Changes Over Time in COVID-19 Severity and Mortality in Patients Undergoing Cancer Treatment in the United States: Initial Report From the ASCO Registry

Abstract

PURPOSE: People with cancer are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ASCO's COVID-19 registry promotes systematic data collection across US oncology practices. METHODS: Participating practices enter data on patients with SARS-CoV-2 infection in cancer treatment. In this analysis, we focus on all patients with hematologic or regional or metastatic solid tumor malignancies. Primary outcomes are 30- and 90-day mortality rates and change over time. RESULTS: Thirty-eight practices provided data for 453 patients from April to October 2020. Sixty-two percent had regional or metastatic solid tumors. Median age was 64 years. Forty-three percent were current or previous cigarette users. Patients with B-cell malignancies age 61-70 years had twice mortality risk (hazard ratio = 2.1 [95% CI, 1.3 to 3.3]) and those age > 70 years had 4.5 times mortality risk (95% CI, 1.8 to 11.1) compared with patients age ≤ 60 years. Association between survival and age was not significant in patients with metastatic solid tumors ( P = .12). Tobacco users had 30-day mortality estimate of 21% compared with 11% for never users (log-rank P = .005). Patients diagnosed with SARS-CoV-2 before June 2020 had 30-day mortality rate of 20% (95% CI, 14% to 25%) compared with 13% (8% to 18%) for those diagnosed in or after June 2020 ( P = .08). The 90-day mortality rate for pre-June patients was 28% (21% to 34%) compared with 21% (13% to 28%; P = .20). CONCLUSION: Older patients with B-cell malignancies were at increased risk for death (unlike older patients with metastatic solid tumors), as were all patients with cancer who smoke tobacco. Diagnosis of SARS-CoV-2 later in 2020 was associated with more favorable 30- and 90-day mortality, likely related to more asymptomatic cases and improved clinical management.

Meta-analysis of COVID-19 patients to understand the key predictors of mortality in the non-vaccinated groups in remote settings

“…The copyright holder for this preprint this version posted January 5, 2022. ; https://doi.org/10.1101/2022.01.04.21267659 doi: medRxiv preprint who died in the hospital (78.6%). The current trends in Douglas county 1 being catalogued as a high-risk zone insinuate that lower vaccination rates and comorbidities prevalent in the area are expected to be the prognostic predictors of mortality. The remote settings also have their challenges (see next section) and other social influences indicated by CDC, such as a higher rate of vaccine hesitancy and dependence on public insurance.…”

“…As of August 31, 2021, there were 38 patients with confirmed vaccination status, 5 of whom met the composite endpoint of severe COVID-19 in the vaccinated group. The model for our primary analysis involves a total of 36 degrees of freedom: age (1), sex (1), lab data performance status category (2, ordinal variable with 3 levels: 0, 1, 2 or greater), smoking status (1, binary variable, All rights reserved. No reuse allowed without permission.…”

“…As of August 31, 2021, there were 38 patients with confirmed vaccination status, 5 of whom met the composite endpoint of severe COVID-19 in the vaccinated group. The model for our primary analysis involves a total of 36 degrees of freedom: age (1), sex (1), lab data performance status category (2, ordinal variable with 3 levels: 0, 1, 2 or greater), smoking status (1, binary variable, current/former or never), state of disease (2, a categorical variable with 3 levels: date of the first admission,.... ), line of therapy received (2, categorical variable with 3 categories: untreated, first line, second line), phase of therapy (2, categorical variable with three categories: induction, consolidation, maintenance), and recent receipt of cytotoxic therapy (1, binary variable). Therefore, the number of events is sufficient to power this analysis, assuming 26 events per degree of freedom.…”

“…The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known as coronavirus disease 2019 (COVID- 19), has been classified as a pandemic by the World Health Organization (WHO) by February 2020. As of today, over ~28.7 million cases have been reported worldwide, with more than ~5.1 million deaths 1 . The effects of the pandemic have been incredibly profound in the unvaccinated group, and a majority of them are destined to comprise the high-risk group of patients 2 .…”

Clinical Evidence Generation During a Pandemic

“…The pandemic catalyzed unparalleled large-scale, multistakeholder collaborations that rapidly generated RWD from EHRs, administrative health care claims, and registries. Several instrumental efforts focused on RWD generation to understand COVID-19 in oncology including registries such as the COVID-19 and Cancer Consortium, the American Society of Clinical Oncology Survey on COVID-19 in Oncology Registry, and the NCI COVID-19 in Cancer Patients Study, as well as broader methodological efforts within the Reagan-Udall Foundation for FDA Evidence Accelerator, among others 21–23 . These registries were designed to include cancer survivors and patients with active cancer with a positive SARS-CoV-2 test or clinical evidence of COVID-19.…”