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Cited by 1,726COVID-19 and healthcare impactsCOVID-19 Clinical Research StudiesCOVID-19 Impact on Reproduction

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

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Kuderer, Nicole M, Choueiri, Toni K, Shah, Dimpy P, Shyr, Yu, Rubinstein, Samuel M, Rivera, Donna R, Shete, Sanjay, Hsu, Chih-Yuan +228 more·2020·The Lancet
DOI 10.1016/s0140-6736(20)31187-9PMC PMC7255743
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Abstract

Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing.Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53-2·21), male sex (1·63, 1·07-2·48), smoking status (former smoker vs never smoked: 1·60, 1·03-2·47), number of comorbidities (two vs none: 4·50, 1·33-15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11-7·18), active cancer (progressing vs remission: 5·20, 2·77-9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79-4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07-0·84) or the US-Midwest (0·50, 0·28-0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality.Interpretation Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.Funding American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

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Authors
Kuderer, N. M., Choueiri, T. K., Shah, D. P., Shyr, Y., Rubinstein, S. M., Rivera, D. R., Shete, S., Hsu, C.-Y., Desai, A., de Lima Lopes, G., Grivas, P., Painter, C. A., Peters, S., Thompson, M. A., Bakouny, Z., Batist, G., Bekaii-Saab, T., Bilen, M. A., Bouganim, N., Larroya, M. B., Castellano, D., Del Prete, S. A., Doroshow, D. B., Egan, P. C., Elkrief, A., Farmakiotis, D., Flora, D., Galsky, M. D., Glover, M. J., Griffiths, E. A., Gulati, A. P., Gupta, S., Hafez, N., Halfdanarson, T. R., Hawley, J. E., Hsu, E., Kasi, A., Khaki, A. R., Lemmon, C. A., Lewis, C., Logan, B., Masters, T., McKay, R. R., Mesa, R. A., Morgans, A. K., Mulcahy, M. F., Panagiotou, O. A., Peddi, P., Pennell, N. A., Reynolds, K., Rosen, L. R., Rosovsky, R., Salazar, M., Schmidt, A., Shah, S. A., Shaya, J. A., Steinharter, J., Stockerl-Goldstein, K. E., Subbiah, S., Vinh, D. C., Wehbe, F. H., Weissmann, L. B., Wu, J. T.-Y., Wulff-Burchfield, E., Xie, Z., Yeh, A., Yu, P. P., Zhou, A. Y., Zubiri, L., Mishra, S., Lyman, G. H., Rini, B. I., Warner, J. L., Abidi, M., Acoba, J. D., Agarwal, N., Ahmad, S., Ajmera, A., Altman, J., Angevine, A. H., Azad, N., Bar, M. H., Bardia, A., Barnholtz-Sloan, J., Barrow, B., Bashir, B., Belenkaya, R., Berg, S., Bernicker, E. H., Bestvina, C., Bishnoi, R., Boland, G., Bonnen, M., Bouchard, G., Bowles, D. W., Busser, F., Cabal, A., Caimi, P., Carducci, T., Casulo, C., Chen, J. L., Clement, J. M., Chism, D., Cook, E., Curran, C., Daher, A., Dailey, M., Dahiya, S., Deeken, J., Demetri, G. D., DiLullo, S., Duma, N., Elias, R., Faller, B., Fecher, L. A., Feldman, L. E., Friese, C. R., Fu, P., Fu, J., Futreal, A., Gainor, J., Garcia, J., Gill, D. M., Gillaspie, E. A., Giordano, A., Glace, (. G., Grothey, A., Gulati, S., Gurley, M., Halmos, B., Herbst, R., Hershman, D., Hoskins, K., Jain, R. K., Jabbour, S., Jha, A., Johnson, D. B., Joshi, M., Kelleher, K., Kharofa, J., Khan, H., Knoble, J., Koshkin, V. S., Kulkarni, A. A., Lammers, P. E., Leighton, J. C., Lewis, M. A., Li, X., Li, A., Lo, K. M. S., Loaiza-Bonilla, A., LoRusso, P., Low, C. A., Lustberg, M. B., Mahadevan, D., Mansoor, A.-H., Marcum, M., Markham, M. J., Handy Marshall, C., Mashru, S. H., Matar, S., McNair, C., McWeeney, S., Mehnert, J. M., Menendez, A., Menon, H., Messmer, M., Monahan, R., Mushtaq, S., Nagaraj, G., Nagle, S., Naidoo, J., Nakayama, J. M., Narayan, V., Nelson, H. H., Nemecek, E. R., Nguyen, R., Nuzzo, P. V., Oberstein, P. E., Olszewski, A. J., Owenby, S., Pasquinelli, M. M., Philip, J., Prabhakaran, S., Puc, M., Ramirez, A., Rathmann, J., Revankar, S. G., Rho, Y. S., Rhodes, T. D., Rice, R. L., Riely, G. J., Riess, J., Rink, C., Robilotti, E. V., Rosenstein, L., Routy, B., Rovito, M. A., Saif, M. W., Sanyal, A., Schapira, L., Schwartz, C., Serrano, O., Shah, M., Shah, C., Shaw, G., Shergill, A., Shouse, G., Soares, H. P., Solorzano, C. C., Srivastava, P. K., Stauffer, K., Stover, D. G., Stratton, J., Stratton, C., Subbiah, V., Tamimi, R., Tannir, N. M., Topaloglu, U., Van Allen, E., Van Loon, S., Vega-Luna, K., Venepalli, N., Verma, A. K., Vikas, P., Wall, S., Weinstein, P. L., Weiss, M., Wise-Draper, T., Wood, W. A., Xu, W. (., Yackzan, S., Zacks, R., Zhang, T., Zimmer, A. J., & West, J.
Affiliations
  • Dana-Farber Cancer Institute (US)
  • The University of Texas at San Antonio Health Science Center (US)
  • Vanderbilt-Ingram Cancer Center (US)
  • National Cancer Institute (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • University of Connecticut (US)
  • University of Washington (US)
  • University of Lausanne (CH)
  • Aurora Health Care (US)
  • Jewish General Hospital (CA)
  • Winship Cancer Institute (US)
  • McGill University Health Centre (CA)
  • Hospital Universitario 12 De Octubre (ES)
  • Tisch Cancer Institute (US)
  • Brown University (US)
  • St. Elizabeth Healthcare (US)
  • Stanford University (US)
  • Roswell Park Comprehensive Cancer Center (US)
  • Stamford Hospital (US)
  • Cleveland Clinic (US)
  • Yale University (US)
  • Mayo Clinic (US)
  • Herbert Irving Comprehensive Cancer Center (US)
  • Hartford Hospital (US)
  • University of Kansas Medical Center (US)
  • University of California San Diego (US)
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University (US)
  • Willis-Knighton Cancer Center (US)
  • Harvard University (US)
  • Washington University in St. Louis (US)
  • Louisiana State University Health Sciences Center New Orleans (US)
  • Mount Auburn Hospital (US)
Corresponding author
Warner, Jeremy L
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-06
Volume
395
Issue
10241
Pages
1907-1918
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(20)31187-9
PMC
PMC7255743
OpenAlex
W3030573714
Cited by
1,726
References
39
Citations by year
2026: 30 · 2025: 59 · 2024: 112 · 2023: 234 · 2022: 360 · 2021: 595 · 2020: 332 · 2018: 1 · 2014: 1
FWCI
137.30
Type
journal article
Language
en
Update notices
erratum (2020-09-12)
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • SERVAL (Université de Lausanne) (publishedVersion, other-oa)
  • IRIS (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • American Cancer Society (P30CA016056, MRSG-16-152-01 -CCE)
  • Vanderbilt University (TR000445, UL1‐TR000445)
  • Vanderbilt Institute for Clinical and Translational Research (UL1 TR000445, UL1 TR000445 from NCATS/NIH)
  • Hope Foundation
  • National Institutes of Health (CA- 016672, UL1TR000445, CA023100, CA196521, TR000445, CA-060553, CA016056, CA-068485, CA013696, CA054174, UL1TR001863)
  • National Human Genome Research Institute (T32HG008341)
  • National Cancer Institute (CA068485, CA-054174, P30CA054174, CA 060553, U01CA231840, CA 016672, CA231840, UG1CA189974, CA023100, U10CA180888, CA189974, UG1CA189828, CA196521, CA016056., CA016672 to, CA013696, P50CA098131, P30CA023100, K12CA090625, T32CA009515, P30CA016672, P30CA068485, P30CA016056, P30CA060553, T32CA203703, P30CA013696, P30CA196521)
  • National Center for Advancing Translational Sciences (TR-000445, CA054174)
Topics
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
Keywords
COVID-19 pandemic, SARS-CoV-2, cancer patients, 30-day mortality, prognostic factors, comorbidities, smoking, age, sex differences, breast cancer, prostate cancer, severe illness, mortality risk stratification, cancer survivorship
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Aged, Antiviral Agents, Cause of Death, Female, Humans, Hydroxychloroquine, Male, Middle Aged, Neoplasms, Pneumonia, Viral, Prognosis, Risk Factors, Comorbidity, Databases, Factual, Azithromycin, Coronavirus Infections, Pandemics

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