Several factors may predict the risk of severe COVID-19, recovery from the disease, and COVID-related death among patients with cancer, according to data presented at the European Society for Medical Oncology (ESMO) Congress 2021.
The findings, from the ESMO CoCARE study, showed that male sex, older age, and hematologic malignancy were all associated with an increased risk of severe COVID-19 and death.
Cancer stage was associated with death but not COVID-19 severity. And although non-Caucasian patients had a greater risk of developing severe COVID-19, Asian patients had a lower risk of death from COVID-19.
These results were presented by Emanuela Romano, MD, PhD, of the Institut Curie in Paris.
Dr Romano explained that ESMO CoCARE is an international, registry-based, cohort study designed to gather real-world data from health care professionals about the natural history, treatment, and outcomes of COVID-19 in patients with cancer.
ESMO CoCARE captures information on patients with any solid or hematologic malignancy (including cancer survivors free of disease for 5 or more years) presenting with a COVID-19 diagnosis in any of the participating centers.
The primary endpoints include COVID-19 severity, recovery from COVID-19, and overall survival.
Dr Romano presented data from 1626 patients treated at 37 centers in 20 countries, most located in Europe (88%). At baseline, the patients’ median age was 64 years, 53% were women, 67% were Caucasian, and 72% had comorbidities.
Exactly half of patients had received their cancer diagnosis within the past year, 90% had solid tumors, 76% had active disease, and 71% were on active cancer treatment.
A majority of patients (81%) had COVID-19 symptoms, 41% experienced complications from COVID-19, and 49% received treatment for COVID-19.
Severe COVID-19, defined as the need for hospitalization, was reported in 64% of patients, and 11% of patients required ICU admission.
In a multivariable analysis, the following factors were associated with an increased risk of severe COVID-19:
- Male sex — odds ratio (OR), 1.37 (P =.019)
- Older age (risk per decade increase) — OR, 1.30 (P <.001)
- Ethnicity other than Caucasian — OR, 1.70 (P =.025)
- Performance status of 2 or higher vs 0-1 — OR, 3.18 (P <.001)
- Having 1 comorbidity vs none — OR, 1.51 (P =.010)
- Having more than 1 comorbidity vs none — OR, 1.75 (P =.0012)
- Progressive disease — OR, 1.89 (P =.0021).
Factors associated with a decreased risk of severe COVID-19 included:
- Solid tumor vs hematologic cancer — OR, 0.51 (P =.0064)
- BMI of 25 or greater — OR, 0.69 (P =.0071)
- Asymptomatic COVID-19 — OR, 0.10 (P <.001).
A majority of patients (80.5%) recovered from COVID-19, including 97% of patients with mild disease and 70% of those with severe disease.
Factors associated with a lower likelihood of COVID-19 recovery included:
- Male sex — OR, 0.52 (P <.001)
- Older age — OR, 0.84 (P =.0022)
- Performance status of 2 or higher vs 0-1 — OR, 0.51 (P <.001)
- Progressive disease — OR, 0.34 (P <.001).
Factors associated with a greater likelihood of COVID-19 recovery included:
- Having stage I-II vs stage IV cancer — OR, 3.11 (P <.001)
- Asymptomatic COVID-19 — OR, 2.19 (P =.029).
There were 1212 patients with survival data available. At a median follow-up of 3.02 months, the overall survival rate was 71.4%.
Factors associated with a higher risk of death included:
- Male sex — hazard ratio (HR), 1.46 (P =.0018)
- Older age — HR, 1.13 (P =.0085)
- Performance status of 2 or higher vs 0-1 — HR, 2.42 (P <.001)
- Current or former smoker vs never smoker — HR, 1.37 (P =.017)
- Having more than 1 comorbidity vs none — HR, 1.48 (P =.0097).
Factors associated with a lower risk of death included:
- Solid tumor vs hematologic cancer — HR, 0.69 (P =.041)
- Stage I-II vs IV disease — HR, 0.37 (P <.001)
- Stage III vs IV disease — HR, 0.68 (P =.045)
- Asian vs Caucasian ethnicity — HR, 0.36 (P =.0019).
Further analyses of associations with outcomes are ongoing, according to Dr Romano.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Romano E, Gennatas S, Rogado J, et al. COVID-19 and cancer: First report of the ESMO international, registry-based, cohort study (ESMO CoCARE). Presented at: European Society for Medical Oncology (ESMO) Congress 2021; September 16-21, 2021. Abstract 1567MO.