Clinical Characteristics and Mortality in Patients With Cancer and COVID-19 From the Epicenter in New York City

Abstract

Purpose/Objective(s)The COVID-19 pandemic has resulted in over 2 million deaths worldwide and numerous studies demonstrate cancer patients are at increased risk of mortality. In this current study, the authors seek to investigate patient characteristics, clinical course, and predictors of COVID-19 diagnosis, severity and mortality in patients with active cancer at Elmhurst Hospital.Materials/MethodsA retrospective analysis of patients presenting to our institution with an active cancer diagnosis between January-June 2020 was performed. Inclusion criteria consisted of diagnosis of cancer or active cancer-directed treatment including surgery, radiation, and systemic therapy during this time period. Demographic, clinical characteristics, treatment, SARS-CoV-2 laboratory results, and outcomes were evaluated. Statistical analysis was performed using students t-test, chi-square, and Fisher's exact test. COVID-confirmed death required confirmatory laboratory evidence for SARS-CoV-2 using RT-PCR testing. Severe events were defined as patients requiring hospitalization, oxygen supplementation, mechanical ventilation, or death.Results266 patients met inclusion criteria for this study. 108 patients were tested for COVID-19 with 21 testing positive. Only 7.9% of cancer patients tested positive for SARS-CoV-2 with a test-positive rate of 19.4%. Median age of entire cohort was 61 years old (IQR 52-69) and 55 years old (IQR 46-70) in COVID positive cohort. There was a male preponderance in COVID positive cohort (66.7%, P = 0.07) and COVID-confirmed deaths (83.3%, P = 0.09) that trended toward statistical significance. A higher proportion of COVID positive patients (66.7%) and COVID-confirmed deaths (83.3%) were of Hispanic ethnicity compared to patients without COVID diagnosis (53.0%, P = 0.23) and patients who died without COVID (31.6%, P = 0.06); however, this was not statistically significant. Furthermore, there was a statistically significant higher proportion of COVID positive patients that were receiving cytotoxic chemotherapy compared non-COVID patients (P = 0.02). The overall 30-day mortality in this cohort of cancer patients was 2.3%, with 3% of patients having severe events. Of the cancer patients who tested positive, 9 had severe events (42.9%) and 6 had confirmed COVID-related deaths (28.6%). There were no significant predictors for diagnosis of COVID nor were there significant predictors of severity or mortality.ConclusionThe incidence of laboratory confirmed SARS-CoV-2 infection in cancer patients during the height of the COVID-19 pandemic in New York City was low suggesting safety procedures implemented were effective. Patients receiving radiation treatment were not at increased risk of COVID diagnosis but patients receiving cytotoxic chemotherapy were. Based on our analysis, patients with cancer seem to be at increased risk for mortality (case-fatality rate of 29%) and severe events (43%) due to the SARS-CoV-2 infection compared to general population.