Hospital admission, mortality high among patients with cancer, COVID-19

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Mark NM, et al. Summary 6566. Presented at: ASCO Annual Meeting (virtual meeting); June 4-8, 2021.

disclosures:
NIH funded this study. Khorana reports research funding to its institution from, consultant/advising roles with, fees or travel, accommodation or expenses from Anthos Therapeutics, Array BioPharma, Bayer, Bristol Myers Squibb, Halozyme, Janssen, Leap Oncology, Medscape, Merck, Nektar Therapeutics, Pfizer , Pharmacyclics, Pharmacyte Biotech and Seagen. See summary for all relevant financial disclosures from other researchers.


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Cancer patients who contracted COVID-19 were at high risk of hospitalization and death, according to research findings presented at ASCO’s virtual annual meeting.

Only a quarter of patients admitted to ICU received invasive mechanical ventilation, according to preliminary findings from the longitudinal NCI COVID-19 in Cancer Patients Study (NCCAPS).

Infographic with the main points of interest of the NCCAPS study

Data derived from Mark NM, et al. Summary 6566. Presented at: ASCO Annual Meeting (virtual meeting); June 4-8, 2021.

โ€œCOVID-19 in patients with solid tumors and hematologic malignancies receiving active therapy is associated with poor outcomes, including high risk [for] clinical mortality,โ€ Alok A. Khorana, MD, professor of medicine at the Cleveland Clinic Lerner College of Medicine, Healio told. โ€œContinued mass vaccination efforts are essential to reduce the risk of [patients with cancer].โ€

Alok A. Khorana, MD

Alok A. Khorana

Individuals with cancer and COVID-19 often experience a severe course of illness and increased risk of death. Previous research suggested that the risks may be higher based on the type of cancer and the presence of metastatic disease.

The NCCAPS study is designed to provide detailed prospective clinical data that can provide insight into which patients are most at risk for poor outcomes.

Researchers hope to get 2,000 adults with COVID-19 treated for cancer. The cohort includes patients with solid tumors or blood cancers.

Researchers collect clinical data, imaging and blood samples during the initial COVID-19 hospitalization of patients. They will collect additional clinical information during subsequent hospitalizations.

โ€œWhile much has been researched on COVID-19 outcomes, detailed prospective data regarding outcomes in particular [among patients with cancer] are missing,โ€ Khorana said. โ€œNCI launched this large national prospective cohort study to examine the epidemiology and outcomes of [patients with cancer] hospitalized with COVID-19.โ€

Researchers enrolled 757 adults from 204 sites on Jan. 22.

By data limit, 124 patients (16.3%) reported at least one hospitalization for COVID-19. Researchers had discharge data for a combined 98 hospitalizations for 88 patients (median age, 67 years; range, 21-93; 40% women).

The most common malignancies among those requiring hospitalization with COVID-19 were lymphoma (18.2%), lung cancer (15.9%) and multiple myeloma (10.2%).

โ€œ[This suggests] susceptibility to serious disease in patients with these diagnoses,โ€ Khorana said.

Sixteen (16.3%) of the 98 total hospitalizations ended in death, a percentage that Khorana described as “particularly concerning.”

“Identifying predictors of poor outcomes, especially clinical mortality, is essential,” Khorana said.

About two-thirds of patients requiring hospitalization experienced shortness of breath (65%) or fatigue/malaise (64%) and nearly half (49%) developed a fever. Seventeen patients (19%) were thrombocytopenic and eight (9%) were neutropenic, defined as an absolute neutrophil count of less than 1,000.

Patients remained hospitalized for an average of 6.5 days (range, 1-41).

Researchers obtained clinical medication data for 63 patients (71.5%). In this subgroup, the most common treatments were corticosteroids (63%), remdesivir (46%) and restorative plasma (14%).

One patient received the monoclonal antibody bamlanivimab (Eli Lilly) and two patients received the immunosuppressive agent tocilizumab (Actemra, Genentech).

Almost three quarters (73%) received anticoagulants, mostly prophylactic low molecular weight heparin. Eleven patients (17%) received a therapeutic dose of anticoagulants.

About one in five hospitalized patients (22.7%) received care in the ICU or in a high-dependency unit (median ICU stay, 7 days; range, 1-22); 25% of those admitted to the ICU received invasive mechanical ventilation, a rate Khorana said was lower than expected.

“We Don’t Really Know” [why invasive mechanical ventilation was not used more frequently]’, Khorana told Healio. “You could speculate that the underlying diagnosis/stage led doctors to [or] families to make ventilation decisions that differ from the non-cancer population.โ€

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