High mortality among hospital-acquiredCOVID-19 infection in patients with cancer: Anobservational cohort study from Quebec and British Columbia

ABSTRACT

Background: Studies suggest that patients with cancer are more likely to experience severe outcomes fromCOVID-19. Therefore, cancer centers have undertaken efforts to care for patients with cancer in COVID-free zones.Nevertheless, nosocomial transmission of COVID-19 in patients with cancer likely occurs, but the frequency andrelevance of these events remain unknown. The goal of this study was to determine the incidence and impact ofhospital-acquired COVID-19 in this population and identify prognostic factors for COVID-19 severity in patients withcancer. Methods: Patients with cancer and a laboratory-confirmed or presumed diagnosis of COVID-19 were prospectivelyidentified using provincial registries and hospital databases between March 3rd and May 23rd, 2020, in theprovinces of Quebec and British Columbia. Patients' baseline characteristics including age, sex, comorbidities, cancer type, and type of anticancer treatment were collected. The primary outcome was incidence of hospital-acquired infection defined by diagnosis of SARS-CoV-2 5 days after hospital admission for COVID-unrelated cause. Co-primary outcomes were death or composite outcomes of severe illness from COVID-19 such as hospitalization, supplemental oxygen, intensive-care unit (ICU) admission, and/or mechanical ventilation. Results: A total of 253 patients (N=250 adult and N=3 pediatric) with COVID-19 and cancer were identified, and themajority were residents of Quebec (N=236). Ninety patients (35.6%) received active anticancer treatment in the last3 months prior to COVID-19 diagnosis. During a median follow-up of 23 days, 209 (82.6%) required hospitalization,38 (15%) required admission to ICU, and 71 (28%) died. Forty-seven (19%) had a diagnosis of hospital-acquiredCOVID-19. Median overall survival was shorter in those with hospital-acquired infection, compared to acontemporary community-acquired population (27 days vs. 71 days, HR 2.2, 95% CI 1.2-4.0, p=0.002). Multivariateanalysis demonstrated that hospital-acquired COVID-19, age, ECOG status, and advanced stage of cancer wereindependently associated with death. Conclusion: Our study demonstrates a high rate of nosocomial transmission of COVID-19, associated withincreased mortality in both univariate and multivariate analysis in the cancer population, reinforcing the importanceof treating patients with cancer in COVID-free zones. We also validated that age, poor ECOG, and advanced cancer were negative prognostic factors for COVID-19 in patients with cancer.