Impact of cancer history on outcomesamong hospitalized COVID-19 patients: A case-controlanalysis

ABSTRACT

Background: Early reports suggest a possible increased risk of serious complications and death in COVID-19patients with cancer. However, rigorous comparisons with non-cancer control patients with COVID-19 are lacking. Methods: We systematically identified all patients with a history of cancer admitted to two major academic medicalcenters in Boston with symptomatic COVID-19 infections between 03/13/2020 and 05/10/2020. 162 cases wereidentified, and matched 12 by age, gender, race, and admission date with systematically identified controls withouta cancer history. Sociodemographics, comorbidities, presenting symptoms, hospital course, and COVID-19outcomes were extracted from medical records for all patients. Cancer history and treatments were documented forcases. Clinical characteristics and outcomes were compared between cases and controls using conditional logisticregression. Among cancer patients, logistic regression models were fit to identify predictors of death/discharge tohospice. Results: As of 06/05/2020, among 162 cancer patients (median time since diagnosis, 35.6 [range 0.39-435]months;80% with solid tumor, 20%, hematologic diagnosis), 27.8% died or were discharged to hospice and 4.3%were still hospitalized. Among the 324 controls, 25.6% died or were discharged to hospice, and 3.1% were stillhospitalized. Median duration of hospitalization was 9 days for both cases and controls. The proportion of controlswho were intubated (36.1%) was higher than cases (27.2%). The odds of mortality/discharge to hospice (vs.discharge to home/facility) were similar between cancer cases and matched controls (univariable OR 1.15, 95% CI0.73-1.82;multivariable OR 1.54, 95% CI 0.90-2.65). In multivariable analyses, cancer patients were more likely tobe immunosuppressed (OR 4.21, 95% CI 2.42-7.34), to have presented at hospital admission with fatigue (OR1.71, 95% CI 1.05-2.78), and were less likely to have a premorbid neurologic condition (OR 0.37, 95% CI 0.16-0.82). Among cancer cases, patients with metastatic disease or who had received cancer-directed therapy in thelast 6 months (n=74, 46%) did not have higher odds of death/discharge to hospice following their hospital course(univariable OR 1.37, 95% CI 0.68-2.75;multivariable OR 1.77, 95% CI 0.80-3.93) compared to patients with noevidence of disease and no treatment within 6 months. Conclusions: Patients with a history of cancer hospitalized for COVID-19 had similar hospital course and mortalityto matched hospitalized COVID-19+ controls without cancer. Additionally, we did not find an association betweenhaving metastatic disease or recent cancer treatment and experiencing an adverse outcome. During the onset andsurge peak of the COVID-19 crisis in Boston, people with a history of cancer admitted to two large teachinghospitals for COVID-19 infection fared no worse than those without a history of cancer.