Determinants of the outcomes of patients with cancer infected with SARS-CoV-2: results from the Gustave Roussy cohort

Abstract

B y early March 2020, the spread of the coronavirus disease 2019 (COVID-19) outbreak had reached the Paris area, France. Since then, all medical resources have been reorganized to handle the pandemic. As a tertiary cancer center, Gustave Roussy has followed two objectives: define processes to safely sustain cancer care in a secured environment and reorganize internally to adapt its capacities to hospitalize patients with cancer and COVID-19 illness. Patients with cancer have been considered at increased risk of COVID-19, on the rationale of the increased systemic immunosuppressive state caused by the underlying malignancy and anticancer treatments. The first report from a retrospective cohort in China suggested that patients with cancer were observed to have a higher risk of severe events (for example, a composite endpoint of intensive care unit (ICU) admission, invasive ventilation or death) compared with patients without cancer (seven (39%) of 18 patients versus 124 (8%) of 1,572 patients; P = 0.0003) and that patients with cancer deteriorated more rapidly than those without cancer 1. While general determinants of COVID-19 severity have emerged from large cohorts from China and Italy 2,3 , limited data are available on the specificity of patients with cancer to help the oncology community to identify patients at risk of severe COVID-19. Furthermore, the impact of COVID-19 infection on ongoing cancer care is unexplored. This study investigated the determinants of clinical worsening and death, as well as the impact on cancer care, for the first patients sequentially managed for COVID-19 and cancer in an academic tertiary cancer center. Results Patient population. From 24 March 2020 until 29 April 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 196 (12%) of 1,633 tests performed internally at the Gustave Roussy Cancer Centre. Overall, 209 patients were identified (including a few identified by PCR with reverse transcription (RT-PCR) performed at another facility and some diagnosed by computed tomography scan alone) and the final study population included 178 adult patients. The following were reasons for exclusion: pediatric population (six patients); non-cancer patients (19 patients); and COVID-19 ultimately ruled out (six patients). Baseline demographics, comorbidities and underlying cancer characteristics for

A global effort to understand the riddles of COVID-19 and cancer

“…A recent pooled analysis of 52 studies, comprising 18,650 patients with both COVID-19 and cancer, showed that the probability of death was 25.6% (95% CI = 22.0-29.9%; I 2 (heterogeneity statistic) = 48•9%) 10 . Increasing age seemed to be consistently associated with death in the Gustave Roussy cohort 1 and Veneto data (≥70 years of age) 2 , in patients at Institut Curie hospitals (the 'Curie cohort') 11 , in the CCC19 registry 8 and in the TERAVOLT registry 9 . One of the main advantages of single-center studies, such as the one from Gustave Roussy 1 , is that they provide a granular and deep 'dive' into the lab abnormalities of patients with COVID-19 and cancer.…”

“…To that end, Albiges et al 1 and Rugge et al 2 presented their early independent studies from France and Italy, in order to add to this growing body of evidence. In their study, Albiges et al analyzed variables with prognostic value for clinical worsening or death in 178 patients with cancer and COVID-19, seen over a six-week period at the Gustave Roussy Cancer Center 1 .…”

“…To that end, Albiges et al 1 and Rugge et al 2 presented their early independent studies from France and Italy, in order to add to this growing body of evidence. In their study, Albiges et al analyzed variables with prognostic value for clinical worsening or death in 178 patients with cancer and COVID-19, seen over a six-week period at the Gustave Roussy Cancer Center 1 . The investigators in this study reported an increased risk of death among patients over 70 years of age, current or former smokers, an Eastern Cooperative Oncology Group performance status of 2 or worse at the last follow up visit, presence of metastatic disease, and/or receipt of cytotoxic chemotherapy in the past three months.…”

“…A comparison with regional data showed that the mortality rate of 17.4% among this cohort of patients was similar to that of contemporaneously admitted patients in the Paris area. One of the most important findings of the study by Albiges et al 1 is the glimpse it provides of the impact of COVID-19 on cancer strategies and post-COVID-19 assessment of patients with cancer, which was not readily provided by the other large registry studies. Through preliminary patient-reported outcomes (PROs), the authors offered a rough recall assessment of what 146 patients with cancer and COVID-19 experienced in the first month assessment; the study highlighted the finding that the PROs included 75% asthenia, 42% exertional dyspnea and 30% cough.…”

Machine learning prediction for mortality of patients diagnosed with COVID-19: a nationwide Korean cohort study

“…Previously reported underlying medical conditions associated with poor prognosis include hypertension 10,12,13,15,17,18 , DM 10,12,14,15 , lung disease including chronic obstructive lung disease and asthma [11][12][13] , cardiovascular disease 10,11,[13][14][15] , cancer 21,22 , and chronic renal disease 12,18 . In our study, DM (from Cox and LASSO), chronic lung disease or asthma (from Cox regression), cancer (from LASSO), and hypertension (from RF) were signi cant predictors.…”