Risk factors for Coronavirus Disease 2019 (COVID-19) severity and mortality among solid cancer patients and impact of the disease on anticancer treatment: A French nationwide cohort study (GCO-002 CACOVID-19)

Abstract

Background Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. Patients and Methods In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and June 11, 2020. The primary endpoint was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary endpoints. Results From April 4 to June 11, 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18-2.52), ECOG PS ≥ 2 (OR 3.23, 95%CI: 2.27-4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01-1.16) and admission to ICU (OR 3.62, 95%CI 2.14-6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except cytotoxic chemotherapy in the subgroup of patients with detectable SARS-CoV-2 by RT-PCR, which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00-2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment interrupted or stopped following diagnosis of COVID-19. Conclusions Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis.

Epidemiology and clinical course of severe acute respiratory syndrome coronavirus 2 infection in cancer patients in the Veneto Oncology Network: The Rete Oncologica Veneta covID19 study

“…The association of PS >=2 with increased risk of death has been already described by the CCC19 cohort study including 928 patients, by the French nationwide cohort study (GCO-002 CACOVID-19) including 1289 patients, and by the Gustave Roussy cohort of 178 patients. 6,9,16 In our study, presence of dyspnea, COVID-19 phenotype >=3, hospitalization, and intensive care unit admission were all significant predictors of increased risk of death.…”

“…As reported in the vast majority of studies, we confirmed the association of age and comorbidities with an increased risk of death. 14,16,24 Poor PS was also associated with an increased risk of death. The association of PS >=2 with increased risk of death has been already described by the CCC19 cohort study including 928 patients, by the French nationwide cohort study (GCO-002 CACOVID-19) including 1289 patients, and by the Gustave Roussy cohort of 178 patients.…”

“…Starting from the first retrospective cohort in China, describing a higher risk of severe events for cancer versus non-cancer patients, data from several multicentric registries including hundreds of cancer patients reported a mortality rate in the range of 10-33%. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 It is important to note, however, the huge heterogeneity of the clinical course of SARS-CoV-2 infection across different countries. Mortality, the most important measure of COVID-19 disease burden, largely differs across countries.…”

Impacts of COVID‐19 on caregivers of childhood cancer survivors

“…Existing evidence in the general population indicates older individuals and those with comorbid chronic conditions are at higher risk for SARS‐CoV‐2 infection, severe disease, and death 2–5 . Cancer patients may also be at increased risk of adverse outcomes if infected, 6–10 though morbidity and mortality appear to vary across tumor histology and treatment status 11–16 . While recent small studies suggest that pediatric patients with cancer may not be more vulnerable than other children to infection or morbidity from SARS‐CoV‐2, 17,18 other studies suggest that children with hematologic malignancies may have a more severe course of COVID‐19 illness 19 …”

Management of digestive cancers during the COVID-19 second wave: A French intergroup point of view (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFR)

“…The risk of death from COVID-19 in patients treated for cancer was overestimated in the first studies [1] . In large European cohorts and a recent meta-analysis, death and severity of COVID-19 were mostly due to patients’ characteristics with low impact of cancer treatments [2] , [3] , [4] . In the French GCO-002 CACOVID-19 cohort ( n = 1289), independent factors associated with death, in multivariate analysis, were male gender, ECOG performance status ≥ 2 and the updated Charlson comorbidity index (ICCa) [2] .…”