Background 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 and Methods 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). Results 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. Conclusions 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.

Coronavirus Disease-2019 (COVID-19) is associated with a prothrombotic state with a high incidence of thrombotic events during hospitalization; however there are limited data examining rates of thrombosis after discharge. We conducted a retrospective observational cohort study of discharged patients with confirmed COVID-19 not receiving anticoagulation. The cohort included 163 patients with median time from discharge to last recorded follow up of 30 days (IQR 17-46). The median duration of index hospitalization was 6 days (IQR 3-12) and 26% required intensive care. The cumulative incidence of thrombosis (including arterial and venous events) at day 30 following discharge was 2.5% (95% CI 0.8-7.6); the cumulative incidence of venous thromboembolism alone at day 30 post-discharge was 0.6% (95% CI 0.1-4.6). The 30-day cumulative incidence of major hemorrhage was 0.7% (95% CI 0.1-5.1) and clinically relevant non-major bleeds was 2.9% (95% CI 1.0-9.1). We conclude that the rates of thrombosis and hemorrhage appear to be similar following hospital discharge for COVID-19, emphasizing the need for randomized data to inform recommendations for universal post-discharge thromboprophylaxis.

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Key Points Question Is Eastern Cooperative Oncology Group (ECOG) performance status at the beginning of therapy associated with survival outcomes in patients with advanced non–small cell lung cancer who are treated with palliative pembrolizumab monotherapy? Findings In this cohort study of 74 patients, those with ECOG performance status of at least 2 had significantly lower disease control, progression-free survival, and overall survival than those with performance status of 0 or 1. Survival differences remained significant after multivariable adjustment for confounding factors. Meaning These findings suggest that ECOG performance status should be considered while making shared therapeutic decisions regarding pembrolizumab monotherapy with patients.