학술논문
Time-Dependent COVID-19 Mortality in Patients With Cancer: An Updated Analysis of the OnCovid Registry
Document Type
Article
Author
Pinato, David J.; Patel, Meera; Scotti, Lorenza; Colomba, Emeline; Dolly, Saoirse; Loizidou, Angela; Chester, John; Mukherjee, Uma; Zambelli, Alberto; Dalla Pria, Alessia; Aguilar-Company, Juan; Bower, Mark; Salazar, Ramon; Bertuzzi, Alexia; Brunet, Joan; Lambertini, Matteo; Tagliamento, Marco; Pous, Anna; Sita-Lumsden, Ailsa; Srikandarajah, Krishnie; Colomba, Johann; Pommeret, Fanny; Seguí, Elia; Generali, Daniele; Grisanti, Salvatore; Pedrazzoli, Paolo; Rizzo, Gianpiero; Libertini, Michela; Moss, Charlotte; Evans, Joanne S.; Russell, Beth; Harbeck, Nadia; Vincenzi, Bruno; Biello, Federica; Bertulli, Rossella; Ottaviani, Diego; Liñan, Raquel; Rossi, Sabrina; Carmona-García, M. Carmen; Tondini, Carlo; Fox, Laura; Baggi, Alice; Fotia, Vittoria; Parisi, Alessandro; Porzio, Giampero; Queirolo, Paola; Cruz, Claudia Andrea; Saoudi-Gonzalez, Nadia; Felip, Eudald; Roqué Lloveras, Ariadna; Newsom-Davis, Thomas; Sharkey, Rachel; Roldán, Elisa; Reyes, Roxana; Zoratto, Federica; Earnshaw, Irina; Ferrante, Daniela; Marco-Hernández, Javier; Ruiz-Camps, Isabel; Gaidano, Gianluca; Patriarca, Andrea; Bruna, Riccardo; Sureda, Anna; Martinez-Vila, Clara; Sanchez de Torre, Ana; Berardi, Rossana; Giusti, Raffaele; Mazzoni, Francesca; Guida, Annalisa; Rimassa, Lorenza; Chiudinelli, Lorenzo; Franchi, Michela; Krengli, Marco; Santoro, Armando; Prat, Aleix; Tabernero, Josep; Van Hemelrijck, Mieke; Diamantis, Nikolaos; Gennari, Alessandra; Cortellini, Alessio
Source
JAMA Oncology; January 2022, Vol. 8 Issue: 1 p114-122, 9p
Subject
Language
ISSN
23742437; 23742445
Abstract
IMPORTANCE: Whether the severity and mortality of COVID-19 in patients with cancer have improved in terms of disease management and capacity is yet to be defined. OBJECTIVE: To test whether severity and mortality from COVID-19 among patients with cancer have improved during the course of the pandemic. DESIGN, SETTING, AND PARTICIPANTS: OnCovid is a European registry that collects data on consecutive patients with solid or hematologic cancer and COVID-19. This multicenter case series study included real-world data from 35 institutions across 6 countries (UK, Italy, Spain, France, Belgium, and Germany). This update included patients diagnosed between February 27, 2020, and February, 14, 2021. Inclusion criteria were confirmed diagnosis of SARS-CoV-2 infection and a history of solid or hematologic cancer. EXPOSURES: SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: Deaths were differentiated at 14 days and 3 months as the 2 landmark end points. Patient characteristics and outcomes were compared by stratifying patients across 5 phases (February to March 2020, April to June 2020, July to September 2020, October to December 2020, and January to February 2021) and across 2 major outbreaks (February to June 2020 and July 2020 to February 2021). RESULTS: At data cutoff, 2795 consecutive patients were included, with 2634 patients eligible for analysis (median [IQR] age, 68 [18-77] years ; 52.8% men). Eligible patients demonstrated significant time-dependent improvement in 14-day case-fatality rate (CFR) with estimates of 29.8% (95% CI, 0.26-0.33) for February to March 2020; 20.3% (95% CI, 0.17-0.23) for April to June 2020; 12.5% (95% CI, 0.06-22.90) for July to September 2020; 17.2% (95% CI, 0.15-0.21) for October to December 2020; and 14.5% (95% CI, 0.09-0.21) for January to February 2021 (all P < .001) across the predefined phases. Compared with the second major outbreak, patients diagnosed in the first outbreak were more likely to be 65 years or older (974 of 1626 [60.3%] vs 564 of 1008 [56.1%]; P = .03), have at least 2 comorbidities (793 of 1626 [48.8%] vs 427 of 1008 [42.4%]; P = .001), and have advanced tumors (708 of 1626 [46.4%] vs 536 of 1008 [56.1%]; P < .001). Complications of COVID-19 were more likely to be seen (738 of 1626 [45.4%] vs 342 of 1008 [33.9%]; P < .001) and require hospitalization (969 of 1626 [59.8%] vs 418 of 1008 [42.1%]; P < .001) and anti–COVID-19 therapy (1004 of 1626 [61.7%] vs 501 of 1008 [49.7%]; P < .001) during the first major outbreak. The 14-day CFRs for the first and second major outbreaks were 25.6% (95% CI, 0.23-0.28) vs 16.2% (95% CI, 0.13-0.19; P < .001), respectively. After adjusting for country, sex, age, comorbidities, tumor stage and status, anti–COVID-19 and anticancer therapy, and COVID-19 complications, patients diagnosed in the first outbreak had an increased risk of death at 14 days (hazard ratio [HR], 1.85; 95% CI, 1.47-2.32) and 3 months (HR, 1.28; 95% CI, 1.08-1.51) compared with those diagnosed in the second outbreak. CONCLUSIONS AND RELEVANCE: The findings of this registry-based study suggest that mortality in patients with cancer diagnosed with COVID-19 has improved in Europe; this improvement may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.