Impact of cancer history on outcomes among hospitalized COVID-19 patients: A case-control analysis
Authors: 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
Journal: Clinical Cancer Research (2020)

Background: Early reports suggest a possible increased risk of serious complications and death in COVID-19patients 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 medicalcenters in Boston with symptomatic COVID-19 infections between 03/13/2020 and 05/10/2020  162 cases wereidentified, and matched 1:2 by age, gender, race, and admission date with systematically identified controls withouta cancer history  Sociodemographics, comorbidities, presenting symptoms, hospital course, and COVID-19outcomes were extracted from medical records for all patients  Cancer history and treatments were documented forcases  Clinical characteristics and outcomes were compared between cases and controls using conditional logisticregression  Among cancer patients, logistic regression models were fit to identify predictors of death/discharge tohospice  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 stillhospitalized  Median duration of hospitalization was 9 days for both cases and controls  The proportion of controlswho 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 tobe 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 thelast 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 noevidence of disease and no treatment within 6 months  Conclusions: Patients with a history of cancer hospitalized for COVID-19 had similar hospital course and mortalityto matched hospitalized COVID-19+ controls without cancer  Additionally, we did not find an association betweenhaving metastatic disease or recent cancer treatment and experiencing an adverse outcome  During the onset andsurge peak of the COVID-19 crisis in Boston, people with a history of cancer admitted to two large teachinghospitals for COVID-19 infection fared no worse than those without a history of cancer