Dutch Oncology COVID-19 consortium: Outcome of COVID-19 in patients with cancer in a nationwide cohort study
de Joode, Karlijn; Dumoulin, Daphne W.; Tol, Jolien; Westgeest, Hans M.; Beerepoot, Laurens V.; van den Berkmortel, Franchette W.P.J.; Mutsaers, Pim G.N.J.; van Diemen, Nico G.J.; Visser, Otto J.; Oomen-de Hoop, Esther; Bloemendal, Haiko J.; van Laarhoven, Hanneke W.M.; Hendriks, Lizza E.L.; Haanen, John B.A.G.; de Vries, Elisabeth G.E.; Dingemans, Anne Marie C.; van der Veldt, Astrid A.M.; van Loenhout, C. J.; van der Leest, C. H.; Becker-Commissaris, A.; Borgers, J. S.W.; Terhegggen, F.; van den Borne, B. E.E.M.; van Warmerdam, L. J.C.; van Leeuwen, L.; van der Meer, F. S.; Tiemessen, M. A.; van Diepen, D. M.; Klaver, Y.; Hamberg, A. P.; Libourel, E. J.; Strobbe, L.; Cloos, M.; Geraedts, E. J.; Drooger, J. C.; Heller, R.; de Groot, J. W.B.; Stigt, J. A.; Nuij, V. J.A.A.; Pitz, C. C.M.; Slingerland, M.; Borm, F. J.; Haberkorn, B. C.M.; Westeinde, S. C.van t.; Aarts, M. J.B.; van Putten, J. W.G.; Youssef, M.; Cirkel, G. A.; Herder, G. J.M.; van Rooijen, C. R.; Citgez, E.; Barlo, N. P.; Scholtes, B. M.J.; Koornstra, R. H.T.; Claessens, N. J.M.; Faber, L. M.; Rikers, C. H.; van de Wetering, R. A.W.; Veurink, G. L.; Bouter, B. W.; Houtenbos, I.; Bard, M. P.L.; Herbschleb, K. H.; Kastelijn, E. A.; Brocken, P.; Douma, G.; Jalving, M.; Hiltermann, T. J.N.; Schuurbiers-Siebers, O. C.J.; Suijkerbuijk, K. P.M.; van Lindert, A. S.R.; van de Wouw, A. J.; van den Boogaart, V. E.M.; Bakker, S. D.; Looysen, E.; Peerdeman, A. L.; de Jong, W. K.; Siemerink, E. J.M.; Staal, A. J.; Franken, B.; van Geffen, W. H.; Bootsma, G. P.
(2020) European Journal of Cancer, volume 141, pp. 171 - 184
(Article)
Abstract
AIM OF THE STUDY: Patients with cancer might have an increased risk for severe outcome of coronavirus disease 2019 (COVID-19). To identify risk factors associated with a worse outcome of COVID-19, a nationwide registry was developed for patients with cancer and COVID-19. METHODS: This observational cohort study has been designed
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as a quality of care registry and is executed by the Dutch Oncology COVID-19 Consortium (DOCC), a nationwide collaboration of oncology physicians in the Netherlands. A questionnaire has been developed to collect pseudonymised patient data on patients' characteristics, cancer diagnosis and treatment. All patients with COVID-19 and a cancer diagnosis or treatment in the past 5 years are eligible. RESULTS: Between March 27th and May 4th, 442 patients were registered. For this first analysis, 351 patients were included of whom 114 patients died. In multivariable analyses, age ≥65 years (p < 0.001), male gender (p = 0.035), prior or other malignancy (p = 0.045) and active diagnosis of haematological malignancy (p = 0.046) or lung cancer (p = 0.003) were independent risk factors for a fatal outcome of COVID-19. In a subgroup analysis of patients with active malignancy, the risk for a fatal outcome was mainly determined by tumour type (haematological malignancy or lung cancer) and age (≥65 years). CONCLUSION: The findings in this registry indicate that patients with a haematological malignancy or lung cancer have an increased risk of a worse outcome of COVID-19. During the ongoing COVID-19 pandemic, these vulnerable patients should avoid exposure to severe acute respiratory syndrome coronavirus 2, whereas treatment adjustments and prioritising vaccination, when available, should also be considered.
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Keywords: Aged, COVID-19/epidemiology, Cohort Studies, Female, Humans, Incidence, Male, Middle Aged, Neoplasms/epidemiology, Netherlands/epidemiology, Pandemics, Registries, Risk Factors, Treatment Outcome, Cancer treatment, Pandemic, COVID-19, Coronavirus, Cancer, Observational Study, Journal Article
ISSN: 0959-8049
Publisher: Elsevier Limited
Note: Funding Information: Although chemotherapy has previously been identified as a risk factor for mortality of COVID-19 in cancer patients [ 21 ], this could not be confirmed in our registry. This is supported by data from a UK registry [ 9 ]. However, steroid use at the time of COVID-19 diagnosis was associated with an increased risk of fatal outcome of COVID-19 in univariable analysis. This result is of particular interest, as a recent randomised clinical trial showed that dexamethasone decreases mortality of COVID-19 in patients requiring respiratory support [ 22 ]. Steroids may contribute to an increased viral load of SARS-CoV-2 by an increase in viral replication and a delay of viral clearance [ 23 ]. Steroid co-medication is usually prescribed as supportive medication for haematological treatment and/or highly emetogenic chemotherapy regimens. Therefore, systemic treatment or disease itself cannot be excluded as confounding factor. Funding Information: Although chemotherapy has previously been identified as a risk factor for mortality of COVID-19 in cancer patients [21], this could not be confirmed in our registry. This is supported by data from a UK registry [9]. However, steroid use at the time of COVID-19 diagnosis was associated with an increased risk of fatal outcome of COVID-19 in univariable analysis. This result is of particular interest, as a recent randomised clinical trial showed that dexamethasone decreases mortality of COVID-19 in patients requiring respiratory support [22]. Steroids may contribute to an increased viral load of SARS-CoV-2 by an increase in viral replication and a delay of viral clearance [23]. Steroid co-medication is usually prescribed as supportive medication for haematological treatment and/or highly emetogenic chemotherapy regimens. Therefore, systemic treatment or disease itself cannot be excluded as confounding factor.This study was supported by a grant from the Dutch Cancer Society, a non-profit organisation. The Dutch Cancer Society had no role in study design, data collection, data analysis, data interpretation or writing of the report. Publisher Copyright: © 2020 The Author(s)
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