ABSTRACT
Background and Aims: Cancers are known to worsen the clinical course of SARS-CoV-2 infection. We aimed to assess health outcome effectors in Coronavirus 19 (COVID-19) cancer patients from different centers in the US. Methods: We retrospectively evaluated medical records of 364 COVID-19 cancer patients from 3 centers in the US (New York, Michigan, and DC) admitted to the hospital between Dec. 2019 to Oct. 2021. Outcomes, symptoms, labs, and comorbidities of cancer patients with COVID 19 (Cases), were analyzed and compared with non-cancer COVID-19 patients (Controls). Results: Among 1934 hospitalized COVID-19 patients, 18.7% (n=364) have an active or previous history of cancer. Cancer patients were older when compared with non-cancer controls (69.7 vs 61.3 years). Among these 364 cancer patients, 222 were African Americans (61.7%) and 121 were Caucasians (33.2%). Cancer patients had an increased length of hospitalization compared to controls (8.24 vs. 6.7 days). The most common types of cancer in cases are prostate cancer (41.5%) and hematological malignancies (10.1%) among males, and breast cancer (41.5%), and head and neck cancers (11.4%) in females. In both genders, lung cancer is associated with high mortality. Patients with a previous history of cancer were more prone to death (p=0.04) than active cancer patients. Cough (23.1%) and fever (19.5%) are the most common symptoms among the cases. In univariate and multivariate analyses, predictors of death among cancer patients were male sex, older age, African American ethnicity/race, asthma, presence or absence of fever, elevated troponin, mechanical ventilation, and previous history of cancer. There is no significant difference in mortality in cancer patients when compared to controls. Abdominal pain (2.2%), diarrhea (3.8%), and vomiting (2%) occurred both in cases and controls but did not associate with death. Albumin is also significantly associated with mortality in cases (p=0.042). AST (54.6%), ALT (12.5%), and Bilirubin (16%) were elevated in the majority of cases. Both AST and ALT alterations have an effect on mortality. Univariate analysis shows that AST is strongly and significantly associated with mortality in cases (p=0.001) but not in controls. ALT is also associated with mortality in cases at the 10% level (p=0.057). Diarrhea is strongly associated with mortality in control (p <0.001) but not in cases. Conclusion: In this retrospective cohort study, we found male sex, and African American race is associated with high mortality. Elevated troponin levels and LFT’s during the hospital stay were significantly associated with poor outcomes. Patients with a previous history of cancer were more prone to death when compared to active cancer COVID-19 patients. Early recognition of cancer COVID-19 patients can help determine appropriate treatment and management plans for better prognosis and outcome.
ABSTRACT
Study Objectives: Patients infected with SARS-CoV-2 who are evaluated in the emergency department but well enough to go home are still at risk for clinical deterioration. They may benefit from a program to monitor oxygen levels at home using portable pulse oximeter devices. Our study aims to evaluate patient engagement in and compliance with a home pulse oximetry monitoring program. The results of this study will be important to inform development and operationalization of remote patient monitoring programs. Methods: This was a single center, prospective pilot study of patients who presented to the ED or urgent care for symptoms consistent with SARS-CoV-2 infection and were considered to have some risk of clinical deterioration and thus could benefit from home SpO2 monitoring. Subjects were given a portable pulse oximeter and diary. They were instructed to perform readings at rest and with exertion twice daily for 14 days. Patients also recorded the presence or absence of symptoms associated with COVID-19 and whether they required additional medical care due to worsening symptoms. Subjects were contacted daily to obtain the recorded data. If contact could not be made with 3 attempts on each of 3 successive days, the subject was considered lost to follow up. The primary outcome of interest was patient engagement in the program defined as completion of the entire 14-day assessment. Secondary outcomes included patient compliance with performing the SpO2 readings and the proportion of subjects who had worsening clinical status requiring medical evaluation. Patient compliance was calculated as a percentage of completed readings out of the total number of possible readings. The difference in engagement and compliance rates between COVID-positive and COVID-negative patients was calculated using the Pearson Chi-squared test and Mann-Whitney U test, respectively. Results: Fifty patients were enrolled in the study with 3 screen failures. The remaining 47 were included in the final analysis. All patients received a qualitative test for detection of SARS-CoV-2;27 (57.4%) patients tested positive. Overall, engagement in the program was 46.8% with no significant difference between COVID- positive and COVID-negative groups (48.15% vs 45 %, p = 0.831). Median compliance was 42.9% (IQR 22.22 78.57) with compliance of 50.0% (IQR 20 - 85.71) and 42.86% (IQR 22.92 - 76.44) for COVID-positive and COVID-negative groups, respectively (p= 0.838). A total of 4 patients required additional medical care during the study period. Of those, two sought medical attention after advisement by the study team members due to decreasing SpO2 levels. Conclusion: Our study demonstrated that there was limited engagement and compliance in a 14-days home pulse oximetry monitoring program. A positive SARS-CoV-2 test did not predict a higher likelihood of engagement or compliance. Our program was helpful in detecting worsening SpO2 levels in two patients who sought medical care and were admitted for further management. These results support the use of home pulse oximetry monitoring;however, design of programs should focus on increasing patient engagement and compliance.