According the results of a study published in JCO Global Oncology, patients with cancer who were hospitalized with COVID-19 had a high mortality rate, highlighting the need for close surveillance in this patient population. The study also identified numerous clinical factors associated with increased risk of death because of COVID-19.
The investigators reviewed medical records for all consecutive patients with cancer and COVID-19 at a single center in Brazil between March 31, 2020, and September 2, 2020.
The cohort included 576 patients. The mean patient age was 63 years (range, 18-93), and males and females each comprised approximately 50% of the cohort. Most patients (64.1%) identified as White, while the remaining identified as Mixed race (18.6%), Black (9.0%), or Other (8.3%). Most patients (75.7%) had at least 1 comorbidity. Among all patients, 50.3% had hypertension, 24.8% had diabetes, and 37.3% had a smoking history. The most common primary solid tumors were classified as gastrointestinal (23.1%), breast (15.6%), genitourinary (15.8%), gynecologic (7.5%), and lung (7.3%), while 10.2% of patients had a hematologic malignancy.
Among all patients, 13.2% did not require hospitalization and received treatment at home, 85.9% required hospitalization, and 31.9% were hospitalized in an intensive care unit (ICU). Among patients admitted to the ICU, 84.4% received invasive mechanical ventilation and 81.8% received vasoactive drugs. Therapies directed towards COVID-19 were administered to 59% of patients.
The overall in-hospital mortality rate was 49.3%. The mortality rate was higher in patients who received best supportive care (BSC) alone (74.7%) and lower in those without evidence of disease (26%) and those who received not BSC alone oncologic treatment (44.6%). The use COVID-19-directed therapies did not appear to impact mortality.
In a multivariate logistic regression, clinical factors associated with increased risk of death because of COVID-19 were age over 65 years (odds ratio [OR], 1.68; 95% CI, 1.17-2.43; P =.005), Eastern Cooperative Oncology Group (ECOG) performance status (PS) greater than zero (ECOG PS 1-2 OR, 3.24; 95% CI, 1.85-5.68; P<.001; ECOG PS 3-4 OR, 3.57; 95% CI, 1.89-6.74; P<.001), BSC (OR, 2.67; 95% CI, 1.50-4.75; P =.001), primary lung cancer (OR, 2.20; 95% CI, 1.04-4.68; P =.039), and the presence of lung metastases (OR, 1.87; 95% CI, 1.18-2.95; P =.007).
Laboratory findings associated with a higher risk of unfavorable outcomes were neutrophilia (OR, 6.99; 95% CI, 2.68-18.20; P <.001), lymphopenia (OR, 2.20; 95% CI, 1.26-3.84; P =.005), and elevated levels of D-dimer (OR, 2.14; 95% CI, 1.21-3.80; P =.009), creatinine (OR, 2.86; 95% CI, 1.40-5.84; P =.004), C-reactive protein (OR, 2.15; 95% CI, 1.27-3.65; P =.004), or aspartate aminotransferase (OR, 1.77; 95% CI, 1.03-3.04; P =.038).
Limitations of the study included the retrospective design, accrual at a single institution, limited ability to evaluate the effect of individual cancer types and systemic therapeutic regimens on clinical outcomes due to restricted numbers of specific malignancy types.
“To our knowledge, this is the largest Latin American cohort to assess the characteristics, determinants of mortality, and clinical outcomes of hospitalized patients with cancer who were diagnosed with COVID-19,” the authors wrote. “In conclusion, delivering care for patients with cancer during the COVID-19 pandemic has become a major challenge for the cancer care community. Our data demonstrate a high mortality rate in patients with cancer who were diagnosed with COVID-19, emphasizing the need for close surveillance in this group of patients.”
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Nader Marta G, Colombo Bonadio R, Nicole Encinas Sejas O, et al. Outcomes and prognostic factors in a large cohort of hospitalized cancer patients with COVID-19. JCO Glob Oncol. 2021;7:1084-1092. doi:10.1200/GO.21.00087