Journal article
Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
The Lancet (British edition), Vol.395(10241), pp.1907-1918
06/20/2020
DOI: 10.1016/S0140-6736(20)31187-9
PMCID: PMC7255743
PMID: 32473681
Abstract
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.
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.
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.
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.
American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.
Details
- Title: Subtitle
- Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
- Creators
- Nicole M Kuderer - Advanced Cancer Research Group, Kirkland, WA, USAToni K Choueiri - Harvard UniversityDimpy P Shah - The University of Texas MD Anderson Cancer CenterYu Shyr - Vanderbilt University Medical CenterSamuel M Rubinstein - Vanderbilt University Medical CenterDonna R Rivera - Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USASanjay Shete - The University of Texas MD Anderson Cancer CenterChih-Yuan Hsu - Vanderbilt University Medical CenterAakash Desai - University of ConnecticutGilberto de Lima Lopes Jr - University of MiamiPetros Grivas - University of WashingtonCorrie A Painter - Count Me In, Cambridge, MA, USASolange Peters - University of LausanneMichael A Thompson - Advocate Aurora Health, Milwaukee, WI, USAZiad Bakouny - Harvard UniversityGerald Batist - McGill UniversityTanios Bekaii-Saab - Mayo Clinic in FloridaMehmet A Bilen - Emory UniversityNathaniel Bouganim - McGill University Health CentreMateo Bover Larroya - Hospital Universitario 12 De OctubreDaniel Castellano - Hospital Universitario 12 De OctubreSalvatore A Del Prete - Stamford HospitalDeborah B Doroshow - Icahn School of Medicine at Mount SinaiPamela C Egan - Brown UniversityArielle Elkrief - McGill UniversityDimitrios Farmakiotis - Brown UniversityDaniel Flora - St. Elizabeth HealthcareMatthew D Galsky - Icahn School of Medicine at Mount SinaiMichael J Glover - Stanford UniversityElizabeth A Griffiths - Roswell Park Cancer InstituteAnthony P Gulati - Stamford HospitalShilpa Gupta - Cleveland ClinicNavid Hafez - Yale UniversityThorvardur R Halfdanarson - Mayo ClinicJessica E Hawley - Columbia UniversityEmily Hsu - University of ConnecticutAnup Kasi - University of KansasAli R Khaki - University of WashingtonChristopher A Lemmon - Cleveland ClinicColleen Lewis - Emory UniversityBarbara Logan - St. Elizabeth HealthcareTyler Masters - Yale UniversityRana R McKay - University of California, San DiegoRuben A Mesa - The University of Texas MD Anderson Cancer CenterAlicia K Morgans - Northwestern UniversityMary F Mulcahy - Northwestern UniversityOrestis A Panagiotou - Brown UniversityPrakash Peddi - Willis-Knighton Cancer CenterNathan A Pennell - Cleveland ClinicKerry Reynolds - Harvard UniversityLane R Rosen - Willis-Knighton Cancer CenterRachel Rosovsky - Harvard UniversityMary Salazar - The University of Texas MD Anderson Cancer CenterAndrew Schmidt - Harvard UniversitySumit A Shah - Stanford UniversityJustin A Shaya - University of California, San DiegoJohn Steinharter - Harvard UniversityKeith E Stockerl-Goldstein - Washington University in St. LouisSuki Subbiah - Stanley S Scott Cancer Center, LSU Health, New Orleans, LA, USADonald C Vinh - McGill University Health CentreFiras H Wehbe - Northwestern UniversityLisa B Weissmann - Mount Auburn HospitalJulie Tsu-Yu Wu - Stanford UniversityElizabeth Wulff-Burchfield - University of KansasZhuoer Xie - Mayo ClinicAlbert Yeh - University of WashingtonPeter P Yu - Hartford Health Care, Hartford, CT, USAAlice Y Zhou - Washington University in St. LouisLeyre Zubiri - Harvard UniversitySanjay Mishra - Vanderbilt University Medical CenterGary H Lyman - University of WashingtonBrian I Rini - Vanderbilt University Medical CenterJeremy L Warner - Vanderbilt University Medical CenterCOVID-19 and Cancer Consortium
- Contributors
- Praveen Vikas (Contributor) - University of Iowa, Hematology, Oncology, and Blood & Marrow Transplantation
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.395(10241), pp.1907-1918
- DOI
- 10.1016/S0140-6736(20)31187-9
- PMID
- 32473681
- PMCID
- PMC7255743
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Grant note
- P30 CA054174 / NCI NIH HHS T32 HG008341 / NHGRI NIH HHS U01 CA231840 / NCI NIH HHS T32 CA203703 / NCI NIH HHS T32 CA009515 / NCI NIH HHS P30 CA060553 / NCI NIH HHS UL1 TR000445 / NCATS NIH HHS P30 CA016056 / NCI NIH HHS P30 CA068485 / NCI NIH HHS P30 CA023100 / NCI NIH HHS P30 CA016672 / NCI NIH HHS P30 CA196521 / NCI NIH HHS P30 CA013696 / NCI NIH HHS UG1 CA189974 / NCI NIH HHS UG1 CA189828 / NCI NIH HHS UL1 TR001863 / NCATS NIH HHS U10 CA180888 / NCI NIH HHS
- Language
- English
- Date published
- 06/20/2020
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359800802771
Metrics
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