As reported in JAMA Oncology by researchers from the OnCovid Study Group, an updated analysis of the European OnCovid registry indicated that mortality due to COVID-19 infection has decreased over time for patients with cancer during the pandemic.
Study Details
The study included real-world data on patients with solid or hematologic cancers from 35 institutions in the United Kingdom, Italy, Spain, France, Belgium, and Germany diagnosed with SARS–CoV-2 infection between February 27, 2020, and February 14, 2021. Patient characteristics and outcomes were assessed across five time periods (February to March 2020, April to June 2020, July to September 2020, October to December 2020, and January to February 2021) and two major outbreaks during this interval (February to June 2020 and July 2020 to February 2021).
Key Findings
The study included 2,634 consecutive eligible patients (median age = 68 years, interquartile range = 18–77 years; 52.8% male). Median time from symptom onset to COVID-19 diagnosis improved from 4 days during April to June 2020 to 1 day during October to December 2020 (P < .001).
A significant time-dependent improvement in 14-day post-diagnosis case-fatality rate was observed across the five predefined time intervals (overall P < .001):
- 29.8% (95% confidence interval [CI] = 26%–33%) for February to March 2020
- 20.3% (95% CI = 17%–23%) for April to June 2020
- 12.5% (95% CI = 6%–22.9%) for July to September 2020
- 17.2% (95% CI = 15%–21%) for October to December 2020
- 14.5% (95% CI = 9%–21%) for January to February 2021.
Compared with patients diagnosed with COVID-19 infection in the second major outbreak (July 2020 to February 2021), those diagnosed in the first outbreak (February to June 2020) were more likely to be aged ≥ 65 years (974 of 1,626 = 60.3% vs 564 of 1,008 = 56.1%, P = .03), have two or more comorbidities (793 of 1,626 = 48.8% vs 427 of 1,008 = 42.4%; P = .001), and have advanced tumors (708 of 1,626 = 46.4% vs 536 of 1,008 = 56.1%; P < .001).
During the first vs second outbreak, patients were more likely to have complications of COVID-19 infection (738 of 1,626 = 45.4% vs 342 of 1,008 = 33.9%; P < .001), require hospitalization (969 of 1,626 = 59.8% vs 418 of 1,008 = 42.1%; P < .001) and to receive anti–COVID-19 therapy (1,004 of 1,626 = 61.7% vs 501 of 1,008 = 49.7%; P < .001).
The 14-day case-fatality rates for the first vs second major outbreaks were 25.6% (95% CI = 23%–28%) vs 16.2% (95% CI = 13%–19%), respectively (P < .001). In analysis adjusting for country, sex, age, comorbidities, tumor stage and status, anti–COVID-19 and anticancer therapy, and COVID-19 complications, risk of death was significantly greater during the first vs second outbreak at 14 days (hazard ratio [HR] = 1.85, 95% CI = 1.47–2.32) and at 3 months (HR = 1.28, 95% CI = 1.08–1.51).
The investigators concluded, “The findings of this registry-based study suggest that mortality in patients with cancer diagnosed with COVID-19 has improved in Europe; this improvement may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.”
Alessio Cortellini, MD, and David J. Pinato, MD, PhD, of the Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, are the corresponding authors for the JAMA Oncology article.
Disclosure: The study was funded by the National Institute for Health Research Imperial Biomedical Research Centre and others. For full disclosures of the study authors, visit jamanetwork.com.
