Abstract S10-01: COVID-19 severity and outcomes in hospitalized patients with cancer at a New York City tertiary medical center: A matched cohort study
Authors: Brar Gagandeep , Pinheiro Laura C. , Shusterman Michael , Swed Brandon , Reshentnyak Evgeniya , Soroka Orysya , Chen Frank , Yamshon Samuel , Vaughn John , Martin Peter , Paul Doru , Hidalgo Manuel , Shah Manish A. 
Published: December 2020

Background: New York City has been at the epicenter of the SARS-CoV-2 (COVID-19) pandemic. Immunocompromised cancer patients may be more vulnerable to COVID-related morbidity and mortality. The objectives of this study were to determine if patients with cancer have worse outcomes compared to their noncancer counterparts and to identify potential demographic and clinical predictors of morbidity and mortality among cancer patients.

Methods: We used data from a retrospective observational cohort of adult patients who tested positive for COVID-19 at New York-Presbyterian hospitals between March 3 and April 25, 2020. Patients with active cancer were matched 1:4 to noncancer controls on age, gender, and diabetes status. Using Kaplan-Meier curves and the log-rank test, we compared morbidity (intensive care unit admission and intubation) and mortality outcomes between cancer patients and controls. We identified demographic and clinical predictors of worse outcomes using Cox Proportional Hazard models. Hazard ratios and 95% confidence intervals were calculated for all estimates.

Results: We included 445 COVID-19 positive adult patients of whom 89 had active malignancy. Among cancer patients, the median age was 72 years, 54% were male, and 52% were non-white. Presenting symptoms were similar between cancer and noncancer groups. Nearly half of cancer patients were on active treatment including cytotoxic and immunosuppressive therapy, and 40.9% of patients received cytotoxic treatment within 90 days of admission. Both patients with and without cancer received hydroxychloroquine in similar proportions (64% vs. 65.5%), and more cancer patients received remdesivir (7.9% vs. 3.7%). Overall, age (HR 1.14; 95% CI 1.00-1.29; p=0.049), male sex (HR 1.43; 95% CI 1.04-1.96, p=0.07), dyspnea on presentation (HR 1.81, 95% CI 1.3-2.58; p=0.0005), and bilateral lung infiltrates (HR 1.94; 95% CI 1.30-2.89; p=0.001) were associated with worse outcomes. Observed complications were similar for cancer and noncancer patients, including myocardial infarction (3.4% vs. 4.2%), vasopressor requirements (24.7% vs. 26.2%), bacteremia (9% vs. 10.4%), and venous thromboembolic events (7.9% vs. 7.3%), respectively. There were no statistically significant differences in morbidity or mortality between cancer and noncancer patients (p=0.287).

Conclusion: We demonstrate that COVID-19 hospitalized patients with active malignancies have comparable morbidity and mortality to patients without cancer. In contrast to previous findings, we observed no differences in risk of ICU admission, intubation, or death between cancer and noncancer patients. Our findings suggest that active malignancy may not be a contributive risk factor in comparison to other significant comorbidities that may be more responsible for the unfavorable prognosis of COVID-19 in cancer patients. We should consider the consequences of limiting care for cancer patients on cancer-specific outcomes and mortality in the context of COVID-19.

Citation Format: Gagandeep Brar, Laura C. Pinheiro, Michael Shusterman, Brandon Swed, Evgeniya Reshentnyak, Orysya Soroka, Frank Chen, Samuel Yamshon, John Vaughn, Peter Martin, Doru Paul, Manuel Hidalgo, Manish A. Shah. COVID-19 severity and outcomes in hospitalized patients with cancer at a New York City tertiary medical center: A matched cohort study [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S10-01.