Researchers in New York City reported a significant increase in case fatality in patients with cancer and COVID-19 compared with patients with COVID-19 who did not have cancer.
In a study of patients with cancer who contracted coronavirus disease 2019 (COVID-19) in New York City published in Cancer Discovery, researchers reported a significant increase in case fatality compared with patients with COVID-19 who did not have cancer.
Given these findings, the study authors suggested a need for proactive strategies to reduce the likelihood of infection and improve early identification in this at-risk patient population.
“Case fatality rates were 2-3 times the age-specific percentages seen in our non-cancer population and the greater New York City area for all COVID-19 patients,” the authors wrote. “Overall, we hope and expect that our data from the current epicenter of the COVID-19 epidemic will help inform other healthcare systems, cancer patients, and the public about the particular vulnerability of oncologic patients to this disease.”
In total, researchers assessed 218 patients with cancer and COVID-19 infection who were treated in the Montefiore Health system from March 18 to April 8, 2020, including 164 (75%) patients with solid tumors and 54 (25%) with hematologic malignancies. The cohort was predominantly comprised of adult patients (98.6%) with a median age of 69 years (range 10-92 years).
Ultimately, 61 (28%) patients died as a result of COVID-19 disease at the time of analysis. Moreover, the mortality was 25% of all solid tumor patients and was found to occur at higher rates among those with lung cancers (55%), gastrointestinal cancers (colorectal [38%], pancreatic [67%], upper GI [38%]), and gynecologic malignancies (38%). Notably, genitourinary (15%) and breast cancers (14%) were associated with relatively low mortality with COVID-19 infection.
Hematologic malignancies were also associated with a higher rate of mortality with COVID-19 (37%). Further, individuals with myeloid malignancies showed a trend for higher mortality compared to those with lymphoid neoplasms. Additionally, rates of ICU admission and ventilator use were slightly higher for patients with hematologic malignancies (26% vs 19% and 11% vs 10%, respectively), however this did not achieve statistical significance.
“Interestingly, active disease (< 1 year) and advanced metastatic disease showed a trend for increased mortality, but the association did not achieve statistical significance (P = 0.09 and 0.06, respectively),” the authors wrote. “Active chemotherapy and radiation therapy treatment were not associated with increased case fatality. Very few patients in this cohort were on immunotherapy, and this did not show any associations with mortality.”
Using an age and sex-matched cohort of 1,090 patients at a 5:1 ratio of patients without cancer to those with cancer and COVID-19 from the same time period and same hospital system, researchers found that case fatality rates were elevated in all age cohorts in patients with cancer and achieved statistial significance in the age groups 45-64 and in patients older than 75 years of age.
“To also compare our case-fatality rates with a larger dataset from the greater New York City region, we obtained official cases numbers from NY State (current up to April 12, 2020),” the authors wrote. “In all cohorts, the percentage of deceased patients was found to rise sharply with increasing age. Strikingly, case-fatality rates in cancer patients with COVID-19 were significantly, many-fold higher in all age groups when compared to all NYC cases.”
According to the researchers, interaction within the healthcare environment before widespread knowledge of the pandemic occurred within New York City was a prominent source of exposure for patients with cancer. In a detailed analysis of deceased patients (n = 61), researchers demonstrated that many patients were either nursing home or shelter (n = 22) residents, and/or admitted as an inpatient or presented to the emergency room within the 30 days prior to their COVID-19 positive test (34%). Overall, 61% of the deceased cohort were exposed to the health care environment at the outset of the COVID-19 epidemic.
“These findings could be utilized to risk stratify cancer patients during this pandemic, or in future viral airborne outbreaks, and inform mitigation practices for high-risk individuals,” the authors wrote. “These strategies could include early and aggressive social distancing, resource allocation towards more outpatient-based care and telemedicine, testing of asymptomatic high-risk patients, and institution of strict infection control measures.”
Mehta V, Goel S, Kabarriti R, et al. Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discovery. doi:10.1158/2159-8290.CD-20-0516.