Risk factors for in-hospital mortality in patients with cancer and COVID-19
Authors: Guosen Zhang, Yang An, Lu Zhang, Longxiang Xie, Xiangqian Guo
Journal: The Lancet Oncology (2020)

We read with great interest the excellent research by Kunyu Yang and colleagues1Yang K Sheng Y Huang C et al.Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID–19 in Hubei, China: a multicentre, retrospective, cohort study.Lancet Oncol. 2020; 21: 904-913Summary Full Text Full Text PDF PubMed Scopus (404) Google Scholar in The Lancet Oncology. The results indicated that receiving chemotherapy within 4 weeks before symptom onset was associated with increased odds of death (odds ratio [OR] 3·51, 95% CI 1·16–10·59; p=0·026) in patients with cancer and COVID-19, adjusted for sex, cancer type, and time since cancer diagnosis. Although we applaud the authors' efforts, we have some questions for the authors and would appreciate some additional information about the research. First, older age (≥60 years) has been proved as a significant independent predictor of mortality in both patients with cancer and patients with COVID-19.2Siegel RL Miller KD Jemal A Cancer statistics, 2019.CA Cancer J Clin. 2019; 69: 7-34Crossref PubMed Scopus (16288) Google Scholar, 3CDC COVID-19 Response TeamSevere outcomes among patients with coronavirus disease 2019 (COVID–19)–United States, Feb 12–March 16, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 343-346Crossref PubMed Scopus (1557) Google Scholar However, the authors excluded this risk factor because of no significant difference in age between the survival group and non-survival group, explaining that their study was comprised of an older population (median age 63 years). We cannot completely accept this elucidation because we found that patients aged younger than 60 years accounted for 86 (42%) of the 205 patients in this study, and they did not belong to the older age group. We think that the explanation might be that patients with haematological malignancies were younger (median age 55 years vs 63 years) but accounted for a higher proportion of mortality (41% vs 20%) compared with the overall patient cohort. As a result, haematological malignancies might increase the odds of death in young people with COVID-19. Therefore, age could be an important factor affecting the risk of mortality in this study, and the results should be presented after adjusting for age. Second, in the group of patients receiving chemotherapy within 4 weeks before symptom onset, 9 (29%) of 31 patients received other anticancer treatments, including targeted therapy or chest radiotherapy concurrently, which also might affect the odds of death. We suggest that the data might be further analysed to evaluate the association of chemotherapy with death after excluding these patients who had received additional treatments. Third, advanced cancer stage has been identified as a risk factor of death for patients with cancer,4Kattan MW Hess KR Amin MB et al.American Joint Committee on Cancer acceptance criteria for inclusion of risk models for individualized prognosis in the practice of precision medicine.CA Cancer J Clin. 2016; 66: 370-374Crossref PubMed Scopus (197) Google Scholar and increased odds of death (OR 3·38; 95% CI 1·33–8·59; p=0·011) in patients with solid tumours and COVID-19 in univariable logistic regression analysis of this study. It would be interesting to know whether or not receiving chemotherapy within 4 weeks before symptom onset is related to death in patients with solid tumours and COVID-19 after adjusting for cancer stage. We declare no competing interests. Risk factors for in-hospital mortality in patients with cancer and COVID-19The COVID-19 pandemic is getting worse globally. We read with interest the recent article by Kunyu Yang and colleagues1 in The Lancet Oncology, which was, to our knowledge, the first to focus on the mortality of COVID-19 in patients with cancer. The authors concluded that receiving chemotherapy within 4 weeks before symptom onset and male sex were independent prognostic factors for in-hospital mortality in patients with cancer and COVID-19. Full-Text PDF Risk factors for in-hospital mortality in patients with cancer and COVID-19 – Authors' replyWe thank Guosen Zhang and colleagues and Kaibo Guo and colleagues for their comments in response to our recent article.1 Full-Text PDF Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort studyPatients with cancer and COVID-19 who were admitted to hospital had a high case-fatality rate. Unfavourable prognostic factors, including receiving chemotherapy within 4 weeks before symptom onset and male sex, might help clinicians to identify patients at high risk of fatal outcomes. Full-Text PDF