COVID-19 related symptoms and the second infection status of SARS-CoV-2 in patients with lung cancer: A single-center, six-month longitudinal observational study

Ruili Pan; Qi He; Nuo Xu; Xiaoxing Gao; Xiaoyun Zhou; Xiaobei Guo; Qianhui Ma; Lin Xu; Siyuan Yu; Chen Chen; Xiaohong Han; Minjiang Chen; Jing Zhao; Wei Zhong; Na Wang; Yan Xu; Mengzhao Wang

doi:10.1016/j.apjon.2025.100735

COVID-19 related symptoms and the second infection status of SARS-CoV-2 in patients with lung cancer: A single-center, six-month longitudinal observational study

Asia Pac J Oncol Nurs. 2025 May 29:12:100735. doi: 10.1016/j.apjon.2025.100735. eCollection 2025 Dec.

Authors

Ruili Pan¹, Qi He¹, Nuo Xu², Xiaoxing Gao¹, Xiaoyun Zhou³, Xiaobei Guo¹, Qianhui Ma¹, Lin Xu², Siyuan Yu¹, Chen Chen⁴, Xiaohong Han⁴, Minjiang Chen¹, Jing Zhao¹, Wei Zhong¹, Na Wang⁴, Yan Xu¹, Mengzhao Wang¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
² Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
³ Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
⁴ Clinical Pharmacology Research Center, Peking Union Medical College Hospital, State Key Laboratory of Complex Severe and Rare Diseases, NMPA Key Laboratory for Clinical Research and Evaluation of Drug, Beijing Key Laboratory of Clinical PK & PD Investigation for Innovative Drugs, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

Abstract

Objective: This study aimed to delineate the occurrence and duration of the symptoms of coronavirus disease 2019 (COVID-19) in patients with lung cancer to provide supporting data for clinical research and epidemic prevention and control.

Methods: This prospective longitudinal study was conducted in a tertiary hospital in China, comprising 697 outpatients and inpatients with lung cancer seeking medical care between March and April 2023. The enrolled patients completed questionnaires during the visit, with subsequent follow-up by telephone at 6 months after the patients' first infection. The questionnaire covered general patient information, disease characteristics, and SARS-CoV-2 infection and vaccine status. The details of COVID-19 treatment included the diagnostic method, infection time, and lung cancer treatment for up to three months after infection. This study also investigated the symptoms and duration of COVID-19.

Results: Among 697 patients, 591 (84.79%) had a history of COVID-19, 165 patients (27.92%) were not vaccinated, and 339 (57.36%) received the recommended ≥ 3 doses of the COVID-19 vaccine, yielding a 72.08% overall vaccination rate. The predominant symptoms of the initial SARS-CoV-2 infection included fever (79.53%), muscle pain (49.24%), cough (48.22%), sore throat (46.02%), and fatigue (35.36%). Patients who were infected with COVID-19 after the lung cancer diagnosis and received systematic treatment exhibited significant differences in muscle pain (χ² = 11.808, P = 0.038), sore throat (χ² = 14.368, P = 0.013), nasal congestion (χ² = 12.934, P = 0.024), and chest tightness/pain (χ² = 12.218, P = 0.032). The symptom analysis indicated that the duration of symptoms was significantly longer in unvaccinated than in vaccinated patients with lung cancer experiencing a first-time COVID-19, especially for fever (χ² = 21.268, P = 0.001) and palpitations (χ² = 17.797, P = 0.007). The six-month follow-ups in this study revealed that 12.01% of patients with lung cancer experienced a second infection. Patients with lung cancer reinfected with COVID-19 exhibited fever (χ² = 16.780, P = 0.005), muscle pain (χ² = 28.489, P = 0.000), sore throat (χ² = 21.915, P = 0.001), rhinorrhea (χ² = 20.783, P = 0.002), cough (χ² = 19.129, P = 0.004), expectoration (χ² = 16.105, P = 0.013), shortness of breath (χ² = 26.461, P = 0.000), palpitations (χ² = 17.065, P = 0.004), chest tightness/pain (χ² = 13.108, P = 0.041), fatigue (χ² = 21.593, P = 0.001), reduced activity tolerance (χ² = 35.476, P = 0.000), headache (χ² = 16.003, P = 0.001), hypogeusia (χ² = 42.511, P = 0.000), hyposmia (χ² = 20.650, P = 0.002), and diarrhea (χ² = 9.397, P = 0.024) revealed significant differences in comparison with the first-time COVID-19 infection in patients with lung cancer.

Conclusions: Our analysis suggests that COVID-19 has a high infection rate in patients with lung cancer, but the duration of different symptoms varies. Patients with a first SARS-CoV-2 diagnosis who had previously been treated for oncology experienced less severe pain-related symptoms than patients with lung cancer diagnosed after infection. COVID-19 vaccines have demonstrated protective effects by mitigating symptom severity following a second infection. Suggest that we should further explore ways to reduce the morbidity, severity, and mortality of COVID-19 while ensuring adherence to patients' standard treatment plans.

Keywords: COVID-19; Lung cancer; SARS-CoV-2 vaccine; Symptom.