1. Time-Dependent COVID-19 Mortality in Patients With Cancer: An Updated Analysis of the OnCovid Registry
- Author
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Gianpiero Rizzo, Eudald Felip, Annalisa Guida, Alessio Cortellini, Francesca Mazzoni, Rachel Sharkey, Alice Baggi, Emeline Colomba, Sabrina Rossi, Salvatore Grisanti, Federica Zoratto, David J. Pinato, Daniela Ferrante, Claudia Andrea Cruz, Giampero Porzio, Lorenzo Chiudinelli, Alessandra Gennari, Alexia Bertuzzi, Gianluca Gaidano, Joan Brunet, Johann Colomba, Alessia Dalla Pria, Nadia Harbeck, Raffaele Giusti, Alberto Zambelli, Angela Loizidou, Clara Martinez-Vila, Daniele Generali, Matteo Lambertini, Isabel Ruiz-Camps, Paola Queirolo, Michela Libertini, Ana Sanchez de Torre, Ailsa Sita-Lumsden, Laura Fox, Federica Biello, Javier Marco-Hernández, Nikolaos Diamantis, Elia Seguí, Lorenza Rimassa, Nadia Saoudi-Gonzalez, Ariadna Roqué Lloveras, Armando Santoro, John D. Chester, Mieke Van Hemelrijck, Carlo Tondini, Marco Krengli, Saoirse Dolly, Raquel Liñan, Elisa Roldán, Charlotte Moss, Diego Ottaviani, Fanny Pommeret, Uma Mukherjee, Andrea Patriarca, Aleix Prat, Joanne Evans, Rossana Berardi, Meera Patel, Mark Bower, Marco Tagliamento, Paolo Pedrazzoli, Juan Aguilar-Company, Lorenza Scotti, Bruno Vincenzi, Irina Earnshaw, M Carmen Carmona-García, Anna Pous, Thomas Newsom-Davis, Riccardo Bruna, Krishnie Srikandarajah, Rossella Bertulli, Josep Tabernero, Vittoria Fotia, Alessandro Parisi, Anna Sureda, Ramon Salazar, Beth Russell, Michela Franchi, Roxana Reyes, Pinato, D. J., Patel, M., Scotti, L., Colomba, E., Dolly, S., Loizidou, A., Chester, J., Mukherjee, U., Zambelli, A., Dalla Pria, A., Aguilar-Company, J., Bower, M., Salazar, R., Bertuzzi, A., Brunet, J., Lambertini, M., Tagliamento, M., Pous, A., Sita-Lumsden, A., Srikandarajah, K., Colomba, J., Pommeret, F., Segui, E., Generali, D., Grisanti, S., Pedrazzoli, P., Rizzo, G., Libertini, M., Moss, C., Evans, J. S., Russell, B., Harbeck, N., Vincenzi, B., Biello, F., Bertulli, R., Ottaviani, D., Linan, R., Rossi, S., Carmona-Garcia, M. C., Tondini, C., Fox, L., Baggi, A., Fotia, V., Parisi, A., Porzio, G., Queirolo, P., Cruz, C. A., Saoudi-Gonzalez, N., Felip, E., Roque Lloveras, A., Newsom-Davis, T., Sharkey, R., Roldan, E., Reyes, R., Zoratto, F., Earnshaw, I., Ferrante, D., Marco-Hernandez, J., Ruiz-Camps, I., Gaidano, G., Patriarca, A., Bruna, R., Sureda, A., Martinez-Vila, C., Sanchez De Torre, A., Berardi, R., Giusti, R., Mazzoni, F., Guida, A., Rimassa, L., Chiudinelli, L., Franchi, M., Krengli, M., Santoro, A., Prat, A., Tabernero, J., Van Hemelrijck, M., Diamantis, N., Gennari, A., and Cortellini, A.
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,solid cancer ,Internal medicine ,Neoplasms ,Tumor stage ,COVID-19 ,real-world data ,hematologic cancer ,medicine ,Humans ,In patient ,Registries ,Pandemics ,Aged ,Original Investigation ,business.industry ,SARS-CoV-2 ,Hazard ratio ,Outbreak ,Cancer ,Infant ,medicine.disease ,Female ,Oncology ,business ,Case series - Abstract
IMPORTANCE Whether the severity and mortality of COVID-19 in patients with cancer have improved in terms of disease management and capacity is yet to be defined. OBJECTIVE To test whether severity and mortality from COVID-19 among patients with cancer have improved during the course of the pandemic. DESIGN, SETTING, AND PARTICIPANTS OnCovid is a European registry that collects data on consecutive patients with solid or hematologic cancer and COVID-19. This multicenter case series study included real-world data from 35 institutions across 6 countries (UK, Italy, Spain, France, Belgium, and Germany). This update included patients diagnosed between February 27, 2020, and February, 14, 2021. Inclusion criteria were confirmed diagnosis of SARS-CoV-2 infection and a history of solid or hematologic cancer. EXPOSURES SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES Deaths were differentiated at 14 days and 3 months as the 2 landmark end points. Patient characteristics and outcomes were compared by stratifying patients across 5 phases (February to March 2020, April to June 2020, July to September 2020, October to December 2020, and January to February 2021) and across 2 major outbreaks (February to June 2020 and July 2020 to February 2021). RESULTS At data cutoff, 2795 consecutive patients were included, with 2634 patients eligible for analysis (median [IQR] age, 68 [18-77] years ; 52.8% men). Eligible patients demonstrated significant time-dependent improvement in 14-day case-fatality rate (CFR) with estimates of 29.8% (95% CI, 0.26-0.33) for February to March 2020; 20.3% (95% CI, 0.17-0.23) for April to June 2020;12.5% (95% Cl, 0.06-22.90) for July to September 2020; 17.2% (95% CI, 0.15-0.21) for October to December 2020; and 14.5% (95% CI, 0.09-0.21) for January to February 2021(all P < .001) across the predefined phases. Compared with the second major outbreak, patients diagnosed in the first outbreak were more likely to be 65 years or older (974 of 1626 [60.3%] vs 564 of 1008 [56.1%]; P = .03), have at least 2 comorbidities (793 of 1626 [48.8%) vs 427 of 1008 [42.4%); P = .001), and have advanced tumors (708 of 1626 [46.4%) vs 536 of 1008 [56.1%]: P < .001). Complications of COVID-19 were more likely to be seen (738 of 1626 [45.4%) vs 342 of 1008 [33.9%]; P < .001) and require hospitalization (969 of 1626 [59.8%) vs 418 of 1008 [42.1%); P < .001) and anti-COVID-19 therapy (1004 of 1626 [61.7%) vs 501of 1008 [49.7%); P < .001) during the first major outbreak. The 14-day CFRs for the first and second major outbreaks were 25.6% (95% CI, 0.23-0.28) vs 16.2% (95% CI, 0.13-0.19; P < .001), respectively. After adjusting for country, sex, age, comorbidities, tumor stage and status, anti-COVID-19 and anticancer therapy, and COVID-19 complications, patients diagnosed in the first outbreak had an increased risk of death at 14 days (hazard ratio [HR], 1.85; 95% CI, 1.47-2.32) and 3 months (HR, 1.28; 95% CI, 1.08-1.51) compared with those diagnosed in the second outbreak. CONCLUSIONS AND RELEVANCE The findings of this registry-based study suggest that mortality in patients with cancer diagnosed with COVID-19 has improved in Europe; this improvement may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.
- Published
- 2021