Abstract PO-063: Impact of cancer history on outcomes among hospitalized COVID-19 patients: A case-control analysis
Authors: Klein Isaac , Rosenberg Shoshana , Kotton Camille , Reynolds Kerry , Zubiri Leyre , Gaither Rachel , Freeman Hannah , Kirkner Greg , Rhee Chanu , Klompas Michael , Baker Meghan , Wadleigh Martha , Winer Eric , Partridge Ann 
Published: December 2020

Background: Early reports suggest a possible increased risk of serious complications and death in COVID-19 patients with cancer. However, rigorous comparisons with non-cancer control patients with COVID-19 are lacking.

Methods: We systematically identified all patients with a history of cancer admitted to two major academic medical centers in Boston with symptomatic COVID-19 infections between 03/13/2020 and 05/10/2020. 162 cases were identified, and matched 1:2 by age, gender, race, and admission date with systematically identified controls without a cancer history. Sociodemographics, comorbidities, presenting symptoms, hospital course, and COVID-19 outcomes were extracted from medical records for all patients. Cancer history and treatments were documented for cases. Clinical characteristics and outcomes were compared between cases and controls using conditional logistic regression. Among cancer patients, logistic regression models were fit to identify predictors of death/discharge to hospice.

Results: As of 06/05/2020, among 162 cancer patients (median time since diagnosis, 35.6 [range 0.39-435] months; 80% with solid tumor, 20%, hematologic diagnosis), 27.8% died or were discharged to hospice and 4.3% were still hospitalized. Among the 324 controls, 25.6% died or were discharged to hospice, and 3.1% were still hospitalized. Median duration of hospitalization was 9 days for both cases and controls. The proportion of controls who were intubated (36.1%) was higher than cases (27.2%). The odds of mortality/discharge to hospice (vs. discharge to home/facility) were similar between cancer cases and matched controls (univariable OR: 1.15, 95% CI: 0.73-1.82; multivariable OR: 1.54, 95% CI: 0.90-2.65). In multivariable analyses, cancer patients were more likely to be immunosuppressed (OR: 4.21, 95% CI: 2.42-7.34), to have presented at hospital admission with fatigue (OR: 1.71, 95% CI: 1.05-2.78), and were less likely to have a premorbid neurologic condition (OR: 0.37, 95% CI: 0.16-0.82). Among cancer cases, patients with metastatic disease or who had received cancer-directed therapy in the last 6 months (n=74, 46%) did not have higher odds of death/discharge to hospice following their hospital course (univariable OR: 1.37, 95% CI: 0.68-2.75; multivariable OR: 1.77, 95% CI: 0.80-3.93) compared to patients with no evidence of disease and no treatment within 6 months.

Conclusions: Patients with a history of cancer hospitalized for COVID-19 had similar hospital course and mortality to matched hospitalized COVID-19+ controls without cancer. Additionally, we did not find an association between having metastatic disease or recent cancer treatment and experiencing an adverse outcome. During the onset and surge peak of the COVID-19 crisis in Boston, people with a history of cancer admitted to two large teaching hospitals for COVID-19 infection fared no worse than those without a history of cancer.

Citation Format: Isaac Klein, Shoshana Rosenberg, Camille Kotton, Kerry Reynolds, Leyre Zubiri, Rachel Gaither, Hannah Freeman, Greg Kirkner, Chanu Rhee, Michael Klompas, Meghan Baker, Martha Wadleigh, Eric Winer, Ann Partridge. Impact of cancer history on outcomes among hospitalized COVID-19 patients: A case-control analysis [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 PO-063.