As reported in The Lancet by Jeremy L. Warner, MD, and colleagues, a cohort study using the COVID-19 and Cancer Consortium (CCC19) database has shown that increased risk of all-cause mortality in patients with cancer infected with COVID-19 is associated with such factors as increased age, male sex, and number of comorbidities, as well as active cancer, but not with such factors as cancer type, recent anticancer therapy, or recent surgery.

Jeremy L. Warner, MD

The CCC19 was formed on March 15, 2020, to study the characteristics and course of illness among patients with COVID-19 and a current or past diagnosis of cancer. Accrual to the registry began on March 17, 2020. The registry is an electronic REDCap database maintained at Vanderbilt University Medical Center. Participating institutions have been restricted to the United States and Canada. Participation of anonymous individual health-care practitioners in Argentina, Canada, the European Union, the United Kingdom, and the United States is permitted.

Study Details

The study used data from 928 patients with active or previous malignancy aged 18 or older with laboratory-confirmed COVID-19 infection from the United States, Canada, and Spain, with information entered into the database between March 17 and April 16, 2020, and follow-up data through May 7, 2020 (date of analysis). The primary endpoint was all-cause mortality within 30 days of COVID-19 diagnosis. In multivariate analyses, odds ratios (ORs) for age, sex, smoking status, and obesity were each adjusted for the other factors; other covariates were adjusted for age, sex, smoking status, and obesity.

Key Findings

Among the 928 patients, median age was 66 years, with 30% aged 75 or older; 468 (50%) were male. The most common malignancies were breast (21%) and prostate (16%) cancers. Overall, 39% of patients were on active cancer treatment and 43% had active (measurable) cancer. A total of 811 patients (87%) were from the United States (Northeast = 40%, Midwest = 22%, South = 13%, and West = 13%), 49 (5%) were from Canada, and 68 (7%) were from Spain.

Overall, 60% of patients had received no anticancer treatment within 4 weeks prior to COVID-19 diagnosis, 22% had received noncytotoxic therapy (including targeted therapy in 8%, endocrine therapy in 9%, immunotherapy in 4%, radiotherapy in 1%, and cancer-related surgery in < 1%), and 17% had received cytotoxic systemic therapy; 3% had received any surgery within 4 weeks of diagnosis.

At time of analysis, 121 patients (13%) patients had died. On multivariate analysis, factors independently associated with increased risk of 30-day mortality were:

• Increased age (per 10 years; OR = 1.84, 95% confidence interval [CI] = 1.53–2.21)
• Male sex (OR = 1.63, 95% CI =  1.07–2.48)
• Smoking status of former vs never (OR = 1.60, 95% CI = 1.03–2.47)
• Two or more vs no comorbidities (eg, OR for 2 vs 0 =  4.50, 95% CI = 1.33–15.28)
• Eastern Cooperative Oncology Group performance status of ≥ 2 (eg, OR for 2 vs 0 = 3.89, 95% CI = 2.11–7.18)
• Active cancer (compared with remission/no evidence of disease: OR for present, stable, or responding to treatment = 1.79, 95% CI = 1.09–2.95; OR for present, progressive disease = 5.20, 95% CI = 2.77–9.77)
• Residence in the Northeastern region of the U.S. (reference category) vs Canada (OR = 0.24, 95% CI = 0.07–0.84) or Midwestern region of the U.S. (OR = 0.50, 95% CI = 0.28–0.90).

Receipt of azithromycin plus hydroxychloroquine vs neither was also associated with increased risk (OR = 2.93, 95% CI = 1.79–4.79). However, the finding may be confounded by use of the combination primarily in patients with more severe COVID-19.

No significant associations were observed for race/ethnicity, obesity, cancer type (hematologic malignancy or multiple cancers vs solid tumors), type of anticancer therapy vs no therapy within 4 weeks prior to COIVID-19 diagnosis, or surgery vs no surgery within 4 weeks of diagnosis. 

Compared with no receipt of treatment within the 4 weeks prior to COVID-19 diagnosis, odds ratios for treatment within the prior 4 weeks were 1.04 (95% CI = 0.62–1.76) for noncytotoxic therapy, 1.47 (95% CI = 0.84–2.56) for cytotoxic systemic therapy, and 1.52 (95% CI = 0.58–3.96) for any surgery.

The investigators concluded, “Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.”

Dr. Warner, of Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, is the corresponding author for The Lancet article. 

Disclosure: The study was funded by the American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research. For full disclosures of the study authors, visit thelancet.com.