Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.
In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing.
Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53-2·21), male sex (1·63, 1·07-2·48), smoking status (former smoker vs never smoked: 1·60, 1·03-2·47), number of comorbidities (two vs none: 4·50, 1·33-15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11-7·18), active cancer (progressing vs remission: 5·20, 2·77-9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79-4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07-0·84) or the US-Midwest (0·50, 0·28-0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality.
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.
American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.
Lancet (London, England). 2020 May 28 [Epub]
Nicole M Kuderer, Toni K Choueiri, Dimpy P Shah, Yu Shyr, Samuel M Rubinstein, Donna R Rivera, Sanjay Shete, Chih-Yuan Hsu, Aakash Desai, Gilberto de Lima Lopes, Petros Grivas, Corrie A Painter, Solange Peters, Michael A Thompson, Ziad Bakouny, Gerald Batist, Tanios Bekaii-Saab, Mehmet A Bilen, Nathaniel Bouganim, Mateo Bover Larroya, Daniel Castellano, Salvatore A Del Prete, Deborah B Doroshow, Pamela C Egan, Arielle Elkrief, Dimitrios Farmakiotis, Daniel Flora, Matthew D Galsky, Michael J Glover, Elizabeth A Griffiths, Anthony P Gulati, Shilpa Gupta, Navid Hafez, Thorvardur R Halfdanarson, Jessica E Hawley, Emily Hsu, Anup Kasi, Ali R Khaki, Christopher A Lemmon, Colleen Lewis, Barbara Logan, Tyler Masters, Rana R McKay, Ruben A Mesa, Alicia K Morgans, Mary F Mulcahy, Orestis A Panagiotou, Prakash Peddi, Nathan A Pennell, Kerry Reynolds, Lane R Rosen, Rachel Rosovsky, Mary Salazar, Andrew Schmidt, Sumit A Shah, Justin A Shaya, John Steinharter, Keith E Stockerl-Goldstein, Suki Subbiah, Donald C Vinh, Firas H Wehbe, Lisa B Weissmann, Julie Tsu-Yu Wu, Elizabeth Wulff-Burchfield, Zhuoer Xie, Albert Yeh, Peter P Yu, Alice Y Zhou, Leyre Zubiri, Sanjay Mishra, Gary H Lyman, Brian I Rini, Jeremy L Warner, COVID-19 and Cancer Consortium
Advanced Cancer Research Group, Kirkland, WA, USA., Dana-Farber Cancer Institute, Boston, MA, USA., Mays Cancer Center, UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA., Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, TN, USA., Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA., MD Anderson Cancer Center, Houston, TX, USA., University of Connecticut, Farmington, CT, USA., Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL, USA., Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA., Count Me In, Cambridge, MA, USA., Lausanne University, Lausanne, Switzerland., Advocate Aurora Health, Milwaukee, WI, USA., Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada., Mayo Clinic Cancer Center, Phoenix, AZ, USA., Winship Cancer Institute of Emory University, Atlanta, GA, USA., McGill University Health Centre, Montreal, QC, Canada., Hospital Universitario 12 de Octubre, Madrid, Spain., Stamford Hospital, Stamford, CT, USA., Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., The Warren Alpert Medical School of Brown University, Providence, RI, USA., St. Elizabeth Healthcare, Edgewood, KY, USA., Stanford University, Stanford, CA, USA., Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA., Cleveland Clinic, Cleveland, OH, USA., Smilow Cancer Hospital at Yale New Haven, New Haven, CT, USA., Mayo Clinic Cancer Center, Rochester, MN, USA., Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, USA., University of Connecticut, Farmington, CT, USA; Hartford Health Care, Hartford, CT, USA., University of Kansas Medical Center, Kansas City, KS, USA., Moores Cancer Center, University of California San Diego, La Jolla, CA, USA., The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA., School of Public Health, Brown University, Providence, RI, USA., Willis-Knighton Cancer Center, Shreveport, LA, USA., Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA., Stanley S Scott Cancer Center, LSU Health, New Orleans, LA, USA., Mount Auburn Hospital, Cambridge, MA, USA., Hartford Health Care, Hartford, CT, USA., Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: .