A study recently published in The Lancet sought to understand the course of COVID-19 and the factors that influence clinical outcomes in patients with cancer
The authors Kuderer et al. used data from the COVID-19 and Cancer Consortium (CCC19). This cohort trial showed that the ratio of increased risk of all-cause mortality in patients with cancer and COVID-19 infection is associated with age, male gender, number of comorbidities and active cancer, but not with factors such as type of cancer, recent antineoplastic therapy or recent surgery.
CCC19 was developed on March 15, 2020 to study the characteristics and course of the disease among patients with COVID -19 and a current or previous diagnosis of cancer. The registration is an electronic REDCap database maintained by Vanderbilt University Medical Center. Participating institutions are restricted to the United States and Canada. Anonymous health care professionals from Argentina, Canada, the European Union, the United Kingdom and the United States are allowed to participate.
The study used data from 928 patients with active or previous malignancy, who were 18 years or older, with COVID-19 infection confirmed in a laboratory in the United States, Canada and Spain, with information entered in the database between March 17 and April 16, 2020 and follow-up data until May 7, 2020 (date of analysis).
The primary endpoint was all-cause mortality within 30 days after the diagnosis of COVID-19. In multivariate analysis, odds ratio (ORs) for age, sex, smoking and obesity were adjusted for the other factors. Other covariates were adjusted for age, sex, smoking and obesity.
Among the 928 patients, the average age was 66 years, (with 30% presenting 75 years or more; ) and 468 (50%) were male. The most common neoplasms were breast cancer (21%) and prostate (16%). Overall, 39% of patients were undergoing active cancer treatment and 43% had measurable cancer. A total of 811 patients (87%) were from the United States, 49 (5%) were from Canada and 68 (7%) were from Spain.
Overall, 60% of patients did not receive anticancer treatment in the 4 weeks prior to the diagnosis of COVID-19, 22% received non-cytotoxic therapy (including Target therapy in 8%, hormone therapy in 9%, immunotherapy in 4%, radiotherapy in 1% and cancer-related surgery in < 1%) and 17% received systemic cytotoxic therapy; 3% had performed any surgery within 4 weeks after diagnosis.
At the time of the analysis, 121 patients (13%) died. In the multivariate analysis, the factors independently associated with the increased risk of mortality in 30 days were:
• Increased age (for 10 years; OR = 1.84, 95% CI = 1.53-2.21);
• Male gender (OR = 1.63, 95% CI = 1.07-2.48);
• Ex-smoker or never smoker (OR = 1.60, 95% CI = 1.03-2.47);
• Two or more vs zero comorbidities (OR for 2 vs 0 = 4.50, 95% CI = 1.33–15.28);
• ECOG ≥ 2 (OR for 2 vs 0 = 3.89, 95% CI = 2.11 – 7.18);
• Active cancer (compared to remission / no evidence of disease: OR for currently stable disease or responding to treatment = 1.79, 95% CI = 1.09–2.95; OR for currently progressing disease = 5.20, 95% CI = 2.77–9.77);
• Residence in the Northeast of the USA (reference category) vs Canada (OR = 0.24, 95% CI = 0.07–0.84); or Midwestern USA (OR = 0.50, 95% CI = 0.28–0.90).
The use of azithromycin plus hydroxychloroquine versus neither was also associated with an increased risk (OR = 2.93, 95% CI = 1.79-4.79). However, the finding may be confused by the use of the combination mainly in patients with more severe COVID-19.
There were no significant associations of ethnicity, obesity, type of cancer (haematological malignancy versus solid tumors), type of anticancer therapy versus no therapy within 4 weeks prior to diagnosis of COVID-19 or surgery versus no surgery within 4 weeks of diagnosis.
Compared to no treatment administration in the 4 weeks prior to the diagnosis of COVID-19, odds ratios for treatment in the 4 weeks prior were 1.04 (95% CI = 0.62-1.76) for non-cytotoxic therapy, 1.47 (95% CI = 0.84–2.56) for systemic cytotoxic therapy and 1.52 (95% CI = 0.58-3.96) for any surgery.
The researchers concluded that among patients with cancer and COVID-19, all-cause mortality in 30 days was high and associated with general risk factors and unique risk factors to cancer patients.
Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, Shete S, Hsu CY, Desai a, de Lima Lopes Jr G, Grivas P. Clinical impact of COVID – 19 on patients with cancer (CCC19): a cohort study. The Lancet. 2020; 395(10241): 1907–1918