IMPACT OF COVID-19 INFECTION AMONG PATIENTS WITH PRE-EXISTING GASTROINTESTINAL CANCERS IN THE UNITED STATES: A MULTICENTER RESEARCH NETWORK STUDY

ABSTRACT

Background: Patients with underlying malignancy are considered to be at a higher risk of severe illness from COVID-19. However, the data on the COVID-19 related outcomes in patients diagnosed with major gastrointestinal cancers is lacking. We aimed to investigate the patients' characteristics and outcomes of COVID-19 infection in patients with a preexisting diagnosis of GI cancer. Methods: A search query was performed to identify all adult patients (≥ 18 years) diagnosed with COVID-19 between January 15, 2020, and July 15, 2020, on TriNet Database. The search criteria to identify potential COVID-19 patients were based on specific COVID-19 diagnosis codes or positive laboratory confirmation of COVID-19. Patients with COVID-19 and a diagnosis of the malignant esophagus, gastric, pancreatobiliary, hepatocellular, and colorectal cancer ever were included in the GI cancer group. Patients with COVID-19 who never had a diagnosis of GI cancer were included in the control group. The main outcomes were the 30-day risk for mortality, mechanical ventilation, and hospitalization after adjusting for confounding factors with 11 propensity score matching. For each outcome, the risk ratio (RR) with a 95% confidence interval (CI) was calculated to compare the outcomes. Results: A total of 434,375 adult patients from 40 HCO’s diagnosed with major GI cancers were identified in the Research Network. We identified a total of 1043 patients in the cancer group and 111,373 patients in the control group. Baseline demographics are described in the Table. More than half of the patients (53%) had a preexisting diagnosis of colorectal cancer while 19% of the patients had liver & intrahepatic bile duct cancers, and 15% had pancreato-biliary and 13% of patients were diagnosed with esophageal or gastric cancers. In crude analysis, COVID-19 patients with pre-existing GI cancers had a significantly higher risk of hospitalization (RR 2.37, 95% CI 2.19-2.55), mechanical ventilation (RR 2.16, 95% CI 1.69-2.75) and mortality (RR 3.81, 95% 3.14-4.63) compared to the control group. After PSM, the risk of hospitalization (RR 1.25, 95% CI 1.11-1.41) and mortality (RR 1.43, 95% CI 1.06-1.93) was still higher in COVID-19 patients with pre-existing GI cancers. However, mechanical ventilation was not significantly different in the matched groups (RR 1.91, 95% CI 0.84-1.71). Conclusion: Our study found that outcomes in patients with pre-existing GI cancers who had COVID-19 infection were worse in regard to hospitalizations and mortality. This difference persisted even after robust propensity score matching. COVID-19 patients with pre-existing GI cancers should be aggressively managed with close monitoring and can be prioritized for COVID-19 vaccination programs.(table presented) Baseline patient characteristics and 30 day outcomes in patients diagnosed with major GI cancers infected with COVID-19.