Strict self-isolation did not protect Swedish cancer patients on active treatment from the risk of becoming seropositive for SARS-CoV-2

Abstract

Background

Swedish recommendations to reduce the risk of COVID-19 relied on each citizen’s own sense of responsibility rather than mandatory lockdowns. We studied how COVID-19-related self-isolation and anxiety correlated to SARS-CoV-2 seropositivity and PCR-positivity in patients with active cancer treatment.

Methods

In a longitudinal cohort study at Uppsala University Hospital patients and cancer personnel were included between April 1^st 2020 to August 1^st 2020. Serological testing for SARS-CoV-2 was done every 8–12-weeks until 30 March 2021. Patients completed a survey at inclusion regarding self-reported COVID-19-related anxiety and self-isolation.

Results

A total of 622 patients [n = 475 with solid malignancies (SM), n = 147 with haematological malignancies (HM)], and 358 healthcare personnel were included. The seropositivity rate was lower for patients than for personnel; 10.5% for SM patients, 6.8% for HM patients, and 16.2% for personnel (p = 0.005). Strict adherence to self-isolation guidelines was reported by 54% of patients but was not associated with a lower risk of becoming seropositive [OR = 1.4 (0.8–2.5), p = 0.2]. High anxiety was expressed by 32% of patients, more often by SM patients than HM patients (34% vs 25% [OR = 1.6 (1.1–2.5, p = 0.03)]). Female gender [OR = 3.5 (2.4–5.2), p < 0.001] and being born outside of Europe [OR = 2.9 (1.4–6.4), p = 0.007] were both associated with high anxiety. Patients reporting high anxiety became seropositive to a similar degree as those with low anxiety [OR = 0.7 (0.3–1.2), p = 0.2]. HM patients with PCR-positive COVID-19 were more likely than SM patients to require oxygen therapy, including non-invasive ventilation/intubation (69% vs. 26%, p = 0.005).

Conclusion

For Swedish patients on active cancer treatment, high self-assessed COVID-19-related anxiety or strict adherence to self-isolation guidelines were not associated with a lower risk of COVID-19. Patients with HM were less likely to develop serological antibody response after COVID-19 and were more likely to require advanced hospital care, but expressed less COVID-19-related anxiety than patients with SM.

Keywords:

• Cancer
• COVID-19
• seropositivity
• PCR-positivity
• self-isolation
• anxiety

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data generated during the current study are not publicly available due to regulations on personal data protection but are available from the corresponding author on reasonable request.

Additional information

Funding

This study was supported with unrestricted grants from SciLife Lab/KAW, Blodcancerfonden, Lions, Stiftelsen Onkologiska klinikens forskningsfond, SciLifeLab Pandemic Preparedness projects 390 (LPP1-007 and REPLP1:005).

This study was supported with unrestricted grants from SciLife Lab/KAW, Blodcancerfonden, Research Cancer Fund, Lions, Stiftelsen Onkologiska klinikens forskningsfond, SciLifeLab Pandemic Preparedness projects 390 (LPP1-007 and REPLP1:005). Ingrid Glimelius has received honoraria from Jansen Cilag and Takeda unrelated to the current project.