Patients with cancer sickened by COVID-19 have a crude death rate of 13%, according to the largest series of data released thus far from a multinational perspective. The data on more than 900 patients, published in The Lancet and simultaneously presented at ASCO20 Virtual, also revealed cancer-specific factors associated with increased mortality.
The information is the first report from an ongoing international initiative by the COVID-19 and Cancer Consortium (CCC19) to track outcomes within this vulnerable population. The CCC19 registry was built and is maintained as an electronic REDCap database housed at Vanderbilt University Medical Center.
“People with cancer face a great deal of uncertainty in the era of COVID-19, including whether the balance of risks and benefits in the treatment of cancer has shifted in some fundamental way,” said Jeremy Warner, M.D., associate professor of medicine and bioinformatics at Vanderbilt and the study’s corresponding author.¹
“The death rate for this group of patients as a whole was 13%, more than twice that reported for all patients with COVID-19 (by the Johns Hopkins Center for Systems Science and Engineering),” Warner said. “Certain subgroups, such as patients with active (measurable) cancer and those with an impaired performance status, fared much, much worse.”
“The death rate for this group of patients as a whole was 13%, more than twice that reported for all patients with COVID-19. Certain subgroups… fared much, much worse.”
Factors Increasing Risk
The data in this first report from CCC19 was gathered from 928 patients in Spain, Canada and the United States. These early data showed no statistical association between 30-day mortality and cancer treatments, suggesting that surgery, adjuvant chemotherapy and maintenance chemotherapy could continue during the pandemic with “extreme caution.”
Cancer-specific factors associated with increased mortality included having an ECOG performance status of two or worse. An ECOG score of two designates a patient who is capable of selfcare but unable to work and who is up and about more than 50% during waking hours. Another factor associated with increased mortality was an active cancer status, particularly progressive cancer.
Mortality risk also increased with the number of comorbidities, such as hypertension or diabetes, particularly with two or more comorbidities. As in the non-cancer population, mortality also increased with age. Mortality was 6% for cancer patients younger than 65, 11% for those 65-74 and 25% for those older than 75. Males also had a higher death rate than females, 17% compared to 9%.
CCC19 was formed to rapidly collect data on the effects of the novel coronavirus SARS-CoV-2 and resulting disease COVID-19 on people with cancer. Participants include members of the European Society for Medical Oncology (ESMO), institutions that are National Cancer Institute Designated Cancer Centers, researchers from several nations as well as community-based oncologists within the US. More than 100 institutions have signed up in the US and Canada. ESMO is coordinating efforts in Europe through ESMO-CoCare registry.
“CCC19 has been a massive effort to accumulate clinically-relevant data on a large number of patients with COVID-19 infection,” said Brian Rini, M.D., Ingram Professor of Cancer Research and Chief of Clinical Trials at Vanderbilt-Ingram Cancer Center and a senior author on the study.