Complications and severity of COVID-19 in patients with head and neck cancer (HNC): A COVID-19 and Cancer Consortium (CCC19) registry analysis.
Authors: Karivedu Vidhya , Hsu Chih-Yuan , Deeken John F. , Jhawar Sachin R , Stover Daniel G. , Bowles Daniel W. , Hwang Clara , McKay Rana R. , Ruiz-Garcia Erika , Bakouny Ziad , Sabbah Arielle , Klein Elizabeth , Yu Peter Paul , Glover Michael , Wotman Michael , Durbin Eric B. , Kulkarni Amit , Blau Sibel , Hallmeyer Sigrun , Wise-Draper Trisha Michel ,   COVID-19 and Cancer Consortium
Published: October 2024

6031

Background:
Patients with cancer have worse outcomes from COVID-19 infection. However, the specific impact of COVID-19 on patients with head and neck cancer (HNC) is largely unknown. The COVID-19 and Cancer Consortium (CCC19) maintains an international registry (NCT04354701) aimed to investigate the clinical course and complications of COVID-19 in patients with cancer. Here, we report severity of COVID-19 and its complications among HNC patients.
Methods:
The CCC19 registry was queried for patients with HNC and laboratory confirmed SARS-CoV-2 infection. The co-primary outcomes were severity of COVID-19 illness on an ordinal scale (0: no complications; 1: hospitalized, no oxygen (O2); 2: hospitalized, required O2; 3: ICU admission; 4: mechanical ventilation (MV); 5: death), and severity of complications (mild, moderate, serious). The outcomes were further stratified by demographics, recent treatment (systemic vs local; surgery, radiation (RT) vs systemic), treatment intent (palliative vs curative), and cancer status (remission, responding, stable, progressing).
Results:
From March 2020 to December 2021, 356 HNC patients were identified. Median age was 65 (interquartile range 58-74), 29% were female, 56% were white, 67% were former or current smokers, 20% had a BMI >30, 15% had an ECOG performance status >2, and 57% had >2 comorbidities. 154 (43%) had no complications, 61 (17%) were hospitalized without O2, 135 (38%) were hospitalized with O2, 50 (14%) required ICU, 32 (9%) required MV, and 74 (21%) died. 88 (25%) had mild, 59 (17%) had moderate, and 132 (37%) had serious complications. 33% of patients who received systemic therapy and 30% who received RT within 3 mo prior to COVID-19 diagnosis died. Mortality was higher in patients receiving palliative when compared to curative intent treatment (44% vs 16%). In addition, 50% of patients with actively progressing cancer, and 45% who had serious complications died. Importantly, 37 (n=12 palliative systemic therapy and n=25 local therapy) patients had a treatment delay due to COVID-19 diagnosis.
Conclusions:
Our study is the largest cohort to date describing COVID-19 outcomes in HNC patients and suggest a high rate of mortality even in those receiving local and curative intent treatment. Variables stratified by COVID-19 severity. Note: Ordinal levels 3 and 4 not shown due to small case numbers.

Characteristics
Worst severity of COVID-19 illness

0(N=150)%
1(N=51)%
2(N=60)%
5(N=74)%

Complication severityMildModerateSerious
8425<3
1037<10
<8278
<7845

ECOG>2
15
<10
19
52

Obesity (BMI >30)
49
10
25
10

SmokingNeverFormer/current
4938
1216
1419
1921

Treatment intentCurativePalliative
4825
1615
1915
1644

Treatment modalitySystemic therapyLocal therapy
3430
1910
1128
3327

Cancer statusRemission/NEDResponding/stableProgressing
503925
121814
1824<8
121650

Note: Ordinal levels 3 and 4 not shown due to small case number