Abstract
BackgroundPatients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.Patients and methodsPatients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).ResultsA total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.ConclusionsClinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.Clinical trial identifierNCT04354701
Highlights
The COVID-19 and Cancer Consortium (CCC19) is an international consortium that collects data on patients with cancer and COVID-19.6,15,16 Studies from CCC19 and other cohorts have suggested that older age, male sex, smoking status, worse performance status (PS), presence of comorbidities, hematological malignancies, and active cancer are associated with more severe outcomes.[6,7,8,9,13]
Few studies have investigated the role of laboratory measurements as possible prognostic indicators, among patients with cancer hospitalized with COVID-19
Leveraging detailed information from almost 5000 patients with COVID-19 and cancer, we evaluated the hypothesis that specific demographic characteristics, clinical factors, and laboratory measurements would be associated
Summary
The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) pandemic has resulted in at least 1.5 million deaths worldwide.[1,2] Patients with cancer may have increased risk for SARS-CoV-2 infection[3,4,5] and worse outcomes.[6,7,8,9,10,11,12,13] Estimates of 30-day mortality associated with coronavirus 2019 (COVID-19) for patients with cancer range from 13% to 33%,6,7 compared with 0.5% to 2% in the general population.[1,14]Patients with cancer comprise a heterogeneous population, and a better understanding of specific risk factors associated with poor outcomes may help guide clinical management. The COVID-19 and Cancer Consortium (CCC19) is an international consortium that collects data on patients with cancer and COVID-19.6,15,16 Studies from CCC19 and other cohorts have suggested that older age, male sex, smoking status, worse performance status (PS), presence of comorbidities, hematological malignancies, and active cancer are associated with more severe outcomes.[6,7,8,9,13]. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. Conclusions: Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Clinical trial identifier: NCT04354701 Key words: SARS-CoV2, neoplasm, cancer, anticancer therapy, laboratory measurements, outcomes
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