A recent study by Dr. Dravid Pinato and colleagues published in JAMA oncology has documented how the COVID-19 related mortality of cancer patients has improved through the pandemic in Europe.
The OnCovid registry enrolled SARS-CoV-2 positive adult cancer patients who had either solid tumors or hematological malignancies. Until March 1, 2021 (database lock), the registry has enrolled 2634 patients diagnosed with COVID-19 (from February 27, 2020, through February 14, 2021) from 35 institutions across six European countries.
The researchers hypothesized that the mortality from COVID-19 varied during the pandemic. Towards this, they analyzed clinical characteristics with mortality by clustering patients in five time periods of COVID-19 infection: (1) February to March 2020, (2) April to June 2020, (3) July to September 2020, (4) October to December 2020, and (5) January to February 2021. In addition, for estimating a more detailed risk of death at 14 days and 3 months, the team grouped patients in two major outbreak periods (February-June 2020 and July 2020-February 2021) as well.
All-cause case fatality rate (CFR) was measured at 14 days (considered COVID-19-related endpoint) and 3 months (considered a cancer-related endpoint). The survival analysis including 2423 patients revealed significant improvement in 14-day CFR throughout 5 time periods. The 14-day CFR during the first time period (29.8%) was reduced to almost half in the last time-period (14.5%) (p<0.0001). In addition, the rate of severe COVID-19 (defined as having at least 1 complication from COVID-19) showed a significant drop from 51.3% (first time period) to 38.7% in the last time period (p<0.0001).
The patients during the first outbreak of COVID-19 had an increased risk of death at 14 days and at 3 months (hazard ratio [HR]: 1.69; p<0.0001 and HR: 1.20; p=0.0115, respectively) as compared to those infected during the second outbreak. Next, a multivariable analysis (n=2154) adjusting for sex, age, comorbidities, tumor features, COVID-19, and anticancer therapy revealed that 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) as compared to those diagnosed during the second outbreak.
The findings from the registry of cancer patients with COVID-19 suggest that the mortality among these patients has improved during pandemic. This improvement was probably associated with early diagnosis and improved disease management.
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