Determinants of mortality from SARS-CoV-2 infection in European cancer patients

ABSTRACT

Background: The severity of SARS-CoV-2 infection (COVID-19) is predicted by advancing age and co-morbidities. The relative contribution of cancer in influencing the course of COVID-19 is poorly understood. We designed the OnCOVID study to investigate natural history of COVID-19 disease in cancer patients. Methods: This retrospective, multi-center observational study conducted across 8 tertiary centers in Europe recruited cancer patients aged >/= 18 and diagnosed with COVID-19 between February 26th and April 1st, 2020. Descriptive statistics, univariable and multivariable Cox regression models were used to assess patient’s main characteristics and to evaluate the factors associated to COVID-19 related mortality. Results: We identified 204 patients from United Kingdom (n=97, 48%), Italy (n=56, 27%) and Spain (n=51, 25%). Most patients were male (n=127, 62%) had a diagnosis of solid malignancy (n=184, 91%) and 103 (51%) had non-metastatic disease. Mean (±SD) patient age was 69±13 years, and 161 (79%) had >/= 1 co-morbidity, most commonly hypertension (n=88, 43%) and diabetes (n=46, 23%). Commonest presenting symptoms were fever (n=136, 67%) and cough (n=119, 58%), beginning 3.8 (±4.5 SD) days before diagnosis. Most patients (n=141, 69%) had >/= 1 complication from COVID-19, including respiratory failure (n=128, 63%) and acute respiratory distress syndrome (n=49, 24%). In total, 36 patients (19%) patients were escalated to high-dependency or intensive care. At time of analysis, 59 patients had died (29%), 53 were discharged from hospital (26%) and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged >/= 65 (36% versus 16%), in those with >/= 2 co-morbidities (40% versus 18%) and developing >/= 1 complication from COVID-19 (38% versus 4%, p=0.004). Multi-variable analyses confirmed age >/= 65 and >/= 2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy or anti-cancer therapy. Conclusions: In the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. Risk stratification based on these factors should inform personalized oncological decision making during the COVID-19 pandemic. Legal entity responsible for the study Imperial College London. Funding: Has not received any funding. Disclosure D.J. Pinato Speaker Bureau/Expert testimony, received lecture fees ViiV Healthcare;Speaker Bureau/Expert testimony, received lecture fees Bayer Healthcare;Travel/Accommodation/Expenses BMS;Advisory/Consultancy Mina Therapeutics;EISAI;Roche;Astra Zeneca;Research grant/Funding (institution) MSD;BMS. A. Patriarca Advisory/Consultancy Takeda;Sanofi. G. Gaidano Advisory/Consultancy, Speaker Bureau/Expert testimony Janssen;Abbvie;Advisory/Consultancy AstraZeneca;Sunesys. J. Brunet Advisory/Consultancy MSD;AstraZeneca. J. Tabernero Advisory/Consultancy Array Biopharma;Astra Zeneca;Bayer;Beigene;Boehringer Ingelheim;Chugai;Genentech;GenMab;Halozyme;Inflection Biosciences Limited;Ipsen;Kura;Lilly;MSD;Menarini;Merck Serono;Merrimack;Merus;Molecular Partners;Novartis;Peptomics;Pfizer;Pharmacyclics;Rafael Pharmaceuticals;ProteoDesign SL;F. Hoffmann-La Roche Ltd;Sanofi;Servier;Seagen;Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS and Roche Diagnostics. A. PratHonoraria (self), Advisory/Consultancy Pfeizer;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self) Novartis;Roche;Honoraria (self) MSD Oncology;Lilly;Honoraria (self), Travel/Accommodation/Expenses Daiichi Sankyo;Advisory/Consultancy BMS;Amgen;NanoString Technologies. A. Gennari Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (self) Roche;Eli Lilly;EISAI;Advisory/Consultancy Pierre Fabre;MSD;Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony Daiichi Sankyo;Speaker Bureau/Expert testimony Teva;Gentili;Pfizer;AstraZeneca;Celgene. All other authors have declared no onflicts of interest.