotherapy for primary breast cancer.   Breast Cancer Res. 2016;18(1):10. doi:10.1186/s13058-015-0669-xPubMedGoogle ScholarCrossref
Loulergue  P, Alexandre  J, Iurisci  I,  et al.  Low immunogenicity of seasonal trivalent influenza vaccine among patients receiving docetaxel for a solid tumour: results of a prospective pilot study.   Br J Cancer. 2011;104(11):1670-1674. doi:10.1038/bjc.2011.142PubMedGoogle ScholarCrossref
Rousseau  B, Loulergue  P, Mir  O,  et al.  Immunogenicity and safety of the influenza A H1N1v 2009 vaccine in cancer patients treated with cytotoxic chemotherapy and/or targeted therapy: the VACANCE study.   Ann Oncol. 2012;23(2):450-457. doi:10.1093/annonc/mdr141PubMedGoogle ScholarCrossref
Läubli  H, Balmelli  C, Kaufmann  L,  et al.  Influenza vaccination of cancer patients during PD-1 blockade induces serological protection but may raise the risk for immune-related adverse events.   J Immunother Cancer. 2018;6(1):40. doi:10.1186/s40425-018-0353-7PubMedGoogle ScholarCrossref
Channappanavar  R, Twardy  BS, Suvas  S.  Blocking of PDL-1 interaction enhances primary and secondary CD8 T cell response to herpes simplex virus-1 infection.   PLoS One. 2012;7(7):e39757. doi:10.1371/journal.pone.0039757PubMedGoogle Scholar
Polack  FP, Thomas  SJ, Kitchin  N,  et al; C4591001 Clinical Trial Group.  Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine.   N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577PubMedGoogle ScholarCrossref
Baden  LR, El Sahly  HM, Essink  B,  et al; COVE Study Group.  Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine.   N Engl J Med. 2021;384(5):403-416. doi:10.1056/NEJMoa2035389PubMedGoogle ScholarCrossref
Fuereder  T, Berghoff  AS, Heller  G,  et al.  SARS-CoV-2 seroprevalence in oncology healthcare professionals and patients with cancer at a tertiary care centre during the COVID-19 pandemic.   ESMO Open. 2020;5(5):e000889. doi:10.1136/esmoopen-2020-000889PubMedGoogle Scholar
Cabezón-Gutiérrez  L, Custodio-Cabello  S, Palka-Kotlowska  M, Oliveros-Acebes  E, García-Navarro  MJ, Khosravi-Shahi  P.  Seroprevalence of SARS-CoV-2-specific antibodies in cancer outpatients in Madrid (Spain): A single center, prospective, cohort study and a review of available data.   Cancer Treat Rev. 2020;90:102102. doi:10.1016/j.ctrv.2020.102102PubMedGoogle Scholar
Steensels  D, Oris  E, Coninx  L,  et al.  Hospital-wide SARS-CoV-2 Antibody screening in 3056 staff in a tertiary center in Belgium.   JAMA. 2020;324(2):195-197. doi:10.1001/jama.2020.11160PubMedGoogle ScholarCrossref
Rudberg  AS, Havervall  S, Månberg  A,  et al.  SARS-CoV-2 exposure, symptoms and seroprevalence in healthcare workers in Sweden.   Nat Commun. 2020;11(1):5064. doi:10.1038/s41467-020-18848-0PubMedGoogle ScholarCrossref
Pollán  M, Pérez-Gómez  B, Pastor-Barriuso  R,  et al; ENE-COVID Study Group.  Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study.   Lancet. 2020;396(10250):535-544. doi:10.1016/S0140-6736(20)31483-5PubMedGoogle ScholarCrossref
Havers  FP, Reed  C, Lim  T,  et al. Seroprevalence of antibodies to SARS-CoV-2 in 10 sites in the United States, March 23-May 12, 2020.  JAMA Intern Med. 2020;180(12):1576-1586. doi:10.1001/jamainternmed.2020.4130
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    Original Investigation
    May 28, 2021

    Difference in SARS-CoV-2 Antibody Status Between Patients With Cancer and Health Care Workers During the COVID-19 Pandemic in Japan

    Author Affiliations
    • 1Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
    • 2Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
    • 3Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
    • 4Division of Molecular Pharmacology, National Cancer Center Research Institute, Tokyo, Japan
    • 5Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
    • 6Department of General Internal Medicine, National Cancer Center Hospital East, Chiba, Japan
    • 7Department of Laboratory Medicine, National Cancer Center Hospital, Tokyo, Japan
    • 8Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan.
    • 9Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
    • 10Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
    • 11Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
    • 12Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
    • 13Central Research Laboratories, Sysmex Corporation, Hyogo, Japan
    • 14Department of Experimental Therapeutics, National Cancer Center Hospital East, Chiba, Japan
    JAMA Oncol. Published online May 28, 2021. doi:10.1001/jamaoncol.2021.2159
    Key Points

    Question  Are there differences in seroprevalence and antibody levels for SARS-CoV-2 between patients with cancer and health care workers (HCWs) during the COVID-19 pandemic in Japan?

    Findings  In this cross-sectional study including 500 patients with cancer and 1190 HCWs, the seroprevalence was 1.0% in patients and 0.67% in HCWs. However, the levels of IgG antibodies against nucleocapsid and spike protein were significantly lower in patients than in HCWs.

    Meaning  These findings indicate that seroprevalence was not different in patients with cancer compared with HCWs, but the immune response to SARS-CoV-2 may differ between patients with cancer and HCWs.


    Importance  Patients with cancer and health care workers (HCWs) are at high risk of SARS-CoV-2 infection. Assessing the antibody status of patients with cancer and HCWs can help understand the spread of COVID-19 in cancer care.

    Objective  To evaluate serum SARS-CoV-2 antibody status in patients with cancer and HCWs during the COVID-19 pandemic in Japan.

    Design, Setting, and Participants  Participants were enrolled for this prospective cross-sectional study between August 3 and October 30, 2020, from 2 comprehensive cancer centers in the epidemic area around Tokyo, Japan. Patients with cancer aged 16 years or older and employees were enrolled. Participants with suspected COVID-19 infection at the time of enrollment were excluded.

    Exposures  Cancer of any type and cancer treatment, including chemotherapy, surgery, immune checkpoint inhibitors, radiotherapy, and targeted molecular therapy.

    Main Outcomes and Measures  Seroprevalence and antibody levels in patients with cancer and HCWs. Seropositivity was defined as positivity to nucleocapsid IgG (N-IgG) and/or spike IgG (S-IgG). Serum levels of SARS-CoV-2 IgM and IgG antibodies against the nucleocapsid and spike proteins were measured by chemiluminescent enzyme immunoassay.

    Results  A total of 500 patients with cancer (median age, 62.5 years [range, 21-88 years]; 265 men [55.4%]) and 1190 HCWs (median age, 40 years [range, 20-70 years]; 382 men [25.4%]) were enrolled. In patients with cancer, 489 (97.8%) had solid tumors, and 355 (71.0%) had received anticancer treatment within 1 month. Among HCWs, 385 (32.3%) were nurses or assistant nurses, 266 (22.4%) were administrative officers, 197 (16.6%) were researchers, 179 (15.0%) were physicians, 113 (9.5%) were technicians, and 50 (4.2%) were pharmacists. The seroprevalence was 1.0% (95% CI, 0.33%-2.32%) in patients and 0.67% (95% CI, 0.29%-1.32%) in HCWs (P = .48). However, the N-IgG and S-IgG antibody levels were significantly lower in patients than in HCWs (N-IgG: β, −0.38; 95% CI, −0.55 to −0.21; P < .001; and S-IgG: β, −0.39; 95% CI, −0.54 to −0.23; P < .001). Additionally, among patients, N-IgG levels were significantly lower in those who received chemotherapy than in those who did not (median N-IgG levels, 0.1 [interquartile range (IQR), 0-0.3] vs 0.1 [IQR, 0-0.4], P = .04). In contrast, N-IgG and S-IgG levels were significantly higher in patients who received immune checkpoint inhibitors than in those who did not (median N-IgG levels: 0.2 [IQR, 0.1-0.5] vs 0.1 [IQR, 0-0.3], P = .02; S-IgG levels: 0.15 [IQR, 0-0.3] vs 0.1[IQR, 0-0.2], P = .02).

    Conclusions and Relevance  In this cross-sectional study of Japanese patients with cancer and HCWs, the seroprevalence of SARS-CoV-2 antibodies did not differ between the 2 groups; however, findings suggest that comorbid cancer and treatment with systemic therapy, including chemotherapy and immune checkpoint inhibitors, may influence the immune response to SARS-CoV-2.