Abstract
Background: There is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies.Methods: We used data from a single large UK Cancer Center to assess the demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February and 12 May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death.Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with a severe case of the disease. An initial cancer diagnosis >24 months before COVID-19 [OR: 1.74 (95% CI: 0.71–4.26)], presenting with fever [6.21 (1.76–21.99)], dyspnea [2.60 (1.00–6.76)], gastro-intestinal symptoms [7.38 (2.71–20.16)], or higher levels of C-reactive protein [9.43 (0.73–121.12)] were linked with greater COVID-19 severity. During a median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Being of Asian ethnicity [3.73 (1.28–10.91)], receiving palliative treatment [5.74 (1.15–28.79)], having an initial cancer diagnosis >24 months before [2.14 (1.04–4.44)], dyspnea [4.94 (1.99–12.25)], and increased CRP levels [10.35 (1.05–52.21)] were positively associated with COVID-19 death. An inverse association was observed with increased levels of albumin [0.04 (0.01–0.04)].Conclusions: A longer-established diagnosis of cancer was associated with increased severity of infection as well as COVID-19 death, possibly reflecting the effects a more advanced malignant disease has on this infection. Asian ethnicity and palliative treatment were also associated with COVID-19 death in cancer patients.
Highlights
In the context of cancer, the COVID-19 pandemic has led to a series of challenging decisions that must be made [1, 2]
We assessed outcomes included in the core outcome sets currently being developed for COVID-19 to ensure all relevant information is collected in our COVID specific database [26]
Until 30 April 2020, a COVID-19 test was ordered for cancer patients if they presented with symptoms necessitating hospitalization or if they were scheduled to undergo a cancer-related treatment
Summary
In the context of cancer, the COVID-19 pandemic has led to a series of challenging decisions that must be made [1, 2]. Current precautionary management decisions being made for cancer patients are based on assumptions supported by limited evidence, based on small case series from China and Italy [5,6,7,8,9,10,11,12,13] and larger series from New York [14, 15] and a recent consortium of 900 patients from over 85 hospitals in the USA, Canada, and Spain [16]. As a result of their limited sample sizes, most studies were not able to distinguish between the effects of age, cancer, and other comorbidities on COVID-19 outcomes in this population [17, 18]. There is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies
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