Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis.
de Azambuja, Evandro; Brandão, Mariana; Wildiers, Hanset al.
[en] 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.
Disciplines :
General & internal medicine
Author, co-author :
de Azambuja, Evandro; Department of Medical Oncology, Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium. Electronic address: evandro.azambuja@bordet.be
Brandão, Mariana; EPI Unit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
Wildiers, Hans; Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
Laenen, Annouschka; Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
Aspeslagh, Sandrine; Department of Medical Oncology, UZ Brussels, Jette, Belgium
Fontaine, Christel; Department of Medical Oncology, UZ Brussels, Jette, Belgium
COLLIGNON, Joëlle ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'oncologie médicale
Lybaert, Willem; Department of Medical Oncology, AZ Nikolaas, Sint-Niklaas, Belgium
Verheezen, Jolanda; Department of Medical Oncology, St. Trudo Hospital, Sint-Truiden, Belgium
Rutten, Annemie; Department of Medical Oncology, GZA Ziekenhuizen, Campus Sint-Augustinus, Wilrijk, Belgium
Vuylsteke, Peter; Department of Medical Oncology, UCLouvain, CHU-UCL Namur, Namur, Belgium, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
Goeminne, Jean-Charles; Department of Medical Oncology, UCLouvain, CHU-UCL Namur, Namur, Belgium
Demey, Wim; Department of Medical Oncology, AZ Klina, Brasschaat, Belgium
Van Beckhoven, Dominique; Epidemiology and Public Health, Sciensano, Ixelles, Belgium
Deblonde, Jessika; Epidemiology and Public Health, Sciensano, Ixelles, Belgium
Rottey, Sylvie; Department of Medical Oncology, Gent University Hospital, Gent, Belgium
Geukens, Tatjana; Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium
Punie, Kevin; Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
Belgian Collaborative Group on COVID-19 Hospital Surveillance and the Belgian Society of Medical Oncology (BSMO)
Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis.
The authors would like to acknowledge all hospitals and healthcare professionals who completed the information in the public database; to the Belgian Society of Medical Oncology Executive Board for their full support of this research; to Professor Nuno Lunet, for his comments; to Dr Gilberto Morgan, for proofreading this manuscript; and to Mrs Christie Freeman and Mr H?lio Silva, for collaborating in the video abstract.
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