May 2021 BSMO Meeting 2021 Tom Feys
Digital 3d rendering illustration of medical care topic.

Presented by: Mariana Brandao, MD (Institut Jules Bordet, Brussels)

Cancer patients have a 13% increase in risk of death from COVID-19 infection, compared to non-cancer patients. This is reflected in the 30-day mortality rate of approximately 13%. Adverse prognostic factors have also been identified.71 However, it is unknown if hospitalised cancer patients present with different signs and symptoms of COVID-19 compared to patients without cancer. Furthermore, the effect on mortality of solid tumours in hospitalised cancer patients is uncertain.

In collaboration with Sciensano, this project compared 30-day morality between patients with prior or current solid cancers, and patients without cancer who were hospitalised with COVID-19. As of May 24th 2020, 12,407 patients in Belgium had been hospitalised with COVID-19, of whom 8.7% had solid cancers (N= 1,187). Surprisingly, these patients actually had fewer symptoms compared to the non-cancer COVID-19 population. In particular, lower rates of fever/chills, fatigue, cough and dyspnoea were observed and radiological lung alterations were less frequently observed in this group. Conversely, however, the 30-day hospital morality rate in patients with solid cancer was higher compared to noncancer patients (31.7% vs. 20.0%. OR[95%CI]: 1.34[1.13–1.58]). Further subgroup analyses revealed that solid cancer patients had a higher likelihood of death at every age group, with this difference being most pronounced in the 60–70 and <60 age ranges. A similar trend was observed in patients with comorbidities, although the largest differences in mortality rate was seen in patients with ≤1 comorbidity. Because of these findings, this study concluded that solid cancer is an independent adverse prognostic factor for 30–day hospital mortality in COVID-19 patients. Furthermore, this effect was most pronounced in younger patients and in those without other comorbidities. Based on these findings, these high-risk patients should be considered in vaccination programs, regardless of age.

Moving forward, a second phase of this study will compare the clinical characteristics and severe event occurrence between patients with active and nonactive solid cancers according to tumour type. The 30-day and 3-month mortality rate will be investigated in these populations as well. Changes to cancer treatment due to the pandemic will also be investigated and a subgroup analysis will investigate toxicities and outcomes, for example, in patients who receive immunotherapy.

BELG J MED ONCOL 2021;15(3):134-44

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