Mortality Risk in Patients With COVID-19 and Thoracic Malignancies: Initial Report From the TERAVOLT Registry Study

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As reported in The Lancet Oncology by Marina C. Garassino, MD, and colleagues, initial findings from the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry study have identified potential factors associated with increased risk of mortality in patients infected with COVID-19 who have thoracic malignancies.

Marina C. Garassino, MD

Marina C. Garassino, MD

TERAVOLT is a global registry with cross-sectional and longitudinal cohort components. Clinical data were extracted from medical records of consecutive patients from January 2020 and will continue to be collected until the end of the pandemic as declared by the World Health Organization.

Study Details

The current report is a preliminary analysis of the first 200 patients with confirmed COVID-19 infection and thoracic cancers from eight countries (98% from Europe) who were included in the registry between March 26 and April 12, 2020.

Key Findings

Patients had a median age of 68.0 years; 70% were male; 72% had Eastern Cooperative Oncology Group performance status of 0 or 1; 81% were current or former smokers; 76% had non–small cell lung cancer; 74% were on active cancer therapy at time of COVID-19 diagnosis; and 57% were receiving first-line therapy at time of diagnosis.

Overall, 152 patients (76%) were hospitalized and 66 (33%) died. Of 134 patients who met criteria for admission to the intensive care unit, 13 (10%) were admitted; all others were hospitalized.


  • Factors associated with increased risk of death were age older than 65 years, current or former smoker status, receiving treatment with chemotherapy alone, presence of any comorbidities, and dyspnea as a symptom of COVID-19.
  • Of 134 patients who met criteria for admission to the intensive care unit, 13 (10%) were admitted.

On univariate analysis, factors associated with increased risk of death were age older than 65 years (odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.00–3.62), current or former smoker status (OR = 4.24, 95% CI = 1.70–12.95), receiving treatment with chemotherapy alone (OR = 2.54, 95% CI = 1.09–6.11), presence of any comorbidities (OR = 2.65, 95% CI = 1.09–7.46), and dyspnea as a symptom of COVID-19 (OR = 6.20, 95% CI = 3.10–13.23).

On multivariate analysis including sex, age, smoking status, hypertension, and chronic obstructive pulmonary disease, only current or former smoker status was associated with increased risk of death (OR = 3.18, 95% CI = 1.11–9.06).

The investigators concluded: “With an ongoing global pandemic of COVID-19, our data suggest high mortality and low admission to [the] intensive care [unit] in patients with thoracic cancer. Whether mortality could be reduced with treatment in intensive care remains to be determined. With improved cancer therapeutic options, access to intensive care should be discussed in a multidisciplinary setting based on cancer specific mortality and patients’ preference.”

Dr. Garassino, of the Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, is the corresponding author for The Lancet Oncology article.

Disclosure: For full disclosures of the study authors, visit

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