Outcomes of COVID-19 in Patients With Cancer: Report From the National COVID Cohort Collaborative (N3C)

Abstract

PURPOSE Variation in risk of adverse clinical outcomes in patients with cancer and COVID-19 has been reported from relatively small cohorts. The NCATS’ National COVID Cohort Collaborative (N3C) is a centralized data resource representing the largest multicenter cohort of COVID-19 cases and controls nationwide. We aimed to construct and characterize the cancer cohort within N3C and identify risk factors for all-cause mortality from COVID-19. METHODS We used 4,382,085 patients from 50 US medical centers to construct a cohort of patients with cancer. We restricted analyses to adults ≥ 18 years old with a COVID-19–positive or COVID-19–negative diagnosis between January 1, 2020, and March 25, 2021. We followed N3C selection of an index encounter per patient for analyses. All analyses were performed in the N3C Data Enclave Palantir platform. RESULTS A total of 398,579 adult patients with cancer were identified from the N3C cohort; 63,413 (15.9%) were COVID-19–positive. Most common represented cancers were skin (13.8%), breast (13.7%), prostate (10.6%), hematologic (10.5%), and GI cancers (10%). COVID-19 positivity was significantly associated with increased risk of all-cause mortality (hazard ratio, 1.20; 95% CI, 1.15 to 1.24). Among COVID-19–positive patients, age ≥ 65 years, male gender, Southern or Western US residence, an adjusted Charlson Comorbidity Index score ≥ 4, hematologic malignancy, multitumor sites, and recent cytotoxic therapy were associated with increased risk of all-cause mortality. Patients who received recent immunotherapies or targeted therapies did not have higher risk of overall mortality. CONCLUSION Using N3C, we assembled the largest nationally representative cohort of patients with cancer and COVID-19 to date. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Full characterization of the cohort will provide further insights into the effects of COVID-19 on cancer outcomes and the ability to continue specific cancer treatments.

Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis

“…However, for patients with solid tumors, immunotherapy could lead to life-threatening outcomes, especially when administered within 50 d. Both chemotherapy and immunotherapy were reported to affect SARS-CoV-2 antibody levels in patients and could influence the immune response to SARS-CoV-2 (Yazaki et al, 2021). In fact, some previous studies even indicated that chemotherapy increased the risk of poor outcomes (Grivas et al, 2021;Sharafeldin et al, 2021), especially in patients with haematologic malignancies (Lee et al, 2020b), which is in agreement with our results. For patients with haematologic malignancies, myelosuppressive chemotherapy could disrupt the immune system and contribute to a more severe form of COVID-19 (Lin et al, 2021).…”

Key findings from the UKCCMP cohort of 877 patients with haematological malignancy and COVID‐19: disease control as an important factor relative to recent chemotherapy or anti‐CD20 therapy

“…We excluded patients treated with curative intent more than 12 months previously, which may explain the difference in effect of cytotoxic chemotherapy reported in other studies. 9 , 10 The lack of increased risk with anti‐CD20 B‐cell depleting treatments in this unvaccinated cohort is of particular interest given the concerns that have been expressed about such agents.…”

“…The impact of anti‐cancer treatments on mortality in SARS‐CoV‐2‐positive haematological patients has been investigated in increasingly large cohorts, although with variation in methodology and reported findings. Two large US studies reported an association between cytotoxic chemotherapy in either the past month or the past three months and increased mortality, 9 , 10 although these cohorts included patients with historic diagnoses of cancer, which limits interpretation. Three further studies, each with >600 patients with haematological malignancies and including a meta‐analysis of 13 studies, observed no statistically significant association between chemotherapy administered in the 28 days before SARS‐CoV‐2 infection and mortality.…”

Serological response following BNT162b2 anti‐SARS‐CoV‐2 mRNA vaccination in haematopoietic stem cell transplantation patients

“…Adult patients with haematological malignancies (HM) and coronavirus disease 2019 (COVID‐19) have a higher mortality than healthy subjects. 1 , 2 , 3 In particular, haematopoietic stem‐cell transplantation (HSCT) recipients have a poor prognosis, 4 , 5 strongly supporting the role of vaccination. Patients with HM also show an attenuated immune response to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)infection, 6 predicting a low rate of seroconversion after vaccination, as confirmed in several recent studies, particularly in B cell malignancies.…”