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.

Patients with cancer may be at high risk of adverse outcomes from SARS-CoV-2 infection. We analyzed a cohort of patients with cancer and COVID-19 reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anti-cancer therapies.

Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between March 17-November 18, 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anti-cancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).

4,966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2,872 (58%) were hospitalized and 695 (14%) died; 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, non-Hispanic Black race, Hispanic ethnicity, worse ECOG performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count, high absolute neutrophil count, low platelet count, abnormal creatinine, troponin, LDH, and CRP were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anti-cancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anti-cancer therapies.

Annals of oncology : official journal of the European Society for Medical Oncology. 2021 Mar 18 [Epub ahead of print]

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University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington, USA. Electronic address: ., University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington, USA; Stanford University, Stanford, California, USA., University of Cincinnati Cancer Center, Cincinnati, Ohio, USA., Vanderbilt University Medical Center, Nashville, Tennessee, USA., Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Broad Institute, Cancer Program, Cambridge, Massachusetts, USA., Lausanne University, Lausanne, Switzerland., Advocate Aurora Health, Milwaukee, Wisconsin, USA., Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA., University of Hawaii Cancer Center, Honolulu, Hawaii, USA., University of Colorado School of Medicine, Aurora, Colorado, USA., Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Mayo Clinic Cancer Center, Phoenix, Arizona, USA., Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, Illinois, USA., Houston Methodist Cancer Center, Houston, Texas, USA., Winship Cancer Institute of Emory University, Atlanta, Georgia, USA., Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., University of Florida, Gainesville, Florida, USA., McGill University Health Centre, Montréal, Quebec, Canada., University of California San Diego, Moores Cancer Center, La Jolla, California, USA., University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA; Case Western Reserve University, Cleveland, Ohio, USA., Thompson Cancer Survival Center, Knoxville, Tennessee, USA., St. Elizabeth Healthcare, Edgewood, Kentucky, USA., Mayo Clinic Cancer Center, Rochester, Minnesota, USA., Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA., The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Tufts Medical Center Cancer Center, Boston and Stoneham, Massachusetts, USA., University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA., Henry Ford Cancer Institute/Henry Ford Health System, Detroit, Michigan, USA., Intermountain Healthcare, Salt Lake City, Utah, USA., Stanford University, Stanford, California, USA., George Washington University, Washington, DC, USA., Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA., Duke University, Durham, North Carolina, USA., Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, New York, USA., Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA., Hartford HealthCare, Hartford, Connecticut, USA; University of Connecticut, Farmington, Connecticut, USA., Mount Auburn Hospital, Cambridge, Massachusetts, USA., Hartford HealthCare, Hartford, Connecticut, USA., University of Kansas Medical Center, Kansas City, Kansas, USA., University of California, San Francisco, San Francisco, California, USA., Advanced Cancer Research Group, LLC, Kirkland, Washington, USA., Baptist Cancer Center, Memphis, Tennessee, USA., Baylor College of Medicine, Houston, Texas, USA., Cancer Treatment Centers of America, Philadelphia, Pennsylvania, USA., The Ohio State University, Columbus, Ohio, USA., University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington, USA., Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, Pennsylvania, USA., Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, Texas, USA., Loma Linda University Cancer Center, Loma Linda, California, USA., Case Western Reserve University, Cleveland, Ohio, USA; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., University of California Davis Comprehensive Cancer Center, Sacramento, California, USA., Willis-Knighton Cancer Center, Shreveport, Louisiana, USA., Virtua Health, Marlton, New Jersey, USA., Medical University of South Carolina, Charleston, South Carolina, USA., Gunderson Health System, La Crosse, Wisconsin, USA., Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., University of North Carolina, Chapel Hill, North Carolina, USA., Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA., ThedaCare Regional Cancer Center, Appleton, Wisconsin, USA., Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA., Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, Louisiana, USA., Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., University of Miami/Sylvester Comprehensive Cancer Center, Miami, Florida, USA.

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