Natural history of coagulopathy in patients with cancer infected with COVID19: A real-world data (RWD) analysis

Background and Objective: Studies of hospitalized patients (pts) with COVID19 indicate that arterial or venous thrombotic complications occur in up to half of pts. Risk of these severe complications in pts with cancer is unknown. We estimated the incidence of arterial thrombosis (AT) and venous thromboembolism (VT) using RWD from pts with active or history of cancer with COVID19. Methods: Adult pts with cancer receiving treatment in community health systems, with COVID19 identified via ICD code or lab confirmation in 2020, were reviewed for incident AT and VT in a 90 day window following COVID19 diagnosis (index). AT was acute myocardial infarction (MI) or acute ischemic or embolic stroke (S). VT was acute deep venous thrombosis (DVT) or acute pulmonary embolism (PE). Medication use (anticoagulant, antiplatelet, statin) and comorbidities were assessed 6 months and 1 year prior to index, respectively. Results: Median age of 7,591 pts with cancer and COVID19 was 67 years and median follow up was 90 days. 32% of pts were hospitalized within 14 days, 2% received ventilator support, 6% had cardiovascular disease (CVD) and 1% had prior VT. Absolute risk of VT was significantly higher than AT (3% vs. 2%, chi square p= < 0.001), with 161 pts experiencing AT [81 (1%) MI;80 (1%) S] and 240 pts experiencing VT [99 (1%) DVT;158 (2%) PE]. This trend held across most subgroups (Table 1). The incidence rate per person-year was 0.094 for AT (0.047 MI, 0.046 S) and 0.141 for VT (0.058 DVT, 0.092 PE). CoxPH models did not show age, sex, comorbidities or medication use as significantly associated with higher probability of AT or VT. Conclusions: RWD showed pts with cancer and COVID19 were at higher risk for VT than AT. Pts who received ventilator support, or had prior VT or prior CVD had highest risk for these events. Severity of these outcomes emphasizes the need for risk reducing interventions. (Table Presented).

It's Challenging but Doable: Lessons Learned from a Remote Collaborative Coding Camp for Elementary Students

The COVID-19 pandemic shifted many U.S. schools from in-person to remote instruction. While collaborative CS activities had become increasingly common in classrooms prior to the pandemic, the sudden shift to remote learning presented challenges for both teachers and students in implementing and supporting collaborative learning. Though some research on remote collaborative CS learning has been conducted with adult learners, less has been done with younger learners such as elementary school students. This experience report describes lessons learned from a remote after-school camp with 24 elementary school students who participated in a series of individual and paired learning activities over three weeks. We describe the design of the learning activities, participant recruitment, group formation, and data collection process. We also provide practical implications for implementation such as how to guide facilitators, pair students, and calibrate task difficulty to foster collaboration. This experience report contributes to the understanding of remote CS learning practices, particularly for elementary school students, and we hope it will provoke methodological advancement in this important area. © 2022 ACM.

Using real-world data (RWD) from anintegrated platform for rapid analysis of patients withcancer with and without COVID-19 across distinct healthsystems

Introduction: Reports suggest worsened outcomes in patients with cancer (pts) and COVID-19 (Cov), varying bygeography and local peak dynamics. We describe characteristics and clinical outcomes of pts with and without Cov. Methods: RWD at 2 Midwestern health systems from the Syapse Learning Health Network were used to identifyadults with active cancer (AC) or past history of cancer (PHC). AC pts were identified by encounters with ICD-10code for malignant neoplasm or receipt of an anticancer agent within 12 months prior to February 15, 2020;PHC pts were identified by encounters with an active cancer code from May 15, 2015 to February 15, 2019 and no receipt ofanticancer therapy within the prior 12 months. Cov was defined by diagnostic codes and laboratory results fromFebruary 15 to May 13, 2020. Comorbidities were assessed prior to February 15, 2020;hospitalizations (hosp), invasive mechanical ventilation (IMV), and all-cause mortality (M) were assessed from February 15 to May 27, 2020. Results: We identified 800 pts with Cov (0.5%) out of a total of 154,585 pts with AC or PHC. Compared to AC pts without Cov (AC WO, 39,402), AC pts with Cov (AC Cov, 388) were more likely to be non-Hispanic Black (NHB,39% vs. 9%), have renal failure (RF, 24% vs. 12%), cardiac arrhythmias (33% vs. 19%), congestive heart failure(CHF, 16% vs. 8%), obesity (19% vs. 14%), pulmonary circulation disorder (PCD, 9% vs. 4%), and a zip code withmedian annual household income (ZMI) <$30k (18% vs. 5%). Comorbidity and income were similarly distributed forPHC pts with Cov (PHC Cov, 412). Compared to PHC pts without Cov (PHC WO, 114,383), coagulopathy (coag)was more common in PHC Cov pts (10% vs. 5%). Hosp for AC Cov pts was higher than for AC WO pts (81% vs.15%). Hosp for PHC Cov pts was also higher than for PHC WO pts (68% vs. 6%). Hosp was highest for NHB pts inboth AC Cov and PHC Cov groups (88% and 72%) and for AC Cov pts in low ZMI (94% in <$30K). Pts <50 yearsold had hosp rates of 79% (AC Cov) and 49% (PHC Cov). IMV rate for AC Cov pts was higher than for PHC Cov pts(21% vs. 14%). Rates of IMV for AC Cov pts were highest in low ZMI (27%) and in pts with coag (36%). M by group was: AC Cov 16%;AC WO 1%;PHC Cov 11%;PHC WO 1%. Among AC Cov pts, M was higher for men (19% vs.13%) and pts with PCD (31%), RF (25%), or diabetes (DM, 24%);among PHC Cov pts, M was also higher for men(14% vs. 8%) and pts with coag (30%), valvular disease (27%), or PCD (24%). Increasing age, DM, RF, and PCD were associated with increased risk of M for AC Cov pts in age, race/ethnicity, and comorbidity-adjusted logisticregression;increasing age and coag were associated with M in PHC Cov pts. Conclusion: In this rapid characterization from RWD, pts with Cov have higher rates of pre-existingcardiopulmonary/vascular and renal conditions and increased risk of hospitalization, IMV, and mortality than pts without Cov. Higher Cov risk and worse outcomes in NHB and lower-income pts suggest health care disparities.Whether these outcomes are due to comorbidities or acute sequelae merits further study, as does investigation ofalternative definitions for real-world populations and outcomes.