1. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
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Dimitrios Farmakiotis, Susie Owenby, Arturo Loaiza-Bonilla, Mansi R. Shah, Matthew Puc, Vadim S. Koshkin, Ahmad Daher, Prakash Peddi, Cameron Rink, Heloisa P. Soares, Eneida R. Nemecek, Mehmet Asim Bilen, Sanjay Mishra, Lidia Schapira, Amit Verma, Ali Raza Khaki, Chih-Yuan Hsu, Sandy DiLullo, Mark Bonnen, Jeanna Knoble, Carla Casulo, Umit Topaloglu, Jorge A. Garcia, Geoffrey Shouse, Praveen Vikas, Clarke A. Low, Archana Ajmera, George D. Demetri, Leyre Zubiri, Grace Glace, Shannon K. McWeeney, Susan Yackzan, Pamela C Egan, Rachel P. Rosovsky, Salvatore Del Prete, Anthony P. Gulati, Lane R. Rosen, Andy Futreal, Merry Jennifer Markham, Sabitha Prabhakaran, Alicia K. Morgans, Sarah Nagle, Lisa Weissmann, Albert C. Yeh, Ziad Bakouny, Stephanie Berg, David Gill, Marcus Messmer, Ryan Nguyen, Terence Duane Rhodes, Vikram M. Narayan, Matthew D. Galsky, Arielle Elkrief, Lori J. Rosenstein, Roy S. Herbst, Justin Shaya, Thorvardur R. Halfdanarson, Douglas B. Johnson, Orestis A. Panagiotou, Sanjay G. Revankar, Toni K. Choueiri, Yu Shyr, Fiona Busser, Kaitlin M. Kelleher, Nicole M. Kuderer, Paul L. Weinstein, Anup Kasi, Grace Shaw, Adam J. Olszewski, Catherine Curran, Samuel M. Rubinstein, Angelo Cabal, Michael H. Bar, John F. Deeken, Vivek Subbiah, Abdul Hai Mansoor, Hina Khan, Rana R. McKay, Catherine Stratton, Saurabh Dahiya, Marc A. Rovito, John Philip, Sanjay Shete, Oscar K. Serrano, Julie Fu, Daniel W. Bowles, Candice Schwartz, Tian Zhang, Pier Vitale Nuzzo, Eric H. Bernicker, Wenxin Xu, Genevieve M. Boland, Sarah Wall, Babar Bashir, Solange Peters, Neeta K. Venepalli, Sandeep H. Mashru, William A. Wood, Anne H. Angevine, Mary F. Mulcahy, Gilberto Lopes, Justin F. Gainor, Jessica Hawley, Monika Joshi, Christopher R. Friese, Navid Hafez, Heather H. Nelson, Gregory J. Riely, Jordan Kharofa, Nilo Azad, Chintan Shah, Gerald Batist, Mary Salazar, Rosemary Zacks, Alice Zhou, Lawrence E. Feldman, Paul Fu, Gary H. Lyman, Nathaniel Bouganim, John A. Steinharter, Shilpa Gupta, Matthias Weiss, Peter Paul Yu, Susan Van Loon, Jamie Stratton, Karen Vega-Luna, Tyler Masters, Christopher Lemmon, Aakash Desai, Bryan A. Faller, Jessica M. Clement, Zhuoer Xie, Keith Stockerl-Goldstein, Corrie A. Painter, Gabrielle Bouchard, Rulla M. Tamimi, Daruka Mahadevan, Rimma Belenkaya, Jill S. Barnholtz-Sloan, Jarushka Naidoo, Amelie G. Ramirez, Philip E. Lammers, Elizabeth A. Griffiths, Michael J. Gurley, X. Li, Jonathan Riess, Syed A. Ahmad, Daniel Blake Flora, Salma K. Jabbour, Jared D. Acoba, Neeraj Agarwal, Ang Li, Sarah Mushtaq, Firas Wehbe, Tanios Bekaii-Saab, Donald C. Vinh, Emily Hsu, Ryan Monahan, Petros Grivas, Harry Menon, John M. Nakayama, Janice M. Mehnert, Elizabeth Marie Wulff-Burchfield, Sara Matar, Paul E. Oberstein, Mary M. Pasquinelli, Axel Grothey, Jack West, John C. Leighton, Dawn L. Hershman, Leslie A. Fecher, Aditya Bardia, Sumit A. Shah, Barbara Logan, Kerry L. Reynolds, Michael A. Thompson, Robert L. Rice, Erin Cook, Trisha Wise-Draper, Christine Bestvina, Daniel Castellano, Paolo Caimi, K. M.Steve Lo, Ruben A. Mesa, Maheen Z. Abidi, Alvaro G. Menendez, Daniel G. Stover, Colleen Lewis, Bertrand Routy, Deborah B. Doroshow, Carmen C. Solorzano, M. Wasif Saif, Rohit Bishnoi, Michael Glover, David D. Chism, Briana Barrow, Christopher McNair, Dimpy P. Shah, Erin A. Gillaspie, Andrea J. Zimmer, Andrew Schmidt, Jessica K. Altman, Michelle Marcum, Rawad Elias, Balazs Halmos, Karen Stauffer, Gayathri Nagaraj, Ardaman Shergill, Mark E. Dailey, Catherine Handy Marshall, Pramod K. Srivastava, Shuchi Gulati, Alokkumar Jha, Mateo Bover Larroya, Mark A. Lewis, Young Soo Rho, James L. Chen, Eli Van Allen, Julie Tsu Yu Wu, Antonio Giordano, Amit Kulkarni, Joerg Rathmann, Donna R. Rivera, Narjust Duma, Maryam B. Lustberg, Theresa M. Carducci, Jeremy L. Warner, Elizabeth Robilotti, Patricia LoRusso, Rohit Jain, Amit Sanyal, Nizar M. Tannir, Kent Hoskins, Nathan A. Pennell, Brian I. Rini, Suki Subbiah, COVID-19 and Cancer Consortium, Abidi, M., Acoba, J.D., Agarwal, N., Ahmad, S., Ajmera, A., Altman, J., Angevine, A.H., Azad, N., Bar, M.H., Bardia, A., Barnholtz-Sloan, J., Barrow, B., Bashir, B., Belenkaya, R., Berg, S., Bernicker, E.H., Bestvina, C., Bishnoi, R., Boland, G., Bonnen, M., Bouchard, G., Bowles, D.W., Busser, F., Cabal, A., Caimi, P., Carducci, T., Casulo, C., Chen, J.L., Clement, J.M., Chism, D., Cook, E., Curran, C., Daher, A., Dailey, M., Dahiya, S., Deeken, J., Demetri, G.D., DiLullo, S., Duma, N., Elias, R., Faller, B., Fecher, L.A., Feldman, L.E., Friese, C.R., Fu, P., Fu, J., Futreal, A., Gainor, J., Garcia, J., Gill, D.M., Gillaspie, E.A., Giordano, A., Glace, M.G., Grothey, A., Gulati, S., Gurley, M., Halmos, B., Herbst, R., Hershman, D., Hoskins, K., Jain, R.K., Jabbour, S., Jha, A., Johnson, D.B., Joshi, M., Kelleher, K., Kharofa, J., Khan, H., Knoble, J., Koshkin, V.S., Kulkarni, A.A., Lammers, P.E., Leighton, J.C., Lewis, M.A., Li, X., Li, A., Lo, KMS, Loaiza-Bonilla, A., LoRusso, P., Low, C.A., Lustberg, M.B., Mahadevan, D., Mansoor, A.H., Marcum, M., Markham, M.J., Handy Marshall, C., Mashru, S.H., Matar, S., McNair, C., McWeeney, S., Mehnert, J.M., Menendez, A., Menon, H., Messmer, M., Monahan, R., Mushtaq, S., Nagaraj, G., Nagle, S., Naidoo, J., Nakayama, J.M., Narayan, V., Nelson, H.H., Nemecek, E.R., Nguyen, R., Nuzzo, P.V., Oberstein, P.E., Olszewski, A.J., Owenby, S., Pasquinelli, M.M., Philip, J., Prabhakaran, S., Puc, M., Ramirez, A., Rathmann, J., Revankar, S.G., Rho, Y.S., Rhodes, T.D., Rice, R.L., Riely, G.J., Riess, J., Rink, C., Robilotti, E.V., Rosenstein, L., Routy, B., Rovito, M.A., Saif, M.W., Sanyal, A., Schapira, L., Schwartz, C., Serrano, O., Shah, M., Shah, C., Shaw, G., Shergill, A., Shouse, G., Soares, H.P., Solorzano, C.C., Srivastava, P.K., Stauffer, K., Stover, D.G., Stratton, J., Stratton, C., Subbiah, V., Tamimi, R., Tannir, N.M., Topaloglu, U., Van Allen, E., Van Loon, S., Vega-Luna, K., Venepalli, N., Verma, A.K., Vikas, P., Wall, S., Weinstein, P.L., Weiss, M., Wise-Draper, T., Wood, W.A., Xu, W.V., Yackzan, S., Zacks, R., Zhang, T., Zimmer, A.J., and West, J.
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Prognostic variable ,medicine.medical_specialty ,business.industry ,Cancer ,General Medicine ,Odds ratio ,Aged ,Antiviral Agents/therapeutic use ,Azithromycin/therapeutic use ,Betacoronavirus ,Cause of Death ,Comorbidity ,Coronavirus Infections/drug therapy ,Coronavirus Infections/epidemiology ,Coronavirus Infections/mortality ,Databases, Factual ,Female ,Humans ,Hydroxychloroquine/therapeutic use ,Male ,Middle Aged ,Neoplasms/epidemiology ,Neoplasms/mortality ,Neoplasms/therapy ,Pandemics ,Pneumonia, Viral/drug therapy ,Pneumonia, Viral/epidemiology ,Pneumonia, Viral/mortality ,Prognosis ,Risk Factors ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cohort ,Clinical endpoint ,Medicine ,030212 general & internal medicine ,business ,Cause of death ,Cohort study - Abstract
Summary Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness. Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing. Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57–76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53–2·21), male sex (1·63, 1·07–2·48), smoking status (former smoker vs never smoked: 1·60, 1·03–2·47), number of comorbidities (two vs none: 4·50, 1·33–15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11–7·18), active cancer (progressing vs remission: 5·20, 2·77–9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79–4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07–0·84) or the US-Midwest (0·50, 0·28–0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. Interpretation Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. Funding American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.
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- 2020