Spanish COVID-19 Cancer Patient Mortality Risk Factors Characterised

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: A study of cancer patients admitted to a Spanish hospital with COVID-19 has identified several factors linked to a poor outcome in this population. 

The team collated information for the first 63 consecutive cancer patients who were admitted to Hospital Universitario 12 de Octubre in Madrid with SARS-CoV-2 infection after 9 March 2020. 

The majority (83%) of these patients had SARS-CoV-2 infection confirmed by a nasopharyngeal swab RT-PCR test, while the remainder were diagnosed using clinical and radiographical findings, explain Carlos Gómez-Martín and team from the hospital. 

The patients were aged an average of 66 years, 54% were male and 86% were White. The most common cancer diagnosis was lung (27%), followed by colorectal and breast (16% each); 88% of patients had metastatic disease, with visceral and pulmonary sites reported for 48% and 40%, respectively.  

All but two (96%) of the patients were undergoing cancer therapy at time of COVID-19 diagnosis, namely chemotherapy (58%), endocrine therapy (11%), targeted therapy (11%) or immunotherapy (12%). 

Overall, 54% experienced respiratory failure – defined as a need for supplemental oxygen – and 70% of patients developed acute respiratory disease syndrome (ARDS). ARDS occurred in 29% of lung cancer patients, 87% of patients with metastatic disease and 46% of patients with pulmonary metastases, as well as 50% of patients who had received chemotherapy in the past 4 weeks. In addition, 90% of the 10 patients who had previously been diagnosed with chronic anaemia experienced respiratory failure, with ARDS occurring in 60% of this group. 

Of note, 14% of patients experienced venous thromboembolism (VTE), including 23% of patients who were chronically anticoagulated at time of hospital admittance. 

Patients experienced respiratory failure an average of 7.0 days after initial symptoms and time to SpO2 improvement took a mean 4.5 days, followed by hospital discharge after an average 14.8 days.  

“In our current series, no single cancer patient underwent mechanical ventilation nor [was] admitted to intensive care unit [ICU] given limited resources at disease outbreak in Madrid, Spain, that were further reserved for non-comorbid patients”, the researchers write in the European Journal of Cancer. 

“This could explain the fact that, while our mortality rate is similar to studies with 14% or 26% of ICU admissions, all those patients who developed severe ARDS (16/63) finally died”, they suggest. 

A quarter (25.4%) of patients died after an average 12.4 days from initial symptoms. More than a third (37.0%) of patients who died had lung cancer and 63.0% had pulmonary metastases, the researchers note. 

Moreover, the mortality rate was 47% among respiratory failure patients rising to 67% for those with ARDS. 

The investigators say that while time to respiratory failure in the cancer patients was comparable to an earlier report in noncancer hospitalised patients, the mean time to death was shorter than the reported 21.0 days for noncancer counterparts. 

“These data may suggest either that oncologic patients may present worse outcomes in a shorter period of time or that [the] global population may have longer time since respiratory deterioration to death owing to the use of mechanical ventilation at ICU units”, they postulate.

Multivariate analysis indicated that ARDS was significantly associated with bilateral pneumonia diagnosis (odds ratio [OR]=21.4), while mortality was significantly predicted by history of VTE (OR=4.82), bilateral pneumonia (OR=32.83), severe neutropenia (OR=16.54) and pulmonary metastases (OR=4.34). 

“SARS-CoV-2-infected cancer patients show worse outcomes in terms of mortality and severe respiratory failure than global population but similar death rate to non-cancer patients hospitalised for this disease”, summarise Carlos Gómez-Martín et al.

“ARDS is the main cause of death, and VTE [disease] screening as well as assessment of neutropenia, lung involvement and bilateral pneumonia at diagnosis are essential for the management of this high risk and fragile population”, they conclude. 

Reference  

Yarza R, Bover M, Paredes D, et al. SARS-CoV-2 infection in cancer patients undergoing active treatment: analysis of clinical features and predictive factors for severe respiratory failure and death. Eur J Cancer; Advance online publication 6 June 2020. DOI: 10.1016/j.ejca.2020.06.001