Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
Nicole M Kuderer, MD Toni K Choueiri, Dimpy P Shah, PhD Yu Shyr, MD Samuel M Rubinstein, Donna R Rivera, Sanjay Shete, Chih-Yuan Hsu, MD Aakash Desai, Gilberto De Lima Lopes, MD Petros Grivas, Corrie A Painter, Solange Peters, Michael A Thompson, MD Ziad Bakouny, MD Gerald Batist, Tanios Bekaii-Saab, MD Mehmet A Bilen, Nathaniel Bouganim, MD Mateo Bover Larroya, Daniel Castellano, Salvatore A Del Prete, MD, M D Galsky Deborah B Doroshow, MD Pamela C Egan, Arielle Elkrief, MD Dimitrios Farmakiotis, MD Daniel Flora, Matthew D Galsky, MD Michael J Glover, Elizabeth A Griffiths, MD Anthony P Gulati, MD Shilpa Gupta, Navid Hafez, MD Thorvardur R Halfdanarson, Jessica E Hawley, MD Emily Hsu, MD Anup Kasi, MD Ali R Khaki, MD Christopher A Lemmon, Colleen Lewis, MS Barbara Logan, Tyler Masters, MD Rana R Mckay, MD Ruben A Mesa, MD Alicia K Morgans, MD Mary F Mulcahy, Orestis A Panagiotou, MD Prakash Peddi, Nathan A Pennell, MD Kerry Reynolds, MD Lane R Rosen, MD Rachel Rosovsky, Mary Salazar, MD, J Steinharter MS Andrew Schmidt, Sumit A Shah, MD Justin A Shaya, John Steinharter, MD Keith E Stockerl-Goldstein, Suki Subbiah, Donald C Vinh, Firas H Wehbe, MD Lisa B Weissmann, Julie Tsu-Yu Wu, MD Elizabeth Wulff-Burchfield, MD Zhuoer Xie, Albert Yeh, MD Peter P Yu, Alice Y Zhou, MD Leyre Zubiri, PhD, B I Rini Sanjay Mishra, MD Gary H Lyman, Brian I Rini, MD Jeremy L Warner, Maheen Abidi, Jared D Acoba, Neeraj Agarwal, Syed Ahmad, Archana Ajmera, Jessica Altman, Anne H Angevine, Nilo Azad, Michael H Bar, Aditya Bardia, Jill Barnholtz-Sloan, Briana Barrow, Babar Bashir, Rimma Belenkaya, Stephanie Berg, Eric H Bernicker, Christine Bestvina, Rohit Bishnoi, Genevieve Boland, Mark Bonnen, Gabrielle Bouchard, Daniel W Bowles, Fiona Busser, Angelo Cabal, Paolo Caimi, Theresa Carducci, Carla Casulo, James L Chen, Jessica M Clement, David Chism, Erin Cook, Catherine Curran, Ahmad Daher, Mark Dailey, Saurabh Dahiya, John Deeken, George D Demetri, Sandy Dilullo, Narjust Duma, Rawad Elias, Bryan Faller, Leslie A Fecher, Lawrence E Feldman, Christopher R Friese, Paul Fu, Julie Fu, Andy Futreal, Justin Gainor, Jorge Garcia, David M Gill, Erin A Gillaspie, Antonio Giordano, (mary) Grace Glace, Axel Grothey, Shuchi Gulati, Michael Gurley, Balazs Halmos, Roy Herbst, Dawn Hershman, Kent Hoskins, Rohit K Jain, Salma Jabbour, Alokkumar Jha, Douglas B Johnson, Monika Joshi, Kaitlin Kelleher, Jordan Kharofa, Hina Khan, Jeanna Knoble, Vadim S Koshkin, Amit A Kulkarni, Philip E Lammers, John C Leighton, Mark A Lewis, Xuanyi Li, Ang Li, K M Steve Lo, Arturo Loaiza-Bonilla, Patricia Lorusso, Clarke A Low, Maryam B Lustberg, Daruka Mahadevan, Abdul-Hai Mansoor, Michelle Marcum, Merry Jennifer Markham, Catherine Handy Marshall, Sandeep H Mashru, Sara Matar, Christopher Mcnair, Shannon Mcweeney, Janice M Mehnert, Alvaro Menendez, Harry Menon, Marcus Messmer, Ryan Monahan, Sarah Mushtaq, Gayathri Nagaraj, Sarah Nagle, Jarushka Naidoo, John M Nakayama, Vikram Narayan, Heather H Nelson, Eneida R Nemecek, Ryan Nguyen, Pier Vitale Nuzzo, Paul E Oberstein, Adam J Olszewski, Susie Owenby, Mary M Pasquinelli, John Philip, Sabitha Prabhakaran, Matthew Puc, Amelie Ramirez, Joerg Rathmann, Sanjay G Revankar, Young Soo Rho, Terence D Rhodes, Robert L Rice, Gregory J Riely, Jonathan Riess, Cameron Rink, Elizabeth V Robilotti, Lori Rosenstein, Bertrand Routy, Marc A Rovito, M Wasif Saif, Amit Sanyal, Lidia Schapira, Candice Schwartz, Oscar Serrano, Mansi Shah, Chintan Shah, Grace Shaw, Ardaman Shergill, Geoffrey Shouse, Heloisa P Soares, Carmen C Solorzano, Pramod K Srivastava, Karen Stauffer, Daniel G Stover, Jamie Stratton, Catherine Stratton, Vivek Subbiah, Rulla Tamimi, Nizar M Tannir, Umit Topaloglu, Eli Van Allen, Susan Van Loon, Karen Vega-Luna, Neeta Venepalli, Amit K Verma, Praveen Vikas, Sarah Wall, Paul L Weinstein, Matthias Weiss, Trisha Wise-Draper, William A Wood, Wenxin (vincent) Xu, Susan Yackzan, Rosemary Zacks, Tian Zhang, Andrea J Zimmer, Jack West
The Lancet, doi:10.1016/s0140-6736(20)31187-9
Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness. Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing. Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1•84, 95% CI 1•53-2•21), male sex (1•63, 1•07-2•48), smoking status (former smoker vs never smoked: 1•60, 1•03-2•47), number of comorbidities (two vs none: 4•50, 1•33-15•28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3•89, 2•11-7•18), active cancer (progressing vs remission: 5•20, 2•77-9•77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2•93, 1•79-4•79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0•24, 0•07-0•84) or the US-Midwest (0•50, 0•28-0•90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. Interpretation Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.
Declaration of interests NMK reports personal fees from G1 Therapeutics, Invitae, Beyond Spring, Spectrum, Bristol-Myers Squibb, Janssen, and Total Health outside of the submitted work. TKC reports research support from AstraZeneca, Alexion, Bayer, Bristol-Myers Squibb/ER Squibb and sons, Cerulean, Eisai, Foundation Medicine, Exelixis, Ipsen, Tracon, Genentech, Roche, Roche Products, F Hoffmann-La Roche, GlaxoSmithKline, Eli Lilly, Merck, Novartis, Peloton, Pfizer, Prometheus Labs, Corvus, Calithera, Analysis Group, Sanofi/Aventis, and Takeda outside of the submitted work; honoraria from AstraZeneca, Alexion, Sanofi/Aventis, Bayer, Bristol-Myers Squibb/ER Squibb and sons, Cerulean, Eisai, Foundation Medicine, Exelixis, Genentech, Roche, Roche Products, F Hoffmann-La Roche, GlaxoSmithKline, Merck, Novartis, Peloton, Pfizer, EMD Serono, Prometheus Labs, Corvus, Ipsen, Up-to-Date, National Comprehensive Cancer Network (NCCN), Analysis Group, MJH Life Sciences (a healthcare communications company with several brands such as OncLive, PeerView and Physicians' Education Resource), Research to Practice, L-path, Kidney Cancer Journal, Clinical Care Options, Platform Q, Navinata Healthcare, Harborside Press, American Society of Medical Oncology, New England Journal of Medicine, The Lancet Oncology, and Heron Therapeutics; consulting or advisory roles for AstraZeneca, Alexion, Sanofi/Aventis, Bayer, Bristol-Myers Squibb/ER Squibb and sons, Cerulean, Eisai, Foundation Medicine, Exelixis,..
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{'given': 'Jorge', 'family': 'Garcia', 'sequence': 'additional', 'affiliation': []},
{'given': 'David M.', 'family': 'Gill', 'sequence': 'additional', 'affiliation': []},
{'given': 'Erin A.', 'family': 'Gillaspie', 'sequence': 'additional', 'affiliation': []},
{'given': 'Antonio', 'family': 'Giordano', 'sequence': 'additional', 'affiliation': []},
{'given': '(Mary) Grace', 'family': 'Glace', 'sequence': 'additional', 'affiliation': []},
{'given': 'Axel', 'family': 'Grothey', 'sequence': 'additional', 'affiliation': []},
{'given': 'Shuchi', 'family': 'Gulati', 'sequence': 'additional', 'affiliation': []},
{'given': 'Michael', 'family': 'Gurley', 'sequence': 'additional', 'affiliation': []},
{'given': 'Balazs', 'family': 'Halmos', 'sequence': 'additional', 'affiliation': []},
{'given': 'Roy', 'family': 'Herbst', 'sequence': 'additional', 'affiliation': []},
{'given': 'Dawn', 'family': 'Hershman', 'sequence': 'additional', 'affiliation': []},
{'given': 'Kent', 'family': 'Hoskins', 'sequence': 'additional', 'affiliation': []},
{'given': 'Rohit K.', 'family': 'Jain', 'sequence': 'additional', 'affiliation': []},
{'given': 'Salma', 'family': 'Jabbour', 'sequence': 'additional', 'affiliation': []},
{'given': 'Alokkumar', 'family': 'Jha', 'sequence': 'additional', 'affiliation': []},
{'given': 'Douglas B.', 'family': 'Johnson', 'sequence': 'additional', 'affiliation': []},
{'given': 'Monika', 'family': 'Joshi', 'sequence': 'additional', 'affiliation': []},
{'given': 'Kaitlin', 'family': 'Kelleher', 'sequence': 'additional', 'affiliation': []},
{'given': 'Jordan', 'family': 'Kharofa', 'sequence': 'additional', 'affiliation': []},
{'given': 'Hina', 'family': 'Khan', 'sequence': 'additional', 'affiliation': []},
{'given': 'Jeanna', 'family': 'Knoble', 'sequence': 'additional', 'affiliation': []},
{'given': 'Vadim S.', 'family': 'Koshkin', 'sequence': 'additional', 'affiliation': []},
{'given': 'Amit A.', 'family': 'Kulkarni', 'sequence': 'additional', 'affiliation': []},
{'given': 'Philip E.', 'family': 'Lammers', 'sequence': 'additional', 'affiliation': []},
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{'given': 'Xuanyi', 'family': 'Li', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ang', 'family': 'Li', 'sequence': 'additional', 'affiliation': []},
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{'given': 'Patricia', 'family': 'LoRusso', 'sequence': 'additional', 'affiliation': []},
{'given': 'Clarke A.', 'family': 'Low', 'sequence': 'additional', 'affiliation': []},
{'given': 'Maryam B.', 'family': 'Lustberg', 'sequence': 'additional', 'affiliation': []},
{'given': 'Daruka', 'family': 'Mahadevan', 'sequence': 'additional', 'affiliation': []},
{'given': 'Abdul-Hai', 'family': 'Mansoor', 'sequence': 'additional', 'affiliation': []},
{'given': 'Michelle', 'family': 'Marcum', 'sequence': 'additional', 'affiliation': []},
{'given': 'Merry Jennifer', 'family': 'Markham', 'sequence': 'additional', 'affiliation': []},
{'given': 'Catherine', 'family': 'Handy Marshall', 'sequence': 'additional', 'affiliation': []},
{'given': 'Sandeep H.', 'family': 'Mashru', 'sequence': 'additional', 'affiliation': []},
{'given': 'Sara', 'family': 'Matar', 'sequence': 'additional', 'affiliation': []},
{'given': 'Christopher', 'family': 'McNair', 'sequence': 'additional', 'affiliation': []},
{'given': 'Shannon', 'family': 'McWeeney', 'sequence': 'additional', 'affiliation': []},
{'given': 'Janice M.', 'family': 'Mehnert', 'sequence': 'additional', 'affiliation': []},
{'given': 'Alvaro', 'family': 'Menendez', 'sequence': 'additional', 'affiliation': []},
{'given': 'Harry', 'family': 'Menon', 'sequence': 'additional', 'affiliation': []},
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{'given': 'Jarushka', 'family': 'Naidoo', 'sequence': 'additional', 'affiliation': []},
{'given': 'John M.', 'family': 'Nakayama', 'sequence': 'additional', 'affiliation': []},
{'given': 'Vikram', 'family': 'Narayan', 'sequence': 'additional', 'affiliation': []},
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{'given': 'Eneida R.', 'family': 'Nemecek', 'sequence': 'additional', 'affiliation': []},
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{'given': 'Paul E.', 'family': 'Oberstein', 'sequence': 'additional', 'affiliation': []},
{'given': 'Adam J.', 'family': 'Olszewski', 'sequence': 'additional', 'affiliation': []},
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{'given': 'Young Soo', 'family': 'Rho', 'sequence': 'additional', 'affiliation': []},
{'given': 'Terence D.', 'family': 'Rhodes', 'sequence': 'additional', 'affiliation': []},
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