ABSTRACT
Background: Since the beginning of the COVID19 outbreak, the Veneto Oncology Network ROV licensed dedicated guidelines for cancer patients care during the pandemic, and developed a regional registry (ROVID) aimed at describing epidemiology and clinical course of SARS-CoV-2 infection in cancer patients. Preliminary data on 170 patients mainly diagnosed during the first pandemic wave have been published (Guarneri V, Eur J Cancer 2021). Here we report the data of additional 270 patients, comparing clinical data and outcomes between first (W1) and second (W2) pandemic waves. Methods: All patients with cancer diagnosis and documented SARS-CoV-2 infection are eligible. Data on diagnosis, comorbidities, anticancer treatments, details on SARS-CoV-infection including source of contagion, clinical presentation, hospitalization, treatments and fate of the infection are recorded. Results: 440 patients have been enrolled, 196 diagnosed during W1 (until September 2020) and 244 during W2. The most common cancer type was breast cancer (n = 116). Significant differences in clinical characteristics between W1 and W2 were the followings: ECOG PS 0 (34% vs 58%), presence of cardiac comorbidities (30% vs 13%), presence of any co-morbidities (81% vs 62%), smoking habits (23% vs 13%). Patients diagnosed in W1 were less likely on active anticancer therapy (54% vs 73%) at the time of SARS-CoV-2 infection. Distribution per stage, presence of lung metastases, disease setting (curative vs palliative), active treatment discontinuation due to infection were similar between W1 and W2. Patients diagnosed in W1 were more likely symptomatic for SARS-CoV-2 infection (80% vs 67%), and reported more frequently an inhospital contact as potential source of infection (44% vs 9%). Significantly more patients diagnosed in W1 were hospitalized (76% vs 25%). All-cause mortality rates were 30.6% for patients diagnosed in W1 vs 12% for patients diagnosed in W2 (p < 0.001). However, deaths due to SARS-CoV-2 infection were more frequent in patients diagnosed in W2 (86% vs 54%, odds ratio 3.22;95% CI 1.97-5.279). Conclusions: Differences in clinical characteristics between W1 and W2 reflect different pattern of virus circulation. The dramatic reduction of in-hospital contact as a source of infection reflects the efforts put in place to protect this vulnerable population from in-hospital exposure. The lower all-cause mortality rate observed in W2 is in line with the observed less frail population. However, the higher relative risk of death due to SARS-CoV-2 infection observed in W2 reinforces the need to adopt protective measures including vaccination in cancer patients, irrespectively of age, stage, and comorbidities.
ABSTRACT
Background: COVID-19 pandemic started in Italy with clusters identified in Northern Italy. Since the beginning, the Veneto region started a proactive approach, including testing for SARS-CoV-2 part of the asymptomatic population and healthcare providers. The Veneto Oncology Network ROV licensed a dedicated PDTA to ensure proper care minimizing the risk of infection in cancer patient (pts). At the same time, a regional registry (ROVID) has been set up, to describe epidemiology and clinical course of SARS-CoV-2 infection in cancer pts. Materials and methods: All pts with cancer diagnosis and documented SARS-CoV-2 infection are eligible. The following information are recorded: age, cancer diagnosis, stage, tumor biology, comorbidities, presence of COVID- 19 symptoms, anticancer treatment at the time infection (type, aim, line of therapy, discontinuation, recovery), other medical treatments, hospitalization, treatments for SARS-CoV-2 infection, fate of the infection. Results: 144 pts from 18 centers have been enrolled. Mean age at the time infection: 69 yrs (25 to 95 yrs). The 5 most common cancer types were breast cancer (n=26), colorectal, prostate, lung cancer (n=16 each), melanoma (n=10). Distribution by stage was as follows: I 19%, II 9%, III 13%, IV 59%. Lung metastases were documented in 15% of the cases. 77% of the pts had at least one comorbidity. COVID-19 symptoms were reported in 78% of the pts. Active anticancer therapy at the time of the infection was reported for 71 pts (chemotherapy n=37, targeted therapy n=14, hormonal therapy n=13, immunotherapy n=6). Treatment was discontinued because of infection in 44 case. 101 pts were hospitalized;45 received low flow oxygen support and 26 received non-invasive mechanical ventilation, high flow nasal cannula or endotracheal intubation. The fate of infection is available for 95 cases so far: 44 infection resolution with confirmed negative swab, 16 with clinical resolution discharged with positive swab, and 35 deaths. Among cases with fatal exitus, 22 were attributable to COVID-19. Conclusions: Data collection is still ongoing, including further follow up and results of serological tests, where available. The mortality rate reported in this study is in line with other registry of cancer patients, confirming the frailty of this population. These data reinforce the need to protect cancer patients from SARS-CoV2 infection.