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Factors Associated with COVID-19 Severity Among Patients with Cancer

Findings from the COVID-19 and Cancer Consortium
22 Mar 2021
Cancer in Special Situations / Population

Petros Grivas of the Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance in Seattle, WA, US and colleagues reported on 18 March 2021 in the Annals of Oncology findings from a cohort of cancer patients with COVID-19 included in the COVID-19 and Cancer Consortium (CCC19). Among 4,966 patients with COVID-19 and a history of or active cancer, 58% were hospitalised and 14% died within 30 days. Older age, male sex, obesity, comorbidities, Black race, and Hispanic ethnicity were associated with more severe COVID-19. Furthermore, worse ECOG performance status (PS), haematologic malignancy, and recent cytotoxic chemotherapy were associated with more severe COVID-19.

The authors reported in the background that patients with cancer comprise a heterogeneous population. Better understanding of specific risk factors associated with poor COVID-19 outcomes may help guide clinical management in these patients. Leveraging detailed information from almost 5,000 cancer patients with COVID-19, researchers from an international CCC19 consortium evaluated the hypothesis that specific demographic characteristics, clinical factors, and laboratory measurements are associated with severity of COVID-19. They also explored the impact of specific anticancer therapies on COVID-19 severity and 30-day all-cause mortality.

Patients with active or history of cancer and a laboratory-confirmed SARS-CoV-2 infection between 17 March and 18 November 2020 were included in the analysis. The primary outcome was COVID-19 severity measured on a scale as uncomplicated, hospitalised, admitted to intensive care unit, mechanically ventilated, died within 30 days. Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements among hospitalised patients.

Median age among 4,966 included patients was 66 years, 51% were female, and 50% white. In total, 2,872 (58%) were hospitalised and 695 (14%) died. In total, 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis.

Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, Black race, Hispanic ethnicity, worse PS, recent cytotoxic chemotherapy, and haematologic malignancy were associated with more severe COVID-19.

Among hospitalised patients, low or high absolute lymphocyte count, high absolute neutrophil count, low platelet count, abnormal creatinine, troponin, LDH, and CRP were associated with more severe COVID-19.

Patients diagnosed early during the COVID-19 pandemic, in particular from January to April 2020 had worser outcomes than those diagnosed later.

Specific anticancer therapies, e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors were associated with high 30-day all-cause mortality.

The authors concluded that older age, male sex, Black race, Hispanic ethnicity, worse PS, haematologic malignancy, and ceratin laboratory measurements were associated with poor outcomes among cancer patients with COVID-19. Some chemotherapy regimens were associated with high all-cause mortality. Although further studies are needed, caution may be required in utilising particular anticancer therapies.

These findings can inform novel translational research, clinical trial designs, and clinical decision-making for cancer patients with COVID-19. The CCC19 researchers plan further investigation into healthcare disparities, outcomes for specific cancer subtypes, and impact of particular anticancer therapies.

Reference

Grivas P, Khaki AR, Wise-Draper TM, et al. Association of Clinical Factors and Recent Anti-Cancer Therapy with COVID-19 Severity among Patients with Cancer: A Report from the COVID-19 and Cancer Consortium. Annals of Oncology; Published online 18 March 2021. doi: https:// doi.org/10.1016/j.annonc.2021.02.024.

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