First-surge COVID-19 experience at a comprehensive cancer center

ABSTRACT

INTRODUCTION: Several reports have associated COVID-19 and cancer patients with poor outcomes. We describe outcomes of COVID-19 cancer patients who required ICU level care. METHODS: A retrospective cohort of cancer patients with COVID-19 admitted to a comprehensive cancer center,between March and May 2020.All patients had positive RT-PCR for SARS-CoV-2.Demographics, clinical, and outcome data were recorded.All patients were admitted to a designated COVID unit.Patients who required >6L O2, HFNC or invasive mechanical ventilation were considered ICU level.Continuous data is presented as median. RESULTS: A total of 37 patients were included.The median age was 62 (54-72) years,65% of them were female, 41% African American, and the median BMI was 30.The majority (54%) had solid tumors;with 55% had metastatic disease. Hematological malignancy were 17 (46%);of them, 47% had active disease, 41% had relapsed malignancy, and 12% were in remission;stem cell transplants receipents 7, (71% were autologous). The most common comorbidities were hypertension (63%), Diabetes mellitus (37%), hyperlipidemia (31%), obstructive sleep apnea (23%), and chronic kidney disease (20%). Majority (81%) had a performance status score of 0-1. The most common symptoms were fever (74%), dyspnea (51%), and cough (48%). 48% patients were neutropenic, and 73% had undergone cancer treatment within 90 days of admission.Total of 54% of patients were mild-moderate,14% severe,and 32% critical.Interventions received57% hydroxychloroquine,51% azithromycin,8% remdesivir,16% convalescent plasma,22% statins,38% vitamin C,30% zinc,43% tocilizumab,11% anakinra,43% aspirin,78% heparin, 40% steroids, and 16 awake patients did self-proning.From this cohort,15 patients required ICU level care;with 3 of them transitioning to palliative care.Of the remaining 12 were ICU patients;67% required HFNC, and 33% IMV with a median 10 ventilator days.Complication wise,83% of them developed shock and required 3 days on vasopressor therapy.All ventilated patients survived, one patient on HFNC developed a sudden fatal pulmonary embolism. Overall hospital and 28-day mortality was 8%. CONCLUSIONS: In our cohort, the mortality rate of critically ill cancer patients with COVID-19 was lower than reported. This early finding should be interpreted with caution.