Preliminary analysis of factorsassociated with COVID-19-related disease severity incancer patients: University of Kansas Cancer Center experience

ABSTRACT

Background: There is insufficient evidence to support clinical decision-making for oncology patients diagnosed withCOVID-19 due to the limited studies focusing on factors affecting COVID-19-associated disease severity/death incancer patients. Methods: We retrospectively analyzed data from KU Cancer Center to assess demographic/clinical characteristicsand ferritin levels of 40 cancer patients with a confirmed COVID19 diagnosis by viral RNA detection in anasopharyngeal swab between 3/1/20 through 6/9/20. Chi square test and Mann-Whitney U test were used toidentify whether demographic/clinical characteristics and ferritin were associated with COVID-19 severity/death. Results: Median age was 59.5 years, 16 (40%) were aged 65 years or older, and 18 (45%) patients were male. 31(77.5%) were non-Hispanic, 21 (52%) were Caucasians, 11 (27%) were African Americans, and 21 (52.5%) werecurrent/former smokers. 14 (35%) were obese. Breast cancer n=9 (22.5%) was the most prevalent malignancy. 28(70%) had ECOG of 0/1. 27 (67.5%) were on active anticancer treatment, and 13 (32.5%) had active (measurable)cancer. 12 (30%) had recent surgery. 6 (15%) were asymptomatic and 34 (85%) were symptomatic. Fever (47.5%), cough (57.5%), productive cough (50%), and shortness of breath (47.5%) were the most common symptoms. Atanalysis (June 9, 2020), 3 (7.5%) patients had died. 8 (38.1%) had mild/moderate COVID-19 illness and 13 (61.9%)had severe illness (ICU admission, intubation, death). Patients with mild/moderate illness were significantly younger(median age 56.5 years) vs. those with severe illness (median age 67.5 years), p=0.02. Sex, race and ethnicity, obesity, ECOG, cancer type, active cancer treatment, and recent surgery were not associated with COVID-19severity. However, productive cough (p=0.01) and shortness of breath (p=0.006) were associated with COVID-19severity. In 19 patients with available ferritin levels, asymptomatic patients (n=2) had a significantly lower ferritin(median 68.5 NG/ML) vs. symptomatic (n=17), who had higher ferritin (median 422 NG/ML) p=0.04. Conclusions: Age was associated with an increased risk of COVID-19-related disease severity/death in cancerpatients. This may possibly reflect the effects of more advanced malignant disease, anticancer treatment, andcomorbidities on the impact of this infection. Ferritin levels appear to have a role in screening and monitoring forCOVID-19 infection in cancer patients. Hence, our findings warrant validation in a larger cohort. A prospective studyis under way at the University of Kansas Cancer Center to validate the factors associated with COVID-19-relateddisease severity/death in cancer patients.