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Raad II, Hachem R, Masayuki N, Datoguia T, Dagher H, Jiang Y, Subbiah V, Siddiqui B, Bayle A, Somer R, Fernández Cruz A, Gorak E, Bhinder A, Mori N, Hamerschlak N, Shelanski S, Dragovich T, Vong Kiat YE, Fakhreddine S, Pierre AH, Chemaly RF, Mulanovich V, Adachi J, Borjan J, Khawaja F, Granwehr B, John T, Yepez EY, Torres HA, Ammakkanavar NR, Yibirin M, Reyes-Gibby CC, Pande M, Ali N, Rojo RD, Ali SM, Deeba RE, Chaftari P, Matsuo T, Ishikawa K, Hasegawa R, Aguado-Noya R, García AG, Puchol CT, Lee DG, Slavin M, Teh B, Arias CA, Kontoyiannis DP, Malek AE, Chaftari AM. International multicenter study comparing COVID-19 in patients with cancer to patients without cancer: Impact of risk factors and treatment modalities on survivorship. eLife 2023; 12:81127. [PMID: 36715684 PMCID: PMC9981148 DOI: 10.7554/elife.81127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Background In this international multicenter study, we aimed to determine the independent risk factors associated with increased 30 day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries. Methods We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020 from 16 international centers. Results We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 without cancer patients. Patients with cancer were more likely to be pancytopenic and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding 2 wk (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin, and procalcitonin) but were less likely to present with clinical symptoms (p≤0.01). By country-adjusted multivariable logistic regression analyses, cancer was not found to be an independent risk factor for 30 day mortality (p=0.18), whereas lymphopenia was independently associated with increased mortality in all patients and in patients with cancer. Older age (≥65y) was the strongest predictor of 30 day mortality in all patients (OR = 4.47, p<0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30 day mortality (OR = 0.64, p=0.036). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30 day mortality rate than those who did not (5.9 vs 17.6%; p=0.03). Conclusions Increased 30 day all-cause mortality from COVID-19 was not independently associated with cancer but was independently associated with lymphopenia often observed in hematolgic malignancy. Remdesivir, particularly in patients with cancer receiving low-flow oxygen, can reduce 30 day all-cause mortality. Funding National Cancer Institute and National Institutes of Health.
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Affiliation(s)
- Issam I Raad
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Ray Hachem
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Nigo Masayuki
- https://ror.org/03gds6c39Division of Infectious Diseases, McGovern Medical School, The University of Texas Health Science Center at HoustonHoustonUnited States
| | - Tarcila Datoguia
- Médica Hematologista Hospital Israelita Albert EinsteinSão PauloBrazil
| | - Hiba Dagher
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Ying Jiang
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Vivek Subbiah
- https://ror.org/0509zzg37MD Anderson Cancer Network, UT MD Anderson Cancer CenterHoustonUnited States
- https://ror.org/04twxam07Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Bilal Siddiqui
- https://ror.org/040cn9093Department of Hematology Oncology, Community Health NetworkIndianapolisUnited States
| | - Arnaud Bayle
- https://ror.org/03xjwb503Department of Medical Oncology, Gustave Roussy, Université Paris-SaclayVillejuifFrance
| | - Robert Somer
- https://ror.org/056nm0533Cooper Medical School of Rowan University, Cooper University Health CareCamdenUnited States
| | - Ana Fernández Cruz
- https://ror.org/01e57nb43Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de HierroMadridSpain
| | - Edward Gorak
- https://ror.org/00v47pv90Department of Hematology Oncology, Baptist HealthJacksonvilleUnited States
| | - Arvinder Bhinder
- https://ror.org/04gqr8882Department of Hematology/Oncology, Ohio Health MarionMarionUnited States
| | - Nobuyoshi Mori
- https://ror.org/002wydw38Department of Infectious Diseases, St. Luke's International HospitalTokyoJapan
| | | | - Samuel Shelanski
- https://ror.org/04cqn7d42Banner MD Anderson Cancer Center – North ColoradoGreelyUnited States
| | - Tomislav Dragovich
- Division of Cancer Medicine, Banner MD Anderson Cancer CenterGilbertUnited States
| | - Yee Elise Vong Kiat
- https://ror.org/032d59j24Department of Medical Oncology, Tan Tock Seng HospitalSingaporeSingapore
| | - Suha Fakhreddine
- https://ror.org/000tqtb97Department of Infectious Diseases, Rafik Hariri University HospitalBeirutLebanon
| | - Abi Hanna Pierre
- https://ror.org/000tqtb97Department of Infectious Diseases, Rafik Hariri University HospitalBeirutLebanon
| | - Roy F Chemaly
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Victor Mulanovich
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Javier Adachi
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Jovan Borjan
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Fareed Khawaja
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Bruno Granwehr
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Teny John
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Eduardo Yepez Yepez
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Harrys A Torres
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Natraj Reddy Ammakkanavar
- https://ror.org/04twxam07Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Marcel Yibirin
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Cielito C Reyes-Gibby
- https://ror.org/04twxam07Department of Emergency Medicine, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Mala Pande
- https://ror.org/04twxam07Department of Gastroenterology, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Noman Ali
- https://ror.org/04twxam07Department of Hospital Medicine, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Raniv Dawey Rojo
- https://ror.org/04twxam07Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Shahnoor M Ali
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Rita E Deeba
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Patrick Chaftari
- https://ror.org/04twxam07Department of Emergency Medicine, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Takahiro Matsuo
- https://ror.org/002wydw38Department of Infectious Diseases, St. Luke's International HospitalTokyoJapan
| | - Kazuhiro Ishikawa
- https://ror.org/002wydw38Department of Infectious Diseases, St. Luke's International HospitalTokyoJapan
| | - Ryo Hasegawa
- https://ror.org/002wydw38Department of Infectious Diseases, St. Luke's International HospitalTokyoJapan
| | - Ramón Aguado-Noya
- https://ror.org/01e57nb43Oncology Department, Hospital Universitario Puerta de Hierro-MajadahondaMadridSpain
| | - Alvaro Garcia García
- https://ror.org/01e57nb43Hematology Department, Hospital Universitario Puerta de Hierro-MajadahondaMadridSpain
| | - Cristina Traseira Puchol
- https://ror.org/01e57nb43Oncology Department, Hospital Universitario Puerta de Hierro-MajadahondaMadridSpain
| | - Dong Gun Lee
- https://ror.org/01fpnj063Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, The Catholic University of KoreaSeoulRepublic of Korea
| | - Monica Slavin
- https://ror.org/02a8bt934Department of Infectious Diseases and National Centre for Infections in Cancer, Peter MacCallum Cancer CentreMelbourneAustralia
| | - Benjamin Teh
- https://ror.org/02a8bt934Department of Infectious Diseases and National Centre for Infections in Cancer, Peter MacCallum Cancer CentreMelbourneAustralia
| | - Cesar A Arias
- https://ror.org/03gds6c39Division of Infectious Diseases, McGovern Medical School, The University of Texas Health Science Center at HoustonHoustonUnited States
| | | | - Dimitrios P Kontoyiannis
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Alexandre E Malek
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
| | - Anne-Marie Chaftari
- https://ror.org/04twxam07Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonUnited States
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Shah YB, Kjelstrom S, Martinez D, Leitenberger A, Manasseh D, Bollmann‐Jenkins M, Partridge A, Kaklamani V, Chlebowski R, Larson S, Weiss M. Risk factors for heightened COVID-19-Related anxiety among breast cancer patients. Cancer Med 2022; 12:3577-3588. [PMID: 36057956 PMCID: PMC9538212 DOI: 10.1002/cam4.5184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted medical care, increased isolation, and exacerbated anxiety in breast cancer patients. Since March 2020, Breastcancer.org experienced a sustained surge in requested pandemic-related information and support. To characterize the pandemic-related experiences of breast cancer patients, we surveyed the Breastcancer.org Community early in the COVID-19 era. METHODS Breastcancer.org Community members were invited to complete an online questionnaire regarding their experience during the pandemic. Self-reported data on demographics, comorbidities, care disruptions, anxiety, coping ability, telemedicine use, and satisfaction with care were collected. Results were analyzed using Stata 16.0 (Stata Corp., Inc). RESULTS Included were 568 current and previous breast cancer patients, primarily with U.S. residence. Overall, 43.8% reported at least one comorbidity associated with severe COVID-19 illness and 61.9% experienced care delays. Moderate to extreme anxiety about contracting COVID-19 was reported by 36.5%, increasing with number of comorbidities (33.0% vs. 55.4%, p = 0.021), current breast cancer diagnosis (30.4% vs. 42.5%, p = 0.011), and poorer coping ability (15.5% vs. 53.9%, p < 0.0001). Moderate to extreme anxiety about cancer care disruptions was reported by 29.1%, increasing with current breast cancer diagnosis (19.1% vs. 38.9%, p < 0.0001), actual delayed care (18.9% vs. 35.3%, p < 0.0001), and poorer coping ability (13.1% vs. 57.7%, p < 0.0001). Most utilized telehealth and found it helpful, but also expressed increased anxiety and subjectively expressed that these were less preferable. CONCLUSION Early in the COVID-19 pandemic, anxiety was reported by a large proportion of breast cancer patients, with increased prevalence in those with risk factors. Attention to mental health is critical, as emotional distress not only harms quality of life but may also compromise outcomes.
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Affiliation(s)
- Yash B. Shah
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA,Breastcancer.orgArdmorePennsylvaniaUSA
| | - Stephanie Kjelstrom
- Main Line Health Center for Population Health ResearchLankenau Institute for Medical ResearchWynnewoodPennsylvaniaUSA,College of Population HealthThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Diana Martinez
- Department of PsychiatryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | | | | | | | - Ann Partridge
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | - Rowen Chlebowski
- The Lundquist Institute, Harbor‐UCLA Medical CenterTorranceCaliforniaUSA
| | - Sharon Larson
- Main Line Health Center for Population Health ResearchLankenau Institute for Medical ResearchWynnewoodPennsylvaniaUSA,College of Population HealthThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Marisa Weiss
- Breastcancer.orgArdmorePennsylvaniaUSA,Radiation OncologyLankenau Medical CenterWynnewoodPennsylvaniaUSA
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Raad I, Hachem R, Masayuki N, Datoguia T, Dagher H, Jiang Y, Subbiah V, Siddiqui B, Bayle A, Somer R, Cruz AF, Gorak E, Bhinder A, Mori N, Hamerschlak N, Shelanski S, Dragivich T, Kiat YEV, Fakhreddine S, Hanna PA, Chemaly RF, Mulanovich V, Adachi J, Borjan J, Khawaja F, Granwehr B, John T, Guevara EY, Torres H, Ammakkanavar NR, Yibirin M, Reyes-Gibby CC, Pande M, Ali N, Rojo RD, Ali SM, Deeba RE, Chaftari P, Matsuo T, Ishikawa K, Hasegawa R, Aguado-Noya R, García-García Á, Puchol CT, Lee DG, Slavin M, Teh B, Arias CA, Kontoyiannis DP, Malek AE, Chaftari AM. International Multicenter Study Comparing Cancer to Non-Cancer Patients with COVID-19: Impact of Risk Factors and Treatment Modalities on Survivorship. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.08.25.22279181. [PMID: 36097568 PMCID: PMC9465833 DOI: 10.1101/2022.08.25.22279181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background In this international multicenter study we aimed to determine the independent risk factors associated with increased 30-day mortality and the impact of novel treatment modalities in a large group of cancer and non-cancer patients with COVID-19 from multiple countries. Methods We retrospectively collected de-identified data on a cohort of cancer and non-cancer patients diagnosed with COVID-19 between January and November 2020, from 16 international centers. Results We analyzed 3966 COVID-19 confirmed patients, 1115 cancer and 2851 non-cancer patients. Cancer patients were more likely to be pancytopenic, and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding two weeks (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin and procalcitonin), but were less likely to present with clinical symptoms (p≤0.01). By multivariable logistic regression analysis, cancer was an independent risk factor for 30-day mortality (OR 1.46; 95% CI 1.03 to 2.07; p=0.035). Older age (≥65 years) was the strongest predictor of 30-day mortality in all patients (OR 4.55; 95% CI 3.34 to6.20; p< 0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30-day mortality (OR 0.58; CI 0.39-0.88; p=0.009). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30-day mortality rate than those who did not (5.9% vs 17.6%; p=0.03). Conclusions Cancer is an independent risk factor for increased 30-day all-cause mortality from COVID-19. Remdesivir, particularly in patients receiving low-flow oxygen, can reduce 30-day all-cause mortality. Condensed Abstract In this large multicenter worldwide study of 4015 patients with COVID-19 that included 1115 patients with cancer, we found that cancer is an independent risk factor for increased 30-day all-cause mortality. Remdesivir is a promising treatment modality to reduce 30-day all-cause mortality.
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Di Felice G, Visci G, Teglia F, Angelini M, Boffetta P. Effect of cancer on outcome of COVID-19 patients: a systematic review and meta-analysis of studies of unvaccinated patients. eLife 2022; 11:74634. [PMID: 35171096 PMCID: PMC8956284 DOI: 10.7554/elife.74634] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Since the beginning of the SARS-CoV-2 pandemic, cancer patients affected by COVID-19 have been reported to experience poor prognosis; however, a detailed quantification of the effect of cancer on outcome of unvaccinated COVID-19 patients has not been performed. Methods: To carry out a systematic review of the studies comparing the outcome of unvaccinated COVID-19 patients with and without cancer, a search string was devised which was used to identify relevant publications in PubMed up to December 31, 2020. We selected three outcomes: mortality, access to ICU, and COVID-19 severity or hospitalization. We considered results for all cancers combined as well as for specific cancers. We conducted random-effects meta-analyses of the results, overall and after stratification by region. We also performed sensitivity analyses according to quality score and assessed publication bias. Results: For all cancer combined, the pooled odds ratio (OR) for mortality was 2.32 (95% confidence interval [CI] 1.82–2.94, I2 for heterogeneity 90.1%, 24 studies), that for ICU admission was 2.39 (95% CI 1.90–3.02, I2 0.0%, 5 studies), that for disease severity or hospitalization was 2.08 (95% CI 1.60–2.72, I2 92.1%, 15 studies). The pooled mortality OR for hematologic neoplasms was 2.14 (95% CI 1.87–2.44, I2 20.8%, 8 studies). Data were insufficient to perform a meta-analysis for other cancers. In the mortality meta-analysis for all cancers, the pooled OR was higher for studies conducted in Asia than studies conducted in Europe or North America. There was no evidence of publication bias. Conclusions: Our meta-analysis indicates a twofold increased risk of adverse outcomes (mortality, ICU admission, and severity of COVID-19) in unvaccinated COVID-19 patients with cancer compared to COVID-19 patients without cancer. These results should be compared with studies conducted in vaccinated patients; nonetheless, they argue for special effort to prevent SARS-CoV-2 infection in patients with cancer. Funding: No external funding was obtained.
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Affiliation(s)
- Giulia Di Felice
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Visci
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Federica Teglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Angelini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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