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Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience.

ABSTRACT: Background:This study aims to compare the outcomes of COVID-19-positive disease in patients with a history of cancer to those without. Methods:We retrospectively collected clinical data and outcomes of COVID-19 positive cancer patients treated consecutively in five North London hospitals (cohort A). Outcomes recorded included time interval between most recent anti-cancer treatment and admission, severe outcome [a composite endpoint of intensive care unit (ITU) admission, ventilation and/or death] and mortality. Outcomes were compared with consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (1 March-30 April 2020). Patients were matched for age, gender and comorbidity. Results:The median age in both cohorts was 74?years, with 67% male, and comprised of 30 patients with cancer, and 90 without (1:3 ratio). For cohort B, 579 patients without a history of cancer and consecutively admitted were screened from the primary London hospital, 105 were COVID-19 positive and 90 were matched and included. Excluding cancer, both cohorts had a median of two comorbidities. The odds ratio (OR) for mortality, comparing patients with cancer to those without, was 1.05 [95% confidence interval (CI) 0.4-2.5], and severe outcome (OR 0.89, 95% CI 0.4-2.0) suggesting no increased risk of death or a severe outcome in patients with cancer. Cancer patients who received systemic treatment within 28?days had an OR for mortality of 4.05 (95% CI 0.68-23.95), p?=?0.12. On presentation anaemia, hypokalaemia, hypoalbuminaemia and hypoproteinaemia were identified predominantly in cohort A. Median duration of admission was 8 days for cancer patients and 7?days for non-cancer. Conclusion:A diagnosis of cancer does not appear to increase the risk of death or a severe outcome in COVID-19 patients with cancer compared with those without cancer. If a second spike of virus strikes, rational decision making is required to ensure optimal cancer care.

SUBMITTER: Joharatnam-Hogan N

PROVIDER: S-EPMC7493246 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience.

Joharatnam-Hogan Nalinie N Hochhauser Daniel D Shiu Kai-Keen KK Rush Hannah H Crolley Valerie V Wilson William W Sharma Anand A Muhammad Aun A Anwar Muhammad M Vasdev Nikhil N Goldstein Robert R Kantser Ganna G Saha Aramita A Raja Fharat F Bridgewater John J Khan Khurum K

Therapeutic advances in medical oncology 20200914

<h4>Background</h4>This study aims to compare the outcomes of COVID-19-positive disease in patients with a history of cancer to those without.<h4>Methods</h4>We retrospectively collected clinical data and outcomes of COVID-19 positive cancer patients treated consecutively in five North London hospitals (cohort A). Outcomes recorded included time interval between most recent anti-cancer treatment and admission, severe outcome [a composite endpoint of intensive care unit (ITU) admission, ventilati ...[more]

PMID: 32968429

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Project description:ObjectivesCoronavirus disease 2019 is associated with high mortality rates and multiple organ damage. There is increasing evidence that these patients are at risk for various cardiovascular insults; however, there are currently no guidelines for the diagnosis and management of such cardiovascular complications in patients with coronavirus disease 2019. We share data and recommendations from a multidisciplinary team to highlight our institution's clinical experiences and guidelines for managing cardiovascular complications of coronavirus disease 2019.Design setting and patientsThis was a retrospective cohort study of patients admitted to one of six ICUs dedicated to the care of patients with coronavirus disease 2019 located in three hospitals within one academic medical center in Atlanta, Georgia.Measurements/interventionsChart review was conducted for sociodemographic, laboratory, and clinical data. Rates of specific cardiovascular complications were assessed, and data were analyzed using a chi-square or Wilcoxon rank-sum test for categorical and continuous variables. Additionally, certain cases are presented to demonstrate the sub committee's recommendations.Main resultsTwo-hundred eighty-eight patients were admitted to the ICU with coronavirus disease 2019. Of these, 86 died (29.9%), 242 (84.03%) had troponin elevation, 70 (24.31%) had dysrhythmias, four (1.39%) had ST-elevation myocardial infarction, eight (2.78%) developed cor pulmonale, and 190 (65.97%) with shock. There was increased mortality risk in patients with greater degrees of troponin elevation (p < 0.001) and with the development of arrhythmias (p < 0.001), cor pulmonale (p < 0.001), and shock (p < 0.001).ConclusionsWhile there are guidelines for the diagnosis and management of pulmonary complications of coronavirus disease 2019, there needs to be more information regarding the management of cardiovascular complications as well. These recommendations garnered from the coronavirus disease 2019 cardiology subcommittee from our institution will add to the existing knowledge of these potential cardiovascular insults as well as highlight suggestions for the diagnosis and management of the range of cardiovascular complications of coronavirus disease 2019. Additionally, with the spread of coronavirus disease 2019, our case-based recommendations provide a bedside resource for providers newly caring for patients with coronavirus disease 2019.

Dataset Information

Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience.

Publications

Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience.

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