A large cohort study by the COVID-19 and Cancer Consortium evaluating the impact of COVID-19 on patients with cancer has found that all-cause 30-day mortality and severe illness were significantly higher in this population than previously reported in the general population. Mortality and severe illness were associated with general risk factors, as well as those unique to patients with cancer, although cancer type and treatment were not independently associated with increased 30-day mortality.
Longer follow-up is needed to better understand the impact of COVID-19 on outcomes in this patient population, including the ability to continue specific cancer treatments. The study was presented by Jeremy L. Warner, MD, and colleagues at the ASCO20 Virtual Scientific Program and featured in a press briefing prior to the meeting (Abstract LBA110).
Jeremy L. Warner, MD
Study Methodology
The researchers analyzed data from 928 patients with cancer infected with COVID-19 accrued during March and April 2020. The participants included patients with active or prior hematologic or invasive solid malignancies reported across academic and community sites.
Median age of the patients was 66 years. Breast cancer (20%) and prostate cancer (16%) were the most prevalent cancers in the cohort. Nearly half (43%) of the patients had active cancer and 39% were on active cancer treatment.
Study Results
According to the researchers’ data analysis, 121 patients (13%) have died and 26% met the composite outcome of death, severe illness requiring hospitalization, and/or mechanical ventilation.
After partial adjustment for several baseline factors, patients with progressing cancer were found to be 5.2 times more likely to die within 30 days compared with patients in remission or with no evidence of disease.
KEY POINTS
- All-cause 30-day mortality and severe illness requiring hospitalization and/or mechanical ventilation were significantly higher in patients with cancer infected with COVID-19 than patients in the general population.
- After partial adjustment for several baseline factors, patients with progressing cancer were found to be 5.2 times more likely to die within 30 days compared with patients in remission or with no evidence of disease.
- Independent factors associated with increased 30-day mortality included age, male sex, obesity, smoking, performance status, progressive disease, and receipt of azithromycin and hydroxychloroquine. Cancer type and treatment were not independently associated with increased 30-day mortality.
In multivariable logistic regression analysis, independent factors associated with increased 30-day mortality were age, male sex, obesity, former smoking, Eastern Cooperative Oncology Group (ECOG) performance status (2 vs 0/1: adjusted odds ratio [AOR] = 2.88, 95% confidence interval [CI] = 1.21–6.61; 3/4 vs 0/1, AOR = 6.23, 95% CI = 2.44–15.94), progressive malignancy (AOR = 3.29, 95% CI = 1.24–8.52), and receipt of azithromycin and hydroxychloroquine.
Hispanic ethnicity was associated with a significantly lower mortality (AOR = 0.29, 95% CI = 0.08–0.95). Tumor type, number of comorbidities, recent surgery, and type of active cancer therapy were not significant factors for mortality.
“All-cause 30-day mortality and severe illness in this cohort were significantly higher than previously reported for the general population and were associated with general risk factors as well as those unique to patients with cancer. Cancer type and treatment were not independently associated with increased 30-day mortality. Longer follow-up is needed to better understand the impact of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments,” concluded the study authors.
Commentary
“This is early and evolving data, and more time and analysis will be needed to confirm and expand on these findings,” said Dr. Warner, Associate Professor of Medicine and Biomedical Informatics at Vanderbilt University Medical Center in Nashville, and lead author of this study, in a statement. “Right now, we’re working to quickly get information about why some patients with cancer become infected with the SARS-CoV-2 virus, and identify the factors that affect disease severity and death. We’re also interested in the effects of treatments that are being used to treat patients with cancer who have COVID-19.”
Howard A. Burris III, MD, FACP, FASCO
“The cancer care community urgently needs data on the effects of COVID-19, specifically in patients with cancer. How we improve the care we provide these patients and reduce the number of deaths and severe consequences associated with this disease are among the top questions,” said ASCO President Howard A. Burris III, MD, FACP, FASCO, in a statement. “The COVID-19 and Cancer Consortium registry is a great example of the community quickly coming together to identify and collect the data we need on a large scale.”
Disclosure: Funding for this study was provided in part by the National Institutes of Health and the American Cancer Society. For full disclosures of the study authors, visit coi.asco.org.
