COVID-19 Prognosis Improved Over Time for Cancer Patients

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The prognosis of COVID-19 in patients with cancer has improved over time, according to a study presented at the European Society for Medical Oncology (ESMO) Congress 2021.

An analysis of patients in the OnCovid registry showed a significant, time-dependent decrease in COVID-19 severity and COVID-related death.


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“I think this is a very important finding because it suggests that improved testing capacity, clinical management, and also better health care policies have guided us through this difficult time,” said David J. Pinato, MD, of Imperial College, London, who presented the study results at ESMO 2021.

Dr Pinato explained that the OnCovid registry (ClinicalTrials.gov Identifier: NCT04393974) enrolls adults with a confirmed SARS-CoV-2 infection who have solid tumors or hematologic malignancies. Thus far, the registry has enrolled patients from 35 institutions across 6 countries in Europe.

The current study included 2634 patients diagnosed with COVID-19 from February 27, 2020, through February 14, 2021.

The researchers analyzed clinical characteristics and outcomes during 5 time periods — February-March 2020, April-June 2020, July-September 2020, October-December 2020, and January-February 2021.

The team also studied predictors of mortality across 2 time periods corresponding to 2 COVID-19 outbreaks —February-June 2020 and July 2020-February 2021.

Results Across 5 Time Periods

The researchers measured the all-cause case fatality rate (CFR) at 14 days, which was considered a COVID-19-related endpoint, and the all-cause CFR at 3 months, which was considered a cancer-related endpoint.

The survival analysis included 2423 patients, and results revealed a significant, time-dependent improvement in 14-day CFR throughout the 5 time periods. The 14-day CFR decreased from 29.8% in the first time period to 14.5% in the last time period (P <.0001).

Dr Pinato noted that the 14-day CFRs in each time period were inversely proportional to testing capacity, which increased steadily over time.

The researchers also found that the rate of severe COVID-19 (defined as having at least 1 complication from COVID-19) decreased from 51.3% in the first time period to 38.7% in the last time period (P <.0001).

The time from symptom onset to COVID-19 diagnosis decreased from 4 days in April-June 2020 to 1 day in October-December 2020 (P <.0001), although it rebounded to 2 days in January-February 2021.

First vs Second Outbreak

When compared with patients who had COVID-19 during the second outbreak, patients diagnosed during the first outbreak had an increased risk of death at 14 days (hazard ratio [HR], 1.69; P <.0001) and at 3 months (HR, 1.20; P =.0115).

A multivariable analysis showed similar results. The analysis included 2154 patients and was adjusted for sex, age, comorbidities, tumor features, COVID-19 and anticancer therapy, and COVID-19 complications.

Again, compared with patients diagnosed during the second COVID-19 outbreak, patients diagnosed during the first outbreak had an increased risk of death at 14 days (HR, 1.85) and at 3 months (HR, 1.28).

“Despite differences in ages, comorbid burden, and oncological features, we are documenting a time-dependent improvement in the prognosis of COVID-19 in patients with cancer,” Dr Pinato said.

“Despite the limitations stemming from the multinational registry nature of the study, we provide a contemporary portrait of mortality and severity, highlighting, if anything, the importance of testing in this particular unresolved pandemic,” he added.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of ESMO 2021 by visiting the conference page.

Reference

Pinato DJ, Patel M, Lambertini M, et al. Time-dependent improvement in clinical outcomes from COVID-19 in cancer patients: An updated analysis of the OnCOVID registry. Presented at: European Society for Medical Oncology (ESMO) Congress 2021; September 16-21, 2021. Abstract 1565MO.



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