Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis.

BACKGROUND

Cancer seems to have an independent adverse prognostic effect on COVID-19-related mortality, but uncertainty exists regarding its effect across different patient subgroups. We report a population-based analysis of patients hospitalised with COVID-19 with prior or current solid cancer versus those without cancer.

METHODS

We analysed data of adult patients registered until 24 May 2020 in the Belgian nationwide database of Sciensano. The primary objective was in-hospital mortality within 30 days of COVID-19 diagnosis among patients with solid cancer versus patients without cancer. Severe event occurrence, a composite of intensive care unit admission, invasive ventilation and/or death, was a secondary objective. These endpoints were analysed across different patient subgroups. Multivariable logistic regression models were used to analyse the association between cancer and clinical characteristics (baseline analysis) and the effect of cancer on in-hospital mortality and on severe event occurrence, adjusting for clinical characteristics (in-hospital analysis).

RESULTS

A total of 13 594 patients (of whom 1187 with solid cancer (8.7%)) were evaluable for the baseline analysis and 10 486 (892 with solid cancer (8.5%)) for the in-hospital analysis. Patients with cancer were older and presented with less symptoms/signs and lung imaging alterations. The 30-day in-hospital mortality was higher in patients with solid cancer compared with patients without cancer (31.7% vs 20.0%, respectively; adjusted OR (aOR) 1.34; 95% CI 1.13 to 1.58). The aOR was 3.84 (95% CI 1.94 to 7.59) among younger patients (<60 years) and 2.27 (95% CI 1.41 to 3.64) among patients without other comorbidities. Severe event occurrence was similar in both groups (36.7% vs 28.8%; aOR 1.10; 95% CI 0.95 to 1.29).

CONCLUSIONS

This population-based analysis demonstrates that solid cancer is an independent adverse prognostic factor for in-hospital mortality among patients with COVID-19. This adverse effect was more pronounced among younger patients and those without other comorbidities. Patients with solid cancer should be prioritised in vaccination campaigns and in tailored containment measurements.

Informations de copyright

© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.

Déclaration de conflit d'intérêts

Competing interests: EdA: honoraria and/or advisory board from Roche/GNE, Novartis, SeaGen and Zodiac; travel grants from Roche/GNE and GSK/Novartis; research grants to his institution from Roche/GNE, AstraZeneca, GSK/Novartis and Servier. MB: speaker honoraria and travel grants from Roche/GNE; research grants to her institution from Roche/GNE, AstraZeneca, GSK/Novartis and Servier. HW: his institution received consulting fees and honoraria from AstraZeneca, Biocartis, Lilly, Novartis, Pfizer, PUMA Biotechnology, Roche, Sirtex, Daiichi; his institution received unrestricted research grants from Roche and Novartis; he received travel support from Roche and Pfizer. AL: no conflicts of interest to disclose. SA: speaker fees from BMS, AstraZeneca, Roche, Sanofi and Novartis; travel grants from Pfizer, Roche; advisory board fee from Sanofi and Pierre Fabre. CF: advisory board fee from Lilly. JC: advisory board and lectures from Amgen, Servier, Bayer, Novartis, Pfizer, Celgen, Ipsen (paid to institution); travel grants from Roche, Pfizer, Amgen, Novartis. WL: honoraria and/or advisory board from BMS, MSD, Novartis, IPSEN and Bayer; travel support from Roche, MSD and IPSEN. JV: no conflicts of interest to disclose. AR: honoraria and/or advisory board from Sanofi, BMS, Novartis, Pierre Fabre, Roche; travel support from Roche, BMS, MSD. PV: honoraria and/or advisory board from Roche, Novartis, Pfizer, Lilly, MSD, Merus; travel grants from Roche, AstraZeneca, MSD and Pfizer; speaker fees from Pfizer and Roche (paid to institution). JCG: advisory board and lectures from Ipsen, BMS, Janssen, Bayer, AstraZeneca. WD: honoraria and/or advisory board from Amgen, Pierre Fabre. DVB: no conflicts of interest to disclose JD: no conflicts of interest to disclose. SR: consulting fees and honoraria from J&J, Roche, Pfizer, AstraZeneca, Novartis, Bayer, MSD, BMS, Ipsen; research grants from Roche, BSM and MSD; travel grants from Ipsen, Pfizer, Bayer. TG: no conflicts of interest to disclose. KP: honoraria for advisory/consultancy roles for AstraZeneca, Eli Lilly, Novartis, Pfizer, Pierre Fabre, Hoffmann/La Roche and Vifor Pharma (paid to institution); speaker fees for Eli Lilly, Mundi Pharma, Novartis, Pfizer and Hoffmann/La Roche (paid to institution); research funding from Sanofi (paid to institution); travel support from AstraZeneca, Novartis, Pfizer, PharmaMar and Hoffmann/La Roche.