Impact of COVID-19 on gynecologic oncology patients: an SGO COVID-19 and Gynecologic Cancer Registry study (050)

Abstract

Objectives: The COVID-19 pandemic has disrupted timely medical care, including receipt of anticancer therapy. Gynecologic oncology (GO) patients (pts), who are often comorbid and require a range of therapies, may have varied responses to COVID-19 infection. Our study aimed to describe outcomes for GO pts with concurrent COVID-19 infection in the United States.Methods: The Society of Gynecologic Oncology COVID-19 and Gynecologic Cancer Registry was developed as a web-based data entry platform to capture the clinical courses and cancer treatment-related effects in GO pts with confirmed COVID-19 infection. Demographics, clinical manifestations, outcomes, treatment type, and disease severity were analyzed.Results: Data were available for 312 GO pts across eight institutions. The median age was 63 years, and most pts were identified as White (70%), Black/African American (17%), or Asian (2%). GO diagnosis included low-grade endometrial (31%), high-grade ovarian (22%), cervical (14%), high-grade endometrial (13%), vulvar (3%), and other (16%). At the time of COVID-19 diagnosis, 37% of pts had active malignancy, with 25% receiving anticancer therapy. The most common anticancer treatments included chemotherapy (51%, n=39), targeted agents (25%, n = 27), and surgery (27%, n = 21), whereas 12 pts (16%) received multi-modal therapy. Delay or discontinuation of treatment due to COVID-19 infection occurred in 28% of patients (median 3-4 weeks delay). Chemotherapy was most frequently delayed (43%), followed by surgery (27%). In total, 19% of GO pts required supplemental oxygen, and 29% were hospitalized (5% in the intensive care setting). Ten pts (3%) required ventilator support, and 30% of pts receiving chemotherapy were hospitalized. Older age, having more than two comorbid conditions, and non-White race were associated (p<0.05) with a higher likelihood of being hospitalized or admitted to the intensive care unit. Patients who required hospitalization were disproportionately Black/African American, Asian, or other non-Whites (p = 0.003). On multivariable analysis, pts of non-White race (aOR: 2.86, 95% CI: 1.64-5.00; p<0.001) and advancing age (aOR: 1.28, 95% CI: 1.16-1.42; p<0.001) had a higher risk of hospitalization. In terms of mortality, 8% of hospitalized pts died of COVID-19 complications, and 4% of the entire cohort was not alive 30 days after COVID-19 diagnosis. Patients who died were more likely to be older (OR: 1.25 per 5-year increase, 95% CI: 1.01-1.55), had active malignancy (OR: 3.86, 95% CI: 1.16-12.85), or be of the non-White race (death rate of 3% White, 8% Black/African American, 25% Asian).Conclusions: GO pts diagnosed with COVID-19 are at high risk of hospitalization, delay of anticancer treatments, and death. Approximately one in 23 GO pts who contracted COVID-19 were not alive 30 days after diagnosis. Racial disparities exist in pt hospitalizations and mortality rates. Additional studies are needed to determine the long-term oncologic and mortality outcomes and the impact of race in this pt cohort.