Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

COVID-19 and Cancer Consortium

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168 Scopus citations

Abstract

Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

Original languageEnglish (US)
Pages (from-to)1907-1918
Number of pages12
JournalThe Lancet
Volume395
Issue number10241
DOIs
StatePublished - Jun 20 2020

Bibliographical note

Funding Information:
This study was partly supported by grants from the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE; to DPS); the Fonds de Recherche du Québec-Santé clinician-scientist scholar program to DCV; the Jim and Carol O'Hare Fund (to SMR); the National Cancer Institute (P30 CA013696 to JEH; P30 CA016056 to EAG; P30 CA016672 to JAS; P30 CA023100 to RRM; P30 CA054174 to DPS, MS, and RAM; P30 CA060553 to FHW; P30 CA068485 to C-YH, BIR, JLW, SM, and YS; P30 CA196521 to DBD and MDG; T32 CA009515 to ARK; T32 CA203703 to JEH; UG1 CA189974 to GHL; and U01 CA231840 to JLW); and the National Human Genome Research Institute (T32 HG008341 to SMR). REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). We thank Pankil K Shah and Margaret Madeleine for statistical input, and Steven A Pergam for virological input.

Funding Information:
This study was partly supported by grants from the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE; to DPS); the Fonds de Recherche du Qu?bec-Sant? clinician-scientist scholar program to DCV; the Jim and Carol O'Hare Fund (to SMR); the National Cancer Institute (P30 CA013696 to JEH; P30 CA016056 to EAG; P30 CA016672 to JAS; P30 CA023100 to RRM; P30 CA054174 to DPS, MS, and RAM; P30 CA060553 to FHW; P30 CA068485 to C-YH, BIR, JLW, SM, and YS; P30 CA196521 to DBD and MDG; T32 CA009515 to ARK; T32 CA203703 to JEH; UG1 CA189974 to GHL; and U01 CA231840 to JLW); and the National Human Genome Research Institute (T32 HG008341 to SMR). REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). We thank Pankil K Shah and Margaret Madeleine for statistical input, and Steven A Pergam for virological input.

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