Complications and severity of COVID-19 in patients with head and neck cancer (HNC): A COVID-19 and Cancer Consortium (CCC19) registry analysis.
Authors: Vidhya Karivedu, Chih-Yuan Hsu, John F. Deeken, Sachin R Jhawar, Daniel G. Stover, Daniel W. Bowles, Clara Hwang, Rana R. McKay, Erika Ruiz-Garcia, Ziad Bakouny, Arielle Sabbah, Elizabeth Klein, Peter Paul Yu, Michael Glover, Michael Wotman, Eric B. Durbin, Amit Kulkarni, Sibel Blau, Sigrun Hallmeyer, Trisha Michel Wise-Draper
Journal: Journal of Clinical Oncology (2022)

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 &gt;30, 15% had an ECOG performance status &gt;2, and 57% had &gt;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&lt;3 1037&lt;10 &lt;8278 &lt;7845 ECOG&gt;2 15 &lt;10 19 52 Obesity (BMI &gt;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&lt;8 121650 Note: Ordinal levels 3 and 4 not shown due to small case number