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Background: Previous reports indicate that lung cancer patients are at an increased risk of severe COVID-19 disease and higher mortality rate compared to general population. However, prognostic factors are not yet clearly identified. The LunG canceR pAtients coVid19 Disease (GRAVID) study aimed to describe clinical characteristics, outcomes and predictors of poor prognosis in patients with lung cancer and COVID-19. Methods: In this large nationwide prospective study, medical records of lung cancer patients with COVID-19 diagnosis from 65 spanish hospitals were included. Clinical features, treatments and disease outcomes were collected. The primary endpoint was to determine any-cause mortality;secondary endpoints were hospitalization and admission at intensive care units (ICU). Risk factors of poor prognosis were identified by univariable and multivariable logistic regression models. Results: Overal, 447 patients were analysed. Mean age was 67.1 ± 9.8 years, and the majority were men (332, 74.3%) and current/former smokers (383 (85.7%). NSCLC was the most frequent cancer type (377, 84.5%), being adenocarcinoma (228, 51.0%) the predominant histology. 354 patients (79.2%) had unresectable stage III or metastatic disease, and 266 (59.5%) where receiving anticancer treatment, mostly first-line chemotherapy. 350 (78.3%) patients were hospitalized for a mean of 13.4 ± 11.4 days, 9 (2.0%) patients were admitted to ICU, and 146 (32.7%) patients died. Advanced disease and corticosteroid treatment at hospitalization were predictors of mortality. Non-terminal stage hospitalized patients with lymphocytopenia and high LDH showed an increased risk of death. Severity of COVID-19 correlated to mortality, admission at ICU and mechanical ventilation. Conclusion: With underlying comorbidities and immunocompromised status, patients with lung cancer and COVID-19 present high hospitalization and mortality rates. These outcomes, alongside the identification of prognostic factors, may inform physicians on risks and benefits for this population to provide individualized oncological care.
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Background : Cancer patients are at increased risk of thrombosis due to multiple factors. Millions of cases of SARS-CoV-2 infection have been detected worldwide and there is multiple evidence of its association with arterial and venous thrombosis.At present, we do not know if Covid-19 adds an increased thrombotic risk to cancer patients. Aims : The aim of our study is to analyze the incidence and risk factors of thrombosis in oncological patients with Covid-19. Methods : We retrospectively reviewed 86 patients with active cancer and Covid-19 admitted to the general ward oh the Hospital Infanta Leonor (Madrid) between March 5th, 2020 to May 3th, 2020. Study data were collected and managed using REDCap electronic data capture tool. Results : We diagnosed 10 thrombotic events in 8 oncological patients with a cumulative incidence of 9.3%. A statistically significant association were found regarding thrombosis and history of obesity ( P = 0.009). Atrend towards significance were detected regarding a previous history of chronic kidney disease¡ were we detected 2 patients in the thrombosis cohort (25%) versus only 6 patients of the 78 (7.6%) without thrombosis ( P = 0.108). No statistically significant differences were found in tumor stage, history of hypertension, acute coronary sindrome, heart disease, history of chronic obstructive pulmonary disease, diabetes, dyslipemia and smoking. Conclusions : In patients with covid-19 and cancer, a statistically significant difference was found for the history of obesity being a classic factor predictor of the development of thrombotic events in our patients. The prothrombotic effect of Covid-19 infection does not seem to be as evident in cancer patients, probably due to the high mortality in this population group before developing thrombosis. More studies are needed to assess the impact of covid 19 in this population.
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Background: During the first year of the SARS-CoV-2 pandemic the management and treatment of COVID-19 have been improved. However, cancer patients continue to be one of the most affected. We evaluate the mortality rate due to COVID-19 and associated risk factors in the cancer population diagnosed in our center during the first year of pandemic. Methods: We retrospectively reviewed the medical records of 189 cancer patients who were diagnosed with COVID-19 between March 5, 2020 and February 28, 2021. Mortality rate nd associated risk factors were studied. Results: Mortality rate: 55/189 patients. Mean age: 72 years (34-95), 125/189 male patients. Predominant histologies: lung cancer (72/189), colorectal (31/189), breast (24/189). Predominant staging: metastatic disease (113/189). Predominant cancer treatment: chemotherapy (63/189);118/189 patients were receiving any type of oncological treatment with palliative intention. Mortality was associated with male gender (45/55 vs 10/55, p=0.004), presence of comorbidities (48/55 vs 7/55, p=0.01), lung cancer (28/72 deaths with this tumor vs 27/117 with the rest, p=0.02), palliative intention cancer treatment (41/55 vs 12/55, p=0.02), older median age (76 vs 71, p = 0.02), higher median CRP (p=115.6 mg/dl vs 46 mg/dl), lower median lymphocytes (600/mm3 vs 1000/mm3 p<0.001). No specific treatment against COVID-19 significantly decreased mortality. Neither IL-6 nor ferritin were prognostic biomarkers. In multivariate analysis, male gender (OR 2.58, 95% CI 1.1-5.9, p = 0.02), lung cancer (OR 2.0, CI 1.0-3.8, p = 0.03), cancer treatment with palliative intention (OR 2.4, CI 1.07-5.3, p = 0.03), higher median CRP (OR 1.0, CI 1.00-1.01, p <0.001), as well as low lymphocyte median (OR 0.5, CI 0.25-1.0, p = 0.56), continued to be evidenced as risk factors, regardless of comorbidities, staging, sex, and palliative intention cancer-specific treatment, among other variables. Conclusions: Men with lung cancer under cancer-specific treatment with palliative intention who present, at the diagnosis of SARS-CoV-2 infection with elevated CRP above 115 mg/dl and a decrease in lymphocytes below 600/mm3 have a higher risk of presenting fatal complications. Legal entity responsible for the study: Medical Oncology department, Hospital Universitario Infanta Leonor. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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Background: Cancer patients are one of the most affected by the current pandemic caused by SARS-CoV-2. Social inequalities influence the incidence rate of this disease, as we have seen in the high incidence in our center. In our study, we asked whether the last covid-19 treatment advances, the capacity for restructuring the health centers and their non-saturation, influences the cancer patients outcomes. Methods: Retrospective review of 189 cancer patients diagnosed in our center with COVID-19 from March 5, 2020 to February 28, 2021. Study data was collected and managed using REDCap. We compared COVID-19 diagnoses in first-wave cancer patients versus the full pandemic period until data cut-off, as well as patient characteristics and mortality rates. Results: Mortality rate: 55/189 patients during the entire pandemic period vs 40/85 patients in the first wave (p = 0.03). Median age: 72 years (34-95) vs 76 (34-94), 125/189 men in all the period vs 50/85 (p = 0.2). Most frequent histologies: lung cancer (72/189 vs 22/85, p = 0.07), colorectal (31/189 vs 19/85, p = 0.23), breast (24/189 vs 10/85, p = 0.82). Staging: 113/189 metastatic disease at diagnosis of infection vs 32/85 in first wave (p <0.001). During the 2 subsequent waves in our center, where 104 more patients have been detected, mortality has dropped significantly: from the initial 47% to 14.4% in the rest of the period (40/85 vs 15/104, p <0.001), despite having more metastatic involvement in infected patients. Conclusions: In our center, one of the worst hit by the coronavirus crisis in Spain, with a supersaturation of almost 250% in the middle of the first wave, we have verified how the knowledge of the behavior of this disease, improvements in its treatment and a multidisciplinary management in Oncology ward have led to a significant decrease in mortality, going from almost 50% in the first wave to less than 15%, despite having suffered the disease during the two subsequent waves a greater number of patients with metastatic disease. Legal entity responsible for the study: Medical Oncology Department, Hospital Universitario Infanta Leonor. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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Background: Patients with cancer may be more susceptible to infection and at increased risk of more severe COVID-19 disease;however, prognostic factors are not yet clearly identified. The LunG canceR pAtients coVid19 Disease (GRAVID) study aimed to describe clinical characteristics, outcomes, and predictors of poor outcome in patients with lung cancer and COVID-19. Methods: In this large nationwide study, we reviewed medical records of patients with lung cancer and confirmed COVID-19 diagnosis from 65 Spanish hospitals. Clinical features, treatments and disease outcomes were collected. The primary endpoint was to determine all-cause mortality;secondary endpoints were hospitalization and admission to intensive care units (ICU). Risk factors for poor prognosis were identified by univariate and multivariate logistic regression models. Results: Overall, 447 patients were included for analysis. Mean age was 67 1 ± 9 8 years;332 (74 3%) were men, and 383 (85 7%) current/former smokers. NSCLC was the most frequent type of cancer (377, 84 5%), consisting mainly of adenocarcinoma (228, 51 0%), and stage III metastatic or unresectable disease (354, 79 2%). Two-hundred and sixty-six (59 5%) patients were receiving anticancer treatment, mostly first-line chemotherapy. In total, 350 (78 3%) patients were hospitalized for a mean of 13 4 ± 11 4 days, nine (2 0%) patients were admitted to the ICU, and 146 (32 7%) died. Advanced disease and the use of corticosteroids to treat COVID-19 during hospitalization were predictors of mortality. Hospitalized, non-endof-life stage patients with lymphocytopenia and high LDH had an increased risk of death. Severity of COVID-19 correlated to higher mortality, ICU admission, and mechanical ventilation rates. Conclusions: Due to their underlying comorbidities and immunocompromised status, patients with lung cancer and COVID-19 show high hospitalization and mortality rates. These outcomes, alongside the identification of prognostic factors, may inform physicians on the risks and benefits in this population, in order to provide individualized oncological care.
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Background: Covid-19 has been shown to present more complications in immunosuppressed patients. Wedetermine whether differences exist in Covid-19-related mortality between cancer patients and general population inour hospital, and we also describe associated risk factors. Methods: We reviewed 2,216 medical records of all patients admitted to hospitalization in Infanta Leonor UniversityHospital in Madrid, Spain, with Covid-19 diagnosis between 5 March and 13 May, 2020. Study data were collectedand managed using REDCap electronic data capture tools. We described Covid-19 cumulative incidence in cancerpatients, treatment outcome, mortality, and associated risk factors. Results: We detected 85/2,216 cancer patients between all Covid-19 diagnoses. Mortality rate: 40/85 cancerpatients vs. 260/2,131 in general ward (p<0.001). Median age: 76 years old (34-94), 50/85 male patients. Mostfrequent histologies were lung cancer (22/85), colorectal cancer (19/85), prostate cancer (15/85), and breast cancer(10/85). Most frequent staging was metastatic disease (32/85). Only 2/85 patients were admitted to ICU. Mortality was associated with older median age (79.5 vs. 73, p=0.03), high d dimer levels (1630 vs. 830, p=0.03), high LDHlevels (315.5 vs. 224, p=0.003), bilateral pneumonia (24/42 vs. 5/22 with unilateral pneumonia, p=0.02), ARDS(12/13 vs. 28/72 without ARDS, p<0.0001), and metastatic disease (20/32 metastatic vs. 20/53 non-metastaticpatients, p=0.02). Differences were maintained in multivariate analyses regarding ARDS (OR 23.7, p=0.007) andmetastatic disease (OR 2.5, p=0.05). Conclusions: Covid-19 had a significant mortality in cancer patients. High D dimer and LDH levels and ARDSdevelopment in elderly metastatic patients carry an elevated risk of death in cancer patients diagnosed with Covid-19. However, only 2/85 patients were admitted to ICU and these data were decisive. It is a priority to createmeasures to avoid Covid-19 transmission in oncologic patients.
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Background: Currently we still have limited information on how COVID-19 infection has affected lung cancer patients. In our study, we analysed whether there are differences in terms of mortality from COVID-19 between patients diagnosed with lung cancer and the overall population within our hospital health area (320,000 people). We have also studied the most frequent characteristics of lung cancer patients who develop infection with COVID-19, and we have analysed possible factors of poor prognosis, as well as treatment outcome. Methods: We performed a retrospective review of a total of 2216 patients admitted to Hospital Universitario Infanta Leonor in Madrid between March 5 and May 13, 2020 to identify the cumulative incidence of COVID-19 in patients with lung cancer and make a description of the characteristics of these patients, treatment outcome, risk factors for poor prognosis and mortality. We performed uni and multivariate logistic regression. Results: 22/2216 of the total number of patients diagnosed with COVID-19 in our hospital had lung cancer (0.99%). 12/22 lung cancer patients with a COVID-19 diagnosis died (54.5%) vs 300/2216 COVID-19 patients in our hospital (p<0.0001). Lung cancer patients who died had a median age of 72 years (range of 49-84 years). Infection with COVID-19 in lung cancer patients was more frequent in men (72.73%). 18/22 (81.81%) had locally advanced or metastatic tumours. We observed a trend towards higher mortality among patients with hypertension than among non-hypertensive patients (10/15 vs 2/7;P=0.095). We found higher mortality among patients who developed acute respiratory distress syndrome (ARDS) than among those who did not (4/4 vs 8/12;P=0.044). There seems to be a trend towards lower mortality among patients who received treatment with the combination of hydroxychloroquine and azithromycin than among those who did not (6/14 vs 6/8;P=0.145). Conclusions: Lung cancer patients who became infected with COVID-19 have higher mortality than the general population. It is more frequent among men and the development of ARDS results in a worse prognosis with higher mortality. Although treatment with azithromycin and hydroxychloroquine appears to be a good treatment option, we must wait until we have more data on the safety of the combination and results in larger patient series. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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Background: There are no large reported series determining the outcome of cancer patients with COVID-19. We aimed to determine whether differences exist in COVID-19 related mortality between cancer patients and the general population in our hospital, and we also describe associated risk factors. Methods: We reviewed 2216 medical records of all patients admitted to hospital with COVID-19 diagnosis between 5 March and 13 May 2020. Study data were collected using REDCap electronic data capture tools. We described COVID-19 cumulative incidence in cancer patients, treatment outcome, mortality and associated risk factors. Results: We detected 85/2216 cancer patients in all COVID-19 diagnoses. Mortality rate: 40/85 cancer patients vs 260/2131 patients in the general ward (P<0.001). Median age: 76 years old (34-94), 50/85 male patients. Most frequent histologies: lung cancer (22/85), colorectal cancer (19/85) and prostate cancer (15/85). Most frequent staging: metastatic disease (32/85). Only 2/85 patients were admitted to ICU. Mortality was associated with older median age (79.5 vs 73, P=0.03), high d dimer levels (1630 vs 830, P=0.03), high LDH levels (315.5 vs 224, P=0.003), bilateral pneumonia (24/42 vs 5/22 with unilateral pneumonia, P=0.02), acute respiratory distress syndrome (ARDS) (12/13 vs 28/72 without ARDS, P<0.0001) and metastatic disease (20/32 metastatic vs 20/53 non-metastatic, P=0.02). Differences were maintained in multivariate analyses regarding ARDS (OR 23.7, P=0.007) and metastatic disease (OR 2.5, P=0.05). Combined treatment with hydroxychloroquine and azithromycin showed a better outcome in uni and multivariate analyses with only 21/61 dead patients (OR 0.13, P=0.005), adjusted by sex, histology, staging, ARDS and comorbidities. Conclusions: COVID-19 had significant mortality in cancer patients. High D dimer and LDH levels and ARDS development in elderly metastatic patients carry an elevated risk of death in cancer patients diagnosed with COVID-19. However, only 2/85 patients were admitted to ICU and this data was decisive. Combined hydroxychloroquine and azithromycin could be a good treatment option in COVID-19 cancer patients. It is a priority to create measures to avoid COVID-19 transmission in oncological patients. Legal entity responsible for the study: Medical Oncology Department, HU Infanta Leonor. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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BACKGROUND: There are no large reported series determining the Covid-19 cancer patient's characteristics. We determine whether differences exist in cumulative incidence and mortality of Covid-19 infection between cancer patients and general population in Madrid. MATERIAL AND METHODS: We reviewed 1069 medical records of all cancer patients admitted at Oncology department between Feb 1 and April 7, 2020. We described Covid-19 cumulative incidence, treatment outcome, mortality, and associated risk factors. RESULTS: We detected 45/1069 Covid-19 diagnoses in cancer patients vs 42,450/6,662,000 in total population (p < 0.00001). Mortality rate: 19/45 cancer patients vs 5586/42,450 (p = 0.0001). Mortality was associated with older median age, adjusted by staging and histology (74 vs 63.5 years old, OR 1.06, p = 0.03). Patients who combined hydroxychloroquine and azithromycin presented 3/18 deaths, regardless of age, staging, histology, cancer treatment and comorbidities (OR 0.02, p = 0.03). CONCLUSION: Cancer patients are vulnerable to Covid-19 with an increase in complications. Combined hydroxychloroquine and azithromycin is presented as a good treatment option.