COVID-19 Mortality in Cancer Patients: A Report from a Tertiary Cancer Centre in India (preprint)

ABSTRACT

BackgroundCancer patients, especially those receiving cytotoxic therapy are assumed to have a higher probability of death from COVID-19. We have conducted this study to identify the Case Fatality Rate (CFR) in cancer patients with COVID-19 and have explored the relationship of various clinical factors to mortality in our patient cohort. MethodsAll active cancer cases presented to the hospital from 8th June to 24 August 2020, and developed symptoms/ radiological features suspicious of COVID-19 were tested by Real-time polymerase chain reaction assay and/or cartridge-based nucleic acid amplification test from a combination of naso-oropharyngeal swab for SARS-CoV-2. Clinical data, treatment details, and outcomes were assessed from the medical records. ResultsOf the total 3101 cancer patients admitted to the hospital, 1088 patients were tested and 186 patients were positive for SARS-CoV-2. The CFR in the cohort was 27/186 (14.5%). Univariate analysis showed that the risk of death was significantly associated with the presence of comorbidities [OR 2.68; (95%CI 1.13-6.32); P = 0.02], multiple comorbidities [OR 3.01; (95%CI 1.02-9.07); P = 0.046 for multiple vs. single], and the severity of COVID-19 presentation [OR 27.48; (95%CI 5.34-141.49); P = 0.0001 for severe vs. not severe]. Among all comorbidities, diabetes [OR 3.3; (95%CI 1.35-8.09); P = 0.008] and cardiovascular diseases [OR 3.77; (95%CI 1.02-13.91); P = 0.045] were significant risk factors for death. The receipt of anticancer treatments including chemotherapy, surgery, radiotherapy, targeted therapy, and immunotherapy within a month before the onset of COVID-19 symptoms had no significant effect on the mortality of cancer patients. ConclusionTo the best of our knowledge, this is the first study from India reporting the CFR, clinical associations, and risk factors for mortality in SARS-CoV-2 infected cancer patients. Our study shows that the frequency of COVID-19 in cancer patients is high, and the CFR is 7.6 times more than the national average. Anticancer therapies did not increase the risk of death. Pre-existing comorbidities specially diabetes, multiple comorbidities, and severity of COVID-19 presenting symptoms are significantly linked with COVID-19 related death in the cohort.