Clinical Characteristics, Care Trajectories and Mortality Rate of SARS-CoV-2 Infected Cancer Patients: A Multicenter Cohort Study

Abstract

Background: COVID-19 may be more frequent and more severe in cancer patients than in other individuals. Our aims were to assess the rate of COVID-19 in hospitalized cancer patients, to describe their demographic characteristics, clinical features and care trajectories, and to assess the mortality rate. Methods: This multicenter cohort study was based on the Electronic Health Records of the Assistance Publique-Hôpitaux de Paris (AP-HP). Cancer patients with a diagnosis of COVID-19 between 3 March and 19 May 2020 were included. Main outcome was all-cause mortality within 30 days of COVID-19 diagnosis. Results: A total of 29,141 cancer patients were identified and 7791 (27%) were tested for SARS-CoV-2. Of these, 1359 (17%) were COVID-19-positive and 1148 (84%) were hospitalized; 217 (19%) were admitted to an intensive care unit. The mortality rate was 33% (383 deaths). In multivariate analysis, mortality-related factors were male sex (aHR = 1.39 [95% CI: 1.07–1.81]), advanced age (78–86 y: aHR = 2.83 [95% CI: 1.78–4.51] vs. <66 y; 86–103 y: aHR = 2.61 [95% CI: 1.56–4.35] vs. <66 y), more than two comorbidities (aHR = 2.32 [95% CI: 1.41–3.83]) and C-reactive protein >20 ng/mL (aHR = 2.20 [95% CI: 1.70–2.86]). Primary brains tumors (aHR = 2.19 [95% CI: 1.08–4.44]) and lung cancer (aHR = 1.66 [95% CI: 1.02–2.70]) were associated with higher mortality. Risk of dying was lower among patients with metabolic comorbidities (aHR = 0.65 [95% CI: 0.50–0.84]). Conclusions: In a hospital-based setting, cancer patients with COVID-19 had a high mortality rate. This mortality was mainly driven by age, sex, number of comorbidities and presence of inflammation. This is the first cohort of cancer patients in which metabolic comorbidities were associated with a better outcome.

Influence of the SARS-CoV-2 outbreak on management and prognosis of new lung cancer cases, a retrospective multicentre real-life cohort study

“…However, in this category, patients referred in 2020 and presenting with a SARS-CoV-2 infection displayed a poorer survival than those without SARS-CoV-2 infection. This observation is perfectly in line with the 30-43% COVID-19-related mortality rate in patients with lung cancer, as reported in previous studies 10 , 11 .…”

Effect of Obesity among Hospitalized Cancer Patients with or without COVID-19 on a National Level

“…However, we did not find that obesity had a negative effect on in-hospital mortality in cancer patients hospitalized for COVID-19. While this result may seem surprising since obesity is classically considered as contributing to a worse prognosis in the COVID-19 population [ 23 , 24 , 25 , 26 , 27 ], it is consistent with other studies [ 23 , 28 , 29 , 30 , 31 , 32 , 33 , 51 ] in cancer patients which did not find that mortality was increased (most ORs were close to 1 even after adjustment). This is the case, for example, for the cancer consortium cohort study, which found that obesity was not significantly associated with the risk of 30-day mortality, either in univariate analysis or after adjustment for age, sex, and smoking (OR = 0.99 [0.58–1.71]).…”

“…In numerous studies, obesity is associated with increased morbidity and mortality in patients with COVID-19 [ 23 , 24 , 25 , 26 , 27 ]. However, in some populations, there seems to be an obesity paradox, especially in severely ill populations such as respiratory failure or cancer patients [ 23 , 28 , 29 , 30 , 31 , 32 , 33 ]. Indeed, it appears that in these studies, obesity was not significantly associated with increased morbidity and mortality in cancer patients with COVID-19.…”

The Intriguing Thyroid Hormones–Lung Cancer Association as Exemplification of the Thyroid Hormones–Cancer Association: Three Decades of Evolving Research

“…Second, low fT3 levels—often encountered in lung cancer patients with NTIS—have been indicated as independent predictor of the severity of COVID-19 disease [ 124 , 150 ]. Third, cancer [ 151 , 152 , 153 , 154 , 155 ], including lung cancer [ 153 , 154 , 155 ], has been recognized as risk factor for increased severity of COVID-19. Fourth, more research and long-term epidemiological surveillance are essential to answer whether the interplay between TH and COVID-19 can contribute to lung carcinogenesis or aggravate a preexisting lung malignancy [ 156 , 157 ].…”