Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study
1. Patients with haematological malignancies had poorer prognoses than patients with solid tumours, and administration of chemotherapy within 4 weeks of symptom onset was associated with higher case fatality rate.
Evidence Rating: 2 (Good)
Although patients with cancer have been identified as an a vulnerable population during the COVID-19 pandemic, due to illness, immunosuppressive therapy, poor nutrition, and treatment related side effects, the clinical characteristics and prognostic factors of these patients were not well characterized. Researchers attempted to address this knowledge gap in a retrospective multicentre cohort study, analyzing the data of 205 patients with a pathological diagnosis of a malignant tumour and laboratory confirmed SARS-CoV-2. Patients were followed up for a mean duration of 68 days, and by the end of the 78 day study period, all patients had either died or been discharged from the hospital. Severe pneumonia occurred in 52 (25%) patients and the in-hospital case-fatality rate in patients with COVID-19 and cancer was 20%, which was considerably higher than previously reported national fatality rate of 1%. Patients with haematological malignancies had significantly poorer prognoses than did those with solid tumours, with 9 of 22 patients (41%) having passed away versus 31 of 183 (hazard ratio for death 3·28 [95% CI 1·56–6·91]; log rank p=0·0009). Interestingly, analysis had also shown receiving chemotherapy within 4 weeks before symptom onset (odds ratio [OR] 3·51 [95% CI 1·16–10·59]; p=0·026) and male sex (OR 3·86 [95% CI 1·57–9·50]; p=0·0033) as significant risk factors for death during hospital stay. No major distinctions in clinical presentation were noted, with fever being the most common symptom, followed by cough, fatigue, and shortness of breath. Although results were not directly compared to a matched control group, the study makes a considerable effort to characterize COVID-19 in cancer patients and demonstrates a significant case mortality rate in this patient population. Haematological malignancies, male sex, and recent chemotherapy appear to be associated with higher mortality rates, and may be used as tools to help clinicians risk stratify early in the clinical setting.
Click here to read the study in The Lancet
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