ABSTRACT
Introduction: Infection with the new coronavirus SARS-CoV-2 leads to the disease COVID-19, the course of which is highly variable and depends on a number of patient-specific risk factors. Tumor patients (pts) are considered to be at risk for a severe course of COVID-19, however represent a heterogenous group with presumably variable risk. The infuence of tumor type, specific cancer treatment modalities and other tumor-specific factors on the outcome of COVID-19 are unknown. Method(s): Pts with proven SARS-CoV-2 infection and established tumor diagnosis are eligible for the multicentric ADHOK coronavirus tumor registry (CoRe). Detailed information about tumor diagnosis and treatment were retrospectively collected. The outcome of the SARS-CoV-2 infection (COVID-19 severity) was graded according to the WHO. Result(s): As of 10 July 2020, 77 pts (54.6% male, 45.4% female) out of 15 german medical institutions were included in the registry. Median age was 71 (range 37-94) years. 49 pts (63.6%) were diagnosed with solid tumors, 28 pts (36.4%) sufered from hematological diseases. Most of the pts registered (59.7%) had active tumor disease, 23% pts were in partial or complete remission. 39 pts (40.3%) were at the time-point of SARS-CoV-2 infection under active tumor treatment, the majority of them (22 pts) were receiving systemic anti-tumor agents. In 55 of the pts (71.4%), the SARS-CoV-2 infection remained either asymptomatic (19 patients), or the course of COVID-19 was mild (20 pts) or moderate (16 pts). In contrast, 22 pts (28.6%) experienced a servere or critical course of the disease, and 14 pts (18.2%) died from the infection. Lethal outcome of COVID-19 was documented in 11 of 49 pts with solid tumors (22.4%) and in 3 of 28 pts (10.7%) with hematological diseases. The mortality of SARS-CoV-2 infection was higher in pts with active tumor disease (10/46 pts, 21.7%) than in those with remission (2/18 pts, 11.1%), but was similar in pts with active tumor treatment (15.5%) versus no active tumor treatment (19.3%). Conclusion(s): The outcome of SARS-CoV-2 infection in pts with tumor diseases is highly variable. In the current registry, a considerable number of asymptomatic and mild infections is documented, suggesting that there may be a group of tumor pts with low risk for complications of COV-ID-19. In contrast, detailed analysis of pts with a severe and lethal course of the disease is required to identify potential factors posing those pts at risk for the infection.
ABSTRACT
Background: Active cancer has been identified as an independent risk factor for severity and mortality in COVID-19. However, direct comparisons of SARS-CoV-2 infected patients (pts) with active and non-active cancers remain scarce. Method(s): We retrospectively analyzed a cohort of pts with cancer with confirmed SARS-CoV-2 infection, enrolled 03/16/2020 - 07/31/2021. Data on demographics, cancer and laboratory findings were collected. Descriptive and subsequent regression analysis was performed. Endpoints were progression to severe COVID-19 and infection-associated mortality. Result(s): In total, 987 pts with cancer (510 active vs 477 non-active) were included in our analysis. Majority was male and > 55 years, with a higher number of elderly pts with non-active cancer. CCI was 4.75 vs 3.85 in pts with active and non-active cancer (p<0.001). Localized solid tumors were reported in 38 vs 79% (p<0.001), metastasized in 37.5 vs 5.5% (p<0.001) and hematological diseases in 37.5 vs 19.5% (p<0.001) pts with active and non-active cancer, respectively. At virus detection, majority of pts showed mild to moderate symptoms, while deterioration to severe COVID-19 was slightly more common in pts with active cancer (19% vs 16%;p=0.284). COVID-19 related mortality was significantly higher in pts with active cancer (24% vs 17.5%, p<0.001). In line, severe cytopenia and an increase of inflammatory markers were common findings in pts with active cancer at baseline, particularly in those who developed severe infection or died. Multivariate analysis revealed that ferritin (14.24 [2.1-96], p=0.006) and CRP (2.85 [1.02-8.02], p=0.046) were associated with severe COVID-19 and infection-related mortality. In pts with non-active cancer, association was seen for ferritin only (4.1 [1.51-11.17], p=0.006). Conclusion(s): Comparing pts with active and non-active cancer, mortality rate was significantly higher in pts with active cancer. Also inflammatory markers were significantly increased assuming higher levels of inflammation may play a role in adverse outcome of COVID-19 in pts with active cancer.
ABSTRACT
INTRODUCTION: Since the early SARS-CoV-2 pandemic, cancer patients have been assumed to be at higher risk for severe COVID-19. Here, we present an analysis of cancer patients from the LEOSS (Lean European Open Survey on SARS-CoV-2 Infected Patients) registry to determine whether cancer patients are at higher risk. PATIENTS AND METHODS: We retrospectively analyzed a cohort of 435 cancer patients and 2636 non-cancer patients with confirmed SARS-CoV-2 infection, enrolled between March 16 and August 31, 2020. Data on socio-demographics, comorbidities, cancer-related features and infection course were collected. Age-, sex- and comorbidity-adjusted analysis was performed. Primary endpoint was COVID-19-related mortality. RESULTS: In total, 435 cancer patients were included in our analysis. Commonest age category was 76-85 years (36.5%), and 40.5% were female. Solid tumors were seen in 59% and lymphoma and leukemia in 17.5% and 11% of patients. Of these, 54% had an active malignancy, and 22% had recently received anti-cancer treatments. At detection of SARS-CoV-2, the majority (62.5%) presented with mild symptoms. Progression to severe COVID-19 was seen in 55% and ICU admission in 27.5%. COVID-19-related mortality rate was 22.5%. Male sex, advanced age, and active malignancy were associated with higher death rates. Comparing cancer and non-cancer patients, age distribution and comorbidity differed significantly, as did mortality (14% vs 22.5%, p value < 0.001). After adjustments for other risk factors, mortality was comparable. CONCLUSION: Comparing cancer and non-cancer patients, outcome of COVID-19 was comparable after adjusting for age, sex, and comorbidity. However, our results emphasize that cancer patients as a group are at higher risk due to advanced age and pre-existing conditions.