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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    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.

    Abstract

    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.

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