TY - JOUR
T1 - Difference in SARS-CoV-2 Antibody Status between Patients with Cancer and Health Care Workers during the COVID-19 Pandemic in Japan
AU - Yazaki, Shu
AU - Yoshida, Tatsuya
AU - Kojima, Yuki
AU - Yagishita, Shigehiro
AU - Nakahama, Hiroko
AU - Okinaka, Keiji
AU - Matsushita, Hiromichi
AU - Shiotsuka, Mika
AU - Kobayashi, Osamu
AU - Iwata, Satoshi
AU - Narita, Yoshitaka
AU - Ohba, Akihiro
AU - Takahashi, Masamichi
AU - Iwasa, Satoru
AU - Kobayashi, Kenya
AU - Ohe, Yuichiro
AU - Yoshida, Tomokazu
AU - Hamada, Akinobu
AU - Doi, Toshihiko
AU - Yamamoto, Noboru
N1 - Funding Information:
Funding/Support: This study was supported by a research fund from the Japan Health Research Promotion Bureau Research Fund (2020-A-1) and also partly supported by Sysmex Co, Japan.
Funding Information:
from AstraZeneca, grants and personal fees from Bristol Myers Squibb, AbbVie, Merck Sharp & Dohme, Ono Pharmaceutical, and Chugai; personal fees from Novartis, Taiho Pharmaceutical, Eli Lilly, Boehringer Ingelheim, Roche Diagnostics, and Archer; and grants from Takeda Pharmaceutical outside the submitted work. Dr Yagishita reported receiving grants from Boehringer Ingelheim outside the submitted work. Dr Matsushita reported receiving a research and development commission fee from Asahi Kasei Medical Co. outside the submitted work. Dr Narita reported receiving grants from Ono Pharmaceutical, Eisai, Sumitomo Dainippon, Taiho, and Daiichi Sankyo outside the submitted work. Dr Ohe reported receiving grants and personal fees from AstraZeneca, Bristol Myers Squibb, Chugai, Eli Lilly, Janssen, Kyorin, Nippon Kayaku, Novartis, Ono Pharmaceutical, Merck Sharp & Dohme, Pfizer, Taiho, and Takeda Pharmaceutical; grants from Amgen and Kissei; and personal fees from Boehringer Ingelheim and Celtrion outside the submitted work. Dr Hamada reported receiving grants from the Japan Health Research Promotion Bureau Research Fund and Sysmex Corporation during the conduct of the study. Dr Doi reported receiving grants from Lilly, Merck Sharp & Dohme, Merck Serono, Pfizer, IQVIA, and Eisai; personal fees from Merck Sharp & Dohme, Amgen, Takeda, Chugai, Bayer, Rakuten Medical, Ono Pharmaceutical, Astellas, Oncolys BioPharma, and Otsuka Pharma; and grants and personal fees from Daiichi Sankyo, Sumitomo Dainippon, Taiho, Novartis, Janssen, Boehringer Ingelheim, Bristol Myers Squibb, and AbbVie outside the submitted work. Dr Yamamoto reported receiving grants from Chugai, Taiho, Eisai, Eli Lilly, Astellas, Bristol Myers Squibb, Novartis, Daiichi Sankyo, Pfizer, Boehringer Ingelheim, Kyowa-Hakko Kirin, Bayer, Ono Pharmaceutical Co., Takeda, Janssen, Merck Sharp & Dohme, Merck, GlaxoSmithKline, Sumitomo Dainippon, Chiome Bioscience, Otsuka; personal fees from Ono Pharmaceutical, Chugai, AstraZeneca, Pfizer, Lilly, Bristol Myers Squibb, Daiichi Sankyo, Eisai, Otsuka, Takeda, Boehringer Ingelheim, and Cimic outside the submitted work. No other disclosures were reported.
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - 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: ß, -0.38; 95% CI, -0.55 to -0.21; P <.001; and S-IgG: ß, -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.
AB - 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: ß, -0.38; 95% CI, -0.55 to -0.21; P <.001; and S-IgG: ß, -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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UR - http://www.scopus.com/inward/citedby.url?scp=85107016373&partnerID=8YFLogxK
U2 - 10.1001/jamaoncol.2021.2159
DO - 10.1001/jamaoncol.2021.2159
M3 - Article
C2 - 34047762
AN - SCOPUS:85107016373
SN - 2374-2437
VL - 7
SP - 1141
EP - 1148
JO - JAMA Oncology
JF - JAMA Oncology
IS - 8
ER -
