medwireNews: A geriatric risk index based on readily available clinical factors can identify older adults with cancer who are most at risk for severe COVID-19, researchers report in The Lancet Healthy Longevity.
Arielle Elkrief (McGill University Health Centre, Montreal, Québec, Canada) and co-authors say their study highlights “the need for continued protective strategies for this vulnerable population.”
Elkrief and team used data from the COVID-19 and Cancer Consortium (CCC19) registry to create the CCC19 geriatric risk index, which assesses COVID-19 risk on the basis of age, modified Charlson comorbidity index, and ECOG performance status.
When they applied the index to 5671 CCC19 patients aged 60 years and older (median 72 years) with a current or previous invasive cancer diagnosis and a current or previous laboratory-confirmed COVID-19 diagnosis, they found that 41.7% were categorized as standard risk, 39.1% as intermediate risk, and 19.2% as high risk. The remaining 0.6% were uncategorized due to missing data.
The patients were followed up for a median of 56 days between March 2020 and June 2021. During this time, the investigators observed that individuals in the high-risk category had more severe COVID-19 than standard-risk patients, as measured by higher rates of hospitalization with and without supplemental oxygen, intensive care admission, mechanical ventilation, and death within 30 days of diagnosis.
The proportion of patients with none of these severe outcomes was approximately 50% in the standard-risk group, 30% in the intermediate-risk group, and 13% in the high-risk group.
After adjustment for potential confounders, high- and intermediate-risk patients were a significant 7.24 and 2.55 times more likely to develop severe COVID-19, respectively, than standard-risk patients.
Overall, 16.2% of patients died within 30 days of a COVID-19 diagnosis. The risk for death was a significant 10.70-fold higher among the high-risk patients than the standard-risk patients, at rates of 32.1% and 6.8%, respectively. The mortality rate among the intermediate-risk patients was 18.5% and these individuals were a significant 3.64 times more likely to die within 30 days of a COVID-19 diagnosis than those in the standard-risk group.
The researchers note that although cough, fever, fatigue or malaise, and dyspnea were the most common symptoms at presentation, altered mental state was a more common presenting symptom in patients aged 80 years and older compared with younger patients.
Elkrief et al conclude: “Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality.”
In an accompanying comment, Nicolò Battisti and colleagues from The Royal Marsden NHS Foundation Trust in Sutton, UK, say that the study findings “have key implications to better inform both individual patient management and public health initiatives.”
They write: “At the individual level, identification of frailty in older patients with cancer allows timely multidisciplinary interventions to address geriatric impairments and minimise adverse outcomes and maintain the benefits of anticancer therapy and quality of life in this population, even during the pandemic.”
Furthermore, “[a]t population level, the findings of this study are important to better inform mitigation risk strategies aiming to protect the most vulnerable individuals in the general population,” the commentators remark.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
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Lancet Healthy Longev 2022; doi:10.1016/S2666-7568(22)00009-5
Lancet Healthy Longev 2022; doi:10.1016/S2666-7568(22)00026-5