In a retrospective cohort study reported in The Lancet Oncology, Yang et al described clinical characteristics, outcomes, and risk factors for mortality in patients with cancer hospitalized with COVID-19 over a 2-month period in Hubei, China.
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Study Details
The study included 205 patients with laboratory-confirmed severe acute COVID-19 and diagnosis of a malignant tumor seen in nine hospitals in Hubei from January 13 to March 18, 2020. All patients were either discharged from hospital or had died by April 20, 2020.
Patient Demographics
Patients with cancer accounted for 2.5% of 8,161 patients admitted to hospitals with COVID-19 during the study period.
Patents had a median age of 63 years (range = 14–96 years); 109 (53%) were women; 183 (89%) had solid tumors and 22 (11%) had hematologic malignancies. The most common solid tumor types were breast cancer (n = 40, 20%), colorectal cancer (n = 28, 14%), and lung cancer (n = 24, 12%).
Overall, 70% of patients received intravenous (IV) antibiotics; 94%, antiviral medications; and 30%, IV corticosteroids. Among 182 patients with data, 54 (30%) received antitumor therapies within 4 weeks prior to symptom onset, including chemotherapy in 31 and targeted therapy in 12.
Results
The median duration of follow-up was 68 days.
Sixteen percent of patients required mechanical ventilation, and 15% were referred to the intensive care unit.
Overall, 40 patients (20%) died during hospital admission. Death occurred in 9 (41%) of 22 patients with hematologic malignancies vs 31 (17%) of 183 patients with solid tumors (hazard ratio [HR] = 3.28, P = .0009) Patient with hematologic malignancies were more likely to have received antitumor treatment and chemotherapy (70% and 55%) within the 4 weeks prior to symptom onset vs patients with solid tumors (25% vs 12%).
On multivariate analysis, the only significant associations with increased risk of death were receiving chemotherapy within 4 weeks before symptom onset (odds ratio [OR] = 3.51, P = .026) and male sex (OR = 3.86, P = .0033). Hematologic malignancy vs solid tumor diagnosis was no longer significant (OR = 2.07, P = .20). Factors such as cancer stage and comorbidity were not associated with significantly increased risk.
The investigators concluded, “Patients with cancer and COVID-19 who were admitted to hospital had a high case-fatality rate. Unfavorable prognostic factors, including receiving chemotherapy within 4 weeks before symptom onset and male sex, might help clinicians to identify patients at high risk of fatal outcomes.”
Gang Wu, MD, of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the National Natural Science Foundation of China. For full disclosures of the study authors, visit thelancet.com.
