1. Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
- Author
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Zhuoer Xie, Julie T Wu, Huili Zhu, Deborah B. Doroshow, Yu Shyr, Thorvardur R. Halfdanarson, Jessica Hawley, Sanjay Mishra, Lidia Schapira, Leslie A. Fecher, Sanjay Goel, Samuel M. Rubinstein, Petros Grivas, Pamela C Egan, Solange Peters, Sumit A. Shah, Gary K. Schwartz, Michael A. Thompson, Jonathan T Arcobello, Chih-Yuan Hsu, Christopher R. Friese, Dimitrios Farmakiotis, Corrie A. Painter, Matthew D. Galsky, Nicole M. Kuderer, Nathan A. Pennell, Ziad Bakouny, Sanjay G. Revankar, Brian I. Rini, Albert C. Yeh, Donna R. Rivera, Jeremy L. Warner, Dimpy P. Shah, Brendan J Lee, Ali Raza Khaki, Adam J. Olszewski, Matthew Puc, Orestis A. Panagiotou, Gary H. Lyman, Christopher Lemmon, Balazs Halmos, Andrew Schmidt, Toni K. Choueiri, Gilberto Lopes, Shilpa Gupta, and COVID-19 and Cancer Consortium
- Subjects
Male ,0301 basic medicine ,Logistic regression ,Severity of Illness Index ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Hospital Mortality ,Research Articles ,Alanine ,Age Factors ,Middle Aged ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Drug Therapy, Combination ,Coronavirus Infections ,Hydroxychloroquine ,Cohort study ,medicine.drug ,medicine.medical_specialty ,Clinical Decision-Making ,Pneumonia, Viral ,Betacoronavirus ,03 medical and health sciences ,Sex Factors ,Pharmacotherapy ,Internal medicine ,Statistical significance ,Severity of illness ,medicine ,Humans ,Healthcare Disparities ,Glucocorticoids ,Pandemics ,Aged ,Adenosine Monophosphate/analogs & derivatives ,Adenosine Monophosphate/therapeutic use ,Alanine/analogs & derivatives ,Alanine/therapeutic use ,Betacoronavirus/pathogenicity ,Coronavirus Infections/complications ,Coronavirus Infections/diagnosis ,Coronavirus Infections/drug therapy ,Coronavirus Infections/mortality ,Drug Therapy, Combination/methods ,Drug Therapy, Combination/statistics & numerical data ,Drug Utilization/statistics & numerical data ,Follow-Up Studies ,Glucocorticoids/therapeutic use ,Healthcare Disparities/statistics & numerical data ,Hydroxychloroquine/therapeutic use ,Neoplasms/complications ,Neoplasms/mortality ,Pneumonia, Viral/complications ,Pneumonia, Viral/diagnosis ,Pneumonia, Viral/drug therapy ,Pneumonia, Viral/mortality ,United States/epidemiology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Cancer ,medicine.disease ,Adenosine Monophosphate ,Drug Utilization ,United States ,COVID-19 Drug Treatment ,030104 developmental biology ,Observational study ,business - Abstract
In a large observational study in patients with COVID-19 and cancer, survival was not significantly influenced by receipt of COVID-19 treatments, except hydroxychloroquine plus any other treatment, which was associated with reduced survival., Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. Significance: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access. This article is highlighted in the In This Issue feature, p. 1426
- Published
- 2020