Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium.

Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer.

In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95% CIs were estimated from ordinal and binary logistic regression models.

5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22-120), and median age was 72 years (IQR 66-79). The CCC19 geriatric risk index identified 2365 (41·7%) patients as standard risk, 2217 (39·1%) patients as intermediate risk, and 1089 (19·2%) as high risk. 36 (0·6%) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95% CI 6·20-8·45). 920 (16·2%) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8%) of 2365 standard-risk patients, 409 (18·5%) of 2217 intermediate-risk patients, and 350 (32·1%) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95% CI 8·54-13·5) than standard-risk patients.

The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality.

US National Institutes of Health National Cancer Institute Cancer Center.

The Lancet. Healthy longevity. 2022 Feb 14 [Epub ahead of print]

Arielle Elkrief, Cassandra Hennessy, Nicole M Kuderer, Samuel M Rubinstein, Elizabeth Wulff-Burchfield, Rachel P Rosovsky, Karen Vega-Luna, Michael A Thompson, Orestis A Panagiotou, Aakash Desai, Donna R Rivera, Ali Raza Khaki, Lisa Tachiki, Ryan C Lynch, Catherine Stratton, Rawad Elias, Gerald Batist, Anup Kasi, Dimpy P Shah, Ziad Bakouny, Angelo Cabal, Jessica Clement, Jennifer Crowell, Becky Dixon, Christopher R Friese, Stacy L Fry, Punita Grover, Shuchi Gulati, Shilpa Gupta, Clara Hwang, Hina Khan, Soo Jung Kim, Elizabeth J Klein, Chris Labaki, Rana R McKay, Amanda Nizam, Nathan A Pennell, Matthew Puc, Andrew L Schmidt, Armin Shahrokni, Justin A Shaya, Christopher T Su, Sarah Wall, Nicole Williams, Trisha M Wise-Draper, Sanjay Mishra, Petros Grivas, Benjamin French, Jeremy L Warner, Tanya M Wildes, COVID-19 and Cancer Consortium

McGill University Health Centre, Montreal, QC, Canada., Vanderbilt University Medical Center, Nashville, TN, USA., Advanced Cancer Research Group, Kirkland, WA, USA., UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA., The University of Kansas Medical Center, Kansas City, KS, USA., Massachusetts General Hospital Cancer Center, Boston MA, USA., Aurora Cancer Care, Advocate Aurora Health, Milwaukee, WI, USA., Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, USA., Mayo Clinic, Rochester, MN, USA., National Cancer Institute, Bethesda, MD, USA., Stanford University, Stanford, CA, USA., Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA., Yale Cancer Center at Yale University School of Medicine, New Haven, CT, USA., Hartford Healthcare Cancer Institute, Hartford, CT, USA., Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada., Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA., Dana-Farber Cancer Institute, Boston, MA, USA., Moores Comprehensive Cancer Center at the University of California, San Diego (UCSD), San Diego, CA, USA., St Elizabeth Healthcare, Edgewood, KY, USA., University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA., University of Cincinnati Cancer Center, Cincinnati, OH, USA., Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA., Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA., The Warren Alpert Medical School of Brown University, Providence, RI, USA., Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Virtua Health, Marlton, NJ, USA., The Ohio State University, Columbus, OH, USA., Cancer and Aging Research Group, St Louis, MO, USA.

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