medwireNews: Findings from a single Spanish center suggest that acute respiratory distress syndrome (ARDS) may be the main cause of death in patients undergoing active cancer treatment who are admitted to hospital for COVID-19.
Carlos Gómez-Martin and colleagues, from the Hospital Universitario 12 de Octubre in Madrid, Spain, screened 287 cancer patients for SARS-CoV-2 between 9 March and 19 April 2020, 63 of whom were admitted to hospital with COVID-19.
The hospitalized patients were aged an average 66 years and lung was the most common type of cancer, affecting 27% of these patients, followed by colorectal and breast cancer, affecting 16% of patients each. The majority of patients had metastatic disease (88%) and 96% were receiving active anticancer treatment in the 4 weeks prior to admission, most commonly chemotherapy (58%).
Fever was the most common COVID-19 symptom, present in 89% of patients, followed by malaise, cough, diarrhea, and dyspnea in 70%, 66%, 50%, and 45%, respectively. Rhinorrhea and loss of taste were less frequent, in a corresponding 18% and 8% of patients.
The mortality rate was 25.4%, which, while higher than the recorded rate for the global population in China, is comparable to the actual death rate described among hospitalized patients in China and New York (24.5 and 25.0%, respectively), the researchers report.
Of the 16 patients who died, 37% had lung cancer and 63% had tumor pulmonary involvement.
The incidence of both respiratory failure (54%) and ARDS (38%) were higher than previously reported for cancer patients with COVID-19. Both outcomes were associated with a high rate of mortality, affecting 47% of the 34 patients with respiratory failure and 67% of the 24 with ARDS.
Patients who developed respiratory failure or ARDS were significantly more likely than other patients to present with low mean lymphocyte counts and serum albumin levels and high levels of lactate dehydrogenase and C-reactive protein, and therefore the researchers say alterations in these levels “may discriminate illness severity.”
They also point out that while the mean 7-day interval between COVID-19 symptom onset and respiratory failure was similar to that previously reported for hospitalized Chinese patients without cancer, the mean time to death after symptom onset was shorter in cancer patients, at 12.4 days versus 21.0 days.
“These data may suggest either that oncologic patients may present worse outcomes in a shorter period of time or that [the] global population may have longer time since respiratory deterioration to death owing to the use of mechanical ventilation at [intensive care units],” Gómez-Martin et al speculate.
In multivariate analysis adjusting for risk factors, ARDS was a significant 21.4 times more likely to occur in patients who had bilateral pneumonia, who were in turn 32.8 times more likely to die than other patients.
Patients were also significantly more likely to die if they had severe neutropenia (odds ratio [OR]=16.4), a previous episode of venous thromboembolic disease (VTED; OR=4.8), and pulmonary tumor involvement (OR=4.3).
The authors therefore conclude in the European Journal of Cancer that “ARDS is the main cause of death, and VTED screening as well as assessment of neutropenia, lung involvement and bilateral pneumonia at diagnosis are essential for the management of this high risk and fragile population.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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