Presenting Features and Early Mortality from SARS-CoV-2 Infection in Cancer Patients during the Initial Stage of the COVID-19 Pandemic in Europe.

David J Pinato,Alessia Dalla Pria,Elia Seguí,Diego Ottaviani,Yien Ning Sophia Wong,Juan Aguilar-Company,Rachel Sharkey,Carme Carmona,Luigi Mario Castello,Isabel Garcia-Fructuoso,Javier Marco-Hernández,Lorenza Scotti,Joan Brunet,Roxana Reyes,Federica Biello,Thomas Newsom-Davis,Alessandra Gennari,Francesca D’Avanzo,Gian Carlo Avanzi,Gianpiero Rizzo,Sarah Benafif,Mattia Bellan,Mario Pirisi,Pier Paolo Sainaghi,Meritxell Mollà,Neha Chopra,Aleix Prat,Daniela Ferrante,Anna Carbó,Myria Galazi,Josep Tabernero,Andrea Patriarca,Mark Bower,Claudia Andrea Cruz,Riccardo Bruna,Alvin Lee ,Joanne Evans ,Christopher C.t Sng ,Isabel Ruiz‐Camps ,Gianluca Gaïdano

doi:10.3390/cancers12071841

Abstract

We describe the outcomes in cancer patients during the initial outbreak of the COVID-19 in Europe from the retrospective, multi-center observational OnCovid study. We identified 204 cancer patients from eight centers in the United Kingdom, Italy, and Spain aged >18 (mean = 69) and diagnosed with COVID-19 between 26 February and 1 April 2020. A total of 127 (62%) were male, 184 (91%) had a diagnosis of solid malignancy, and 103 (51%) had non-metastatic disease. A total of 161 (79%) had >1 co-morbidity. A total of 141 (69%) patients had >1 COVID-19 complication. A total of 36 (19%) were escalated to high-dependency or intensive care. A total of 59 (29%) died, 53 (26%) were discharged, and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged >65 (36% vs. 16%), in those with >2 co-morbidities (40% vs. 18%) and developing >1 complication from COVID-19 (38% vs. 4%, p = 0.004). Multi-variable analyses confirmed age > 65 and >2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy, or anticancer therapy. During the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. The ongoing OnCovid study will allow us to compare risks and outcomes in cancer patients between the initial and later stages of the COVID-19 pandemic.

Highlights

Coronavirus disease 2019 (COVID-19), the viral infection caused by SARS-CoV-2, recognizes a spectrum of clinical entities ranging from a mild flu-like illness to life-threatening forms with acute respiratory compromise [1]
Whether cancer or active anticancer therapy per se influence severity and outcome from COVID-19 disease is the subject of concern and ongoing debate [18,19,20]
This study portrays a detailed account of the early SARS-CoV-2 outbreak in cancer patients in Europe, by surveying amongst the three hardest hit geographical areas in Europe: London (UK), North-West Italy, and Catalunya (Spain) during the initial phase of the outbreak; February and Currently, there is a lack of published multi-center data sharing the initial impact on cancer patients during the early period of the COVID-19 outbreak in Europe

Summary

Introduction

Coronavirus disease 2019 (COVID-19), the viral infection caused by SARS-CoV-2, recognizes a spectrum of clinical entities ranging from a mild flu-like illness to life-threatening forms with acute respiratory compromise [1]. During the early stages of the COVID-19 outbreak in the Hubei province in China, cancer patients were noted to have a 6.2-fold difference in mortality compared to healthy individuals (5.6% vs 0.9%) [3]. Mortality among cancer patients who develop COVID-19 has subsequently been reported to range between 9% and 33%, many of these studies were either non-European studies or focused on the later stages of the COVID-19 pandemic in Europe [4,5,6,7,8,9]. The relative contribution of cancer over other co-morbidities and clinical factors in influencing outcome from SARS-CoV-2 infection has not been fully elucidated.

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