Deaths with COVID-19 declined in patients with cancers

December 2021 Covid-19 Nalinee Pathak

A recent study by Dr. Dravid Pinato and colleagues published in JAMA oncology has documented how the COVID-19 related mortality of cancer patients has improved through the pandemic in Europe.

The OnCovid registry enrolled SARS-CoV-2 positive adult cancer patients who had either solid tumors or hematological malignancies. Until March 1, 2021 (database lock), the registry has enrolled 2634 patients diagnosed with COVID-19 (from February 27, 2020, through February 14, 2021) from 35 institutions across six European countries.

The researchers hypothesized that the mortality from COVID-19 varied during the pandemic. Towards this, they analyzed clinical characteristics with mortality by clustering patients in five time periods of COVID-19 infection: (1) February to March 2020, (2) April to June 2020, (3) July to September 2020, (4) October to December 2020, and (5) January to February 2021. In addition, for estimating a more detailed risk of death at 14 days and 3 months, the team grouped patients in two major outbreak periods (February-June 2020 and July 2020-February 2021) as well.

Major Findings

All-cause case fatality rate (CFR) was measured at 14 days (considered COVID-19-related endpoint) and 3 months (considered a cancer-related endpoint). The survival analysis including 2423 patients revealed significant improvement in 14-day CFR throughout 5 time periods. The 14-day CFR during the first time period (29.8%) was reduced to almost half in the last time-period (14.5%) (p<0.0001).  In addition, the rate of severe COVID-19 (defined as having at least 1 complication from COVID-19) showed a significant drop from 51.3% (first time period) to 38.7% in the last time period (p<0.0001).

The patients during the first outbreak of COVID-19 had an increased risk of death at 14 days and at 3 months (hazard ratio [HR]: 1.69; p<0.0001 and HR: 1.20; p=0.0115, respectively) as compared to those infected during the second outbreak. Next, a multivariable analysis (n=2154) adjusting for sex, age, comorbidities, tumor features, COVID-19, and anticancer therapy revealed that patients diagnosed during the first outbreak had an increased risk of death at 14 days (HR: 1.85) and at 3 months (HR: 1.28) as compared to those diagnosed during the second outbreak.

Conclusion

The findings from the registry of cancer patients with COVID-19 suggest that the mortality among these patients has improved during pandemic. This improvement was probably associated with early diagnosis and improved disease management.

Reference

OnCovid Study Group, Pinato DJ, Patel M, Scotti L, Colomba E, Dolly S, Loizidou A, et al. Time-Dependent COVID-19 Mortality in Patients with Cancer: An Updated Analysis of the OnCovid Registry. JAMA Oncol. 2021 Nov 24. doi: 10.1001/jamaoncol.2021.6199. Epub ahead of print. PMID: 34817562.

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