Cancer patients with COVID-19 die at three times the rate of non-cancer patients with the disease, according to findings just released by the COVID-19 & Cancer Consortium, or CCC19.
The patient registry, launched and crowdsourced by cancer researchers from 100-plus institutions including Fred Hutchinson Cancer Research Center, has been tracking, in near-real-time, the impact of the novel coronavirus on cancer patients, amassing data on promising and problematic therapies, mortality rates, comorbidities and more. Their first findings were published in The Lancet in May.
This new data, released by CCC19 at an American Association for Cancer Research meeting and simultaneously published in Cancer Discovery, includes twice as many people — 2,200 cancer patients with COVID-19 — and shows a jump in cancer patient mortality after 30 days.
“In our first analysis of just over 1,000 patients, we discovered that cancer patients with COVID-19 had a mortality rate of 13%. But with this longer follow-up and larger numbers, it is now up to 16%, more than threefold greater than reported in the affected general population,” said the Hutch’s Dr. Gary Lyman, a senior co-author of the study and a member of the national CCC19 steering committee.
Nearly half of the 2,186 cancer patients diagnosed with COVID-19 had mild cases, while 40% were deemed moderate and 12%, severe. Cancer patients in good health with no comorbidities — both in active treatment and remission — had a mortality rate of 4%, slightly higher than that of the U.S. general population, generally cited as between 2 and 3.4% (and notoriously difficult to pinpoint).
When all cancer patients with COVID-19 were cobbled together, though, the mortality rate rose — and it was “much higher in several important subgroups,” Lyman said.
People whose cancer was progressing despite treatment had a mortality rate of 26%, researchers found. People 75 and older had a mortality rate of 27%. And those who displayed poor performance (an ECOG rating of 2 or higher) — people who were unable to work, were confined to bed or disabled — had a mortality rate of 35%. Clinicians use the ECOG Performance Status scale to assess the impact of disease on their patients.
Fred Hutch public health researcher, oncologist and CCC-19 senior co-author Dr. Gary Lyman
Comorbidities, as always, increased the risk for poor outcomes. Other findings from the second analysis of the ever-expanding CCC19 registry:
• Broad use of unproven therapies. Patients continue to receive a range of unproven COVID-19 therapies (49 treatment combos, all told) almost all outside of clinical trials. The most common: hydroxychloroquine plus azithromycin, given to 23% of patients; hydroxychloroquine alone, given to 21% of patients; and azithromycin alone, given to 18% of patients. Seven percent received Remdesivir alone.
• Troubling treatment results. Hydroxychloroquine given with other medications (most commonly, azithromycin) continued to be linked to patient mortality. “We find no evidence for a favorable impact of this treatment, which aligns with the majority of results coming out of other studies including clinical trials,” Lyman said.
• Cancer patients react differently to COVID-19 therapies. The use of high-dose corticosteroids with any other COVID-19 treatment in cancer patients was also associated with more deaths. “Much like hydroxychloroquine, these therapies were given to sicker patients,” Lyman said. “That limits the assessment of benefit or harm and makes it difficult to confirm or refute the U.K. trial, RECOVERY, which showed a benefit in the steroid dexamethasone in critically ill patients in the general population.”
• Remdesivir and racial disparities. This potential treatment, available primarily through clinical trials, continued to show promise in patients with cancer. But Black patients with COVID-19 were half as likely to receive it as white patients. Researchers said their findings pointed to racial disparities in access to certain clinical trial therapies and urged scientists to recruit people of color, especially given they’re “taking the brunt of the pandemic.”
Are cancer patients in Washington state facing treatment delays? Has COVID-19 made health disparities worse in our state?
Fred Hutch public health researchers just received funding to drill down into patient data to assess the impact of the COVID-19 pandemic on the health of Washington state citizens, particularly its cancer patients and underserved populations.
Launched with a $1 million grant from Andy Hill CARE Fund, a Washington state cancer research endowment, Hutch data scientists and epidemiologists will utilize surveys, cancer registries, insurance claims and other data to track the care, outcomes and experiences of cancer patients with COVID-19 as well as assess the pandemic’s impact on cancer screening, cancer care and follow-up in both cancer and non-cancer patients.
Announced last month, the newly established Washington State COVID-19 and Cancer Research Repository is a collaboration between Fred Hutch, the MultiCare Institute for Research & Innovation and the Community Cancer Fund.
Co-investigators for the project include Dr. Scott Ramsey, director of HICOR, the Hutchinson Institute for Cancer Outcomes Research; Dr. Margaret Madeleine in the Hutch’s Epidemiology Program; and Dr. Jay Mendoza, head of the Office of Community Outreach & Engagement, or OCOE.
“Our community partners who focus on underserved populations report many of these people hold essential worker positions and face substantial barriers to safe social distancing,” said Mendoza, who along with OCOE, will lead a survey of Washington state’s general population. “They may also lack personal protective equipment or suffer from food and housing insecurity. These factors, coupled with longstanding structural inequities in health care, have created serious disruptions in cancer screening and cancer care.”
Studies have already shown that African Americans, Latinx populations, Indigenous people and other groups have been disproportionately affected by the pandemic. The new registry will focus particularly on minority patients, those from lower socioeconomic backgrounds and those living in rural areas.
Researchers will survey a representative sample of both cancer patients and the general population to compare outcomes, treatments and disparities in pandemic care or screening; analyze COVID-19 outcomes based on cancer site, tumor characteristics and time since diagnosis; and identify communities with the highest concentrations of COVID-19 and cancer. They will also identify disease clusters throughout the state and examine neighborhood level factors that impact COVID-19 risk.
“This project will provide comprehensive, state-level data on the impact of COVID-19 on cancer patients and the care that they receive,” said Mendoza. “It will also track the impact of the pandemic on access to cancer care, cancer screening and follow-up — in both cancer and non-cancer patients in our state.”
Data from the repository will be available as a web-based tool for researchers and research organizations in Washington state and nationally.
Also just launched, a new serological survey designed to determine just how prevalent the COVID-19 outbreak has been in Washington. A serology test shows whether a person has developed antibodies to an infection, such as COVID-19. Scientists are still working to establish whether humans develop antibodies in response to this new infection and if so, how long they last.
Headed by Hutch and University of Washington virologist Dr. Keith Jerome, the project will enroll, gather data and follow 7,000 people, selected via the state’s census.
Willing participants will receive one diagnostic and three antibody tests over the course of eight months. UW Medicine and its field agents will conduct the tests (serology tests are done through blood while diagnostic tests involve a nasal swab).
Jerome said he hopes the testing will start by the end of July, with initial results on COVID-19’s actual prevalence in the state expected in the fall. Researchers hope the study will also shed light on health disparities as well as show the overall effectiveness of antibodies to this new infection.
Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at firstname.lastname@example.org.
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