Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study

Abstract

Background Patients with cancer are a high-risk population in the COVID-19 pandemic. We aimed to describe clinical characteristics and outcomes of patients with cancer and COVID-19, and examined risk factors for mortality in this population. Methods We did a retrospective, multicentre, cohort study of 205 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and with a pathological diagnosis of a malignant tumour in nine hospitals within Hubei, China, from Jan 13 to March 18, 2020. All patients were either discharged from hospitals or had died by April 20, 2020. Clinical characteristics, laboratory data, and cancer histories were compared between survivors and non-survivors by use of χ² test. Risk factors for mortality were identified by univariable and multivariable logistic regression models. Findings Between Jan 13 and Mar 18, 2020, 205 patients with cancer and laboratory-confirmed SARS-CoV-2 infection were enrolled (median age 63 years [IQR 56-70; range 14-96]; 109 [53%] women). 183 (89%) had solid tumours and 22 (11%) had haematological malignancies. The median duration of follow-up was 68 days (IQR 59-78). The most common solid tumour types were breast (40 [20%] patients), colorectal (28 [14%]), and lung cancer (24 [12%]). 54 (30%) of 182 patients received antitumour therapies within 4 weeks before symptom onset. 30 (15%) of 205 patients were transferred to an intensive care unit and 40 (20%) died during hospital admission. Patients with haematological malignancies had poorer prognoses than did those with solid tumours: nine (41%) of 22 patients with haematological malignancies died versus 31 (17%) of 183 patients with solid tumours (hazard ratio for death 3•28 [95% CI 1•56-6•91]; log rank p=0•0009). Multivariable regression analysis showed that 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) were risk factors for death during admission to hospital. Interpretation Patients with cancer and COVID-19 who were admitted to hospital had a high case-fatality rate. Unfavourable prognostic factors, including receiving chemotherapy within 4 weeks before symptom onset and male sex, might help clinicians to identify patients at high risk of fatal outcomes. Funding National Natural Science Foundation of China.

Chemotherapy Increases the Risk of Developing Severe Illness in Breast Cancer Patients with COVID-19: A Multi-Center Retrospective Study in Hubei, China

“…A current report indicated the SARS-CoV-2 variant with Spike D614 to G614 increased the infectivity of the COVID-19. [19] However, the mortality of our study (6.7%) was much lower than that of general cancer patients (11.4-18.6%) [5,[8][9][10]. Besides, as to disease severity, 26.7% of breast cancer patients in our study had severe disease, which still lower than that of general cancer patients observed by H. Zhang (47.8%), Ma (54.1%), and Dai (34.3%) [7,8,20].…”

“…As the most common cancer among women, breast cancer has a long treatment cycle resulting in immunosuppression and increased risk of infection [13], thus individuals with breast cancer are at increased risk of SARS-CoV-2 infection and should be given more attention. In our previous study, breast cancer patients had the highest proportion among all cancer patients with COVID-19 [9]. Their mortality rate was 14%, far below the average of general cancer patients (28%) [5,9].…”

“…In our previous study, breast cancer patients had the highest proportion among all cancer patients with COVID-19 [9]. Their mortality rate was 14%, far below the average of general cancer patients (28%) [5,9]. A study from Paris suggested that the severity of breast cancer patients with COVID-19 resided more in comorbidities [14].…”

“…With the rapid progression of COVID-19 worldwide, it is inevitable that large numbers of cancer patients will be affected by this pandemic [5][6][7][8][9][10]. This leads to grave concerns about standard-of-care treatment regimens in COVID-19 era and the adoption of protective measures, such as postponing active cancer treatments.…”

“…Some researchers have conducted studies to characterize cancer patients with COVID-19 [5][6][7][8][9][10][11][12]. Approximately 1-2.5% of COVID-19 patients had cancer, and their mortality rate ranged from 11.4-28.6%, which is much higher than that of the general population [4][5][6][7][8][9][10][11][12]. Regrettably, many of these studies described in general and ignored effects of different cancer types.…”