Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study

Abstract

Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. SIgnIfICAnCe: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access.

Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis

“…In a more recent report of the COVID-19 and Cancer Consortium, among 2186 cancer patients the 30-day mortality was 16%, but only half of patients had been admitted, explaining differences in mortality compared with cohorts limited to hospitalised patients. 11 A mortality rate of 33% was reported among 428 patients with thoracic cancer, of whom 76% were hospitalised. 12 Prior administration of chemotherapy was associated with increased risk of death, while immunotherapy and tyrosine kinase inhibitor use were not.…”

Randomized Controlled Trials Versus Real-World Data in the COVID-19 Era: A False Narrative

“…Confounding by indication is common and nearly unavoidable in observational studies where available therapies are given at the discretion of the clinician and not by random allocation as in an RCT. In further analysis of the CCC19 data, reduced access of Black patients to an experimental therapy, Rendesivir, that was only available to eligible patients in major centers was observed (34). While the improved outcomes of observed with Rendesivir in this study, while potentially representing a true therapeutic effect, could also represent confounding by access to a more favorable risk segment of the population receiving a higher level of healthcare (34).…”

COVID-19, Cancer, and Consequences: Where Are We Now?

“…In a more recent updated analysis of the CCC19 Registry with more than 2000 patients with cancer and laboratory-confirmed SARS-CoV-2 infection, 30-day all-cause mortality was 16%, hospitalizations 60% and a composite of severe COVID-19 outcomes of 29% with a median followup of 30 days (14). Mortality varied by cancer type from a low for cancers of the thyroid (2%) and breast (8%) to a high for lymphoma (22%) and lung cancer (26%).…”