COVID-19 mortality in cancer patients: a report from a tertiary cancer centre in India

Abstract

Background Cancer patients, especially those receiving cytotoxic therapy, are assumed to have a higher probability of death from COVID-19. We have conducted this study to identify the Case Fatality Rate (CFR) in cancer patients with COVID-19 and have explored the relationship of various clinical factors to mortality in our patient cohort. Methods All confirmed cancer cases presented to the hospital from June 8 to August 20, 2020, and developed symptoms/radiological features suspicious of COVID-19 were tested by Real-time polymerase chain reaction assay and/or cartridge-based nucleic acid amplification test from a combination of naso-oropharyngeal swab for SARS-CoV-2. Clinical data, treatment details, and outcomes were assessed from the medical records. Results Of the total 3,101 cancer patients admitted to the hospital, 1,088 patients were tested and 186 patients were positive for SARS-CoV-2. The CFR in the cohort was 27/186 (14.52%). Univariate analysis showed that the risk of death was significantly associated with the presence of any comorbidity (OR: 2.68; (95% CI [1.13–6.32]); P = 0.025), multiple comorbidities (OR: 3.01; (95% CI [1.02–9.07]); P = 0.047 for multiple vs. single), and the severity of COVID-19 presentation (OR: 27.48; (95% CI [5.34–141.49]); P < 0.001 for severe vs. not severe symptoms). Among all comorbidities, diabetes (OR: 3.31; (95% CI [1.35–8.09]); P = 0.009) and cardiovascular diseases (OR: 3.77; (95% CI [1.02–13.91]); P = 0.046) were significant risk factors for death. Anticancer treatments including chemotherapy, surgery, radiotherapy, targeted therapy, and immunotherapy administered within a month before the onset of COVID-19 symptoms had no significant effect on mortality. Conclusion To the best of our knowledge, this is the first study from India reporting the CFR, clinical associations, and risk factors for mortality in SARS-CoV-2 infected cancer patients. Our study shows that the frequency of COVID-19 in cancer patients is high. Recent anticancer therapies are not associated with mortality. Pre-existing comorbidities, especially diabetes, multiple comorbidities, and severe symptoms at presentation are significantly linked with COVID-19 related death in the cohort.

Clinical Profile and Outcome of Critically Ill COVID-19 Patients With Malignancy Admitted in Intensive Care Unit of a Tertiary COVID Center, India

“…Higher age and altered sensorium at presentation is a predictor of mortality in our series. Our finding is similar to previous studies [5,7] which showed advanced age as a predictor of worse outcome. Altered sensorium has not been the clinical presentation in most series and thus a relation to it has not been inferred in existing data.…”

“…This series is a snapshot of clinical profile of these severe cases. Previous studies have shown a lower percentage of cancer patients developing severe events [2][3][4][5][6][7][8]. The main reasons for the discrepancy can be attributed to variation in the strain affecting this cohort of patients and also variation in study populations.…”

“…The co-morbidities were not very common in our cohort with approximately 60% of patients having no comorbidities. Other studies have found an association between co-morbidities and outcome [ 4 , 7 , 9 ]. However, our sample with co-morbidities was small to draw any conclusions.…”

“…Malignancy and COVID-19 is surrounded by various unanswered questions and our study is an addition to the sparse literature on COVID-19 and malignancy. Studies on COVID-19 in patients with malignancy are there [4][5][6][7][8] but very few related to only critically ill patients of COVID-19 admitted to ICU. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with malignancy admitted in an ICU of a tertiary care center in India.…”

Impact of COVID-19 on healthcare workers at a cancer care centre

“…The first case of COVID-19 infection among the HCWs of our Institute was reported on May 1, 2020. The suspicious cases for COVID-19 were investigated by real-time polymerase chain reaction test and/or cartridge-based nucleic acid amplification test from a combination of naso-oropharyngeal swabs for SARS-CoV-2 as described previously 6 and/or by Standard Q Covid-19 Ag test following the latest national guidelines of Indian Council of Medical Research and international regulations. The laboratory confirmed COVID-19 positive HCWs during five months (May 1, 2020 to September 30, 2020) were included in the study.…”