COVID‐19 outcomes of patients with gynecologic cancer in New York City

Abstract

Background New York City (NYC) is the epicenter of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID‐19]) in the United States. Clinical characteristics and outcomes of vulnerable populations, such as those with gynecologic cancer who develop COVID‐19 infections, is limited. Methods Patients from 6 NYC‐area hospital systems with known gynecologic cancer and a COVID‐19 diagnosis were identified. Demographic and clinical outcome data were abstracted through a review of electronic medical records. Results Records for 121 patients with gynecologic cancer and COVID‐19 were abstracted; the median age at the COVID‐19 diagnosis was 64.0 years (interquartile range, 51.0‐73.0 years). Sixty‐six of the 121 patients (54.5%) required hospitalization; among the hospitalized patients, 45 (68.2%) required respiratory intervention, 20 (30.3%) were admitted to the intensive care unit, and 9 (13.6%) underwent invasive mechanical ventilation. Seventeen patients (14.0%) died of COVID‐19 complications. No patient requiring mechanical ventilation survived. On multivariable analysis, hospitalization was associated with an age ≥64 years (risk ratio [RR], 1.73; 95% confidence interval [CI], 1.18‐2.51), African American race (RR, 1.56; 95% CI, 1.13‐2.15), and 3 or more comorbidities (RR, 1.43; 95% CI, 1.03‐1.98). Only recent immunotherapy use (RR, 3.49; 95% CI, 1.08‐11.27) was associated with death due to COVID‐19 on multivariable analysis; chemotherapy treatment and recent major surgery were not predictive of COVID‐19 severity or mortality. Conclusions The case fatality rate among gynecologic oncology patients with a COVID‐19 infection is 14.0%. Recent immunotherapy use is associated with an increased risk of mortality related to COVID‐19 infection. Lay Summary The case fatality rate among gynecologic oncology patients with a coronavirus disease 2019 (COVID‐19) infection is 14.0%; there is no association between cytotoxic chemotherapy and cancer‐directed surgery and COVID‐19 severity or death. As such, patients can be counseled regarding the safety of continued anticancer treatments during the pandemic. This is important because the ability to continue cancer therapies for cancer control and cure is critical.

Inflammatory markers in gynecologic oncology patients hospitalized with COVID-19 infection

“…Prospective and retrospective studies of COVID-19 mortality in the US, Canada, and UK have demonstrated COVID-19 mortality rates between 17 and 28% among patients with active malignancy [4][5][6]. In a prior study, the present authors noted a mortality rate of 14% among gynecologic oncology patients in New York City (NYC) [7].…”

A novel multi-omics-based identification of symptoms, comorbid conditions, and possible long-term complications in COVID-19

“…In this analysis too, the viral infection is ranked one. The common comorbid conditions such as autoimmune disease (Rank-2) [50], vascular disease (Rank-4) [71], kidney disease (Rank-5) [56, 57], neurodegenerative disease (Rank-6) [72], bone inflammation disease (Rank-7) [73], myocardial disorder (Rank-7) [74], mood disorder (Rank-7) [34], breast cancer (Rank-10) [75], liver disease (Rank-10) [58], gynaecologic cancers (Rank-11) [76], asthma (Rank-12) [77], liver cancer (Rank-13) [78], musculoskeletal abnormality (Rank-14) [63], hematologic cancer (Rank-15) [79], retinal degeneration (Rank-15) [80], sepsis / septicaemia / septic shock (Rank-15) [60, 81], diabetes (Rank-16) [82], other cardiovascular diseases (Rank-17) [71, 74], viral encephalitis (Rank-17) [83], other cognitive disorder (Rank-18) [24], immunodeficiency (Rank-19) [84], brain disease (Rank-19) [85], COPD (Rank-19) [86], gastric / colon cancer (Rank-20) [87], autism (Rank-21) [88, 89], anemia (Rank-21) [90], bone development and degenerative disease (Rank-20) [91], dyslipidaemia (Rank-22) [92, 93], and ataxia (Rank-23) [94] etc. are among the top 25 child disease categories at a cut off score of 4 ( Fig-2B ).…”

COVID-19 and Gynecological Cancers: A Summary of International Recommendations

“…These results show that the mortality rate among patients hospitalized in this series is lower compared with the rate reported in the general population of the New York region which is 34.3%. This suggests that patients with gynecologic cancer and COVID-19 infection do not have a higher risk of COVID-19-related mortality compared with the general population [24].…”