medwireNews: Mortality rates have fallen with time among people with cancer and SARS-CoV-2 infection, show data from the European OnCovid registry.
Alessio Cortellini (Imperial College London, UK) and colleagues from the OnCovid Study group say that the improvement “may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.”
Cortellini and team reviewed data for 2634 patients (median age 68 years, 53% men) from six European countries who had a confirmed COVID-19 diagnosis between February 2020 and February 2021 and a history of solid or hematologic cancer.
They report in JAMA Oncology that there was a significant reduction in all-cause case-fatality rates (CFR) at 14 days after a COVID-19 diagnosis from the start to the end of the study period.
Specifically, the estimated 14-day CFRs were:
- 29.8% for February to March 2020;
- 20.3% for April to June 2020;
- 12.5% for July to September 2020;
- 17.2% for October to December 2020; and
- 14.5% for January to February 2021.
There were also significant reductions between the first and fifth time period in the proportion of patients who required hospitalization due to COVID-19 (64.7% of 906 vs 42.7% of 222), oxygen therapy (62.6 vs 46.0%), and mechanical ventilation (12.1 vs 11.8%), while the proportion requiring intensive care was relatively stable (16.0 vs 16.9%).
Conversely, there was a significant increase from the start to the end of the study period in the proportion of patients who acquired COVID-19 during a pre-existing hospitalization (22.4 vs 33.2%), which the investigators say may be due in part to increased hospital screening with time.
Increased testing may also have led to the significant reduction in the median time from symptom onset to COVID-19 diagnosis, from 4 days in April–June 2020 to 1 day in October–December 2020, the researchers note.
Cortellini et al also analyzed the data for the first (February to June 2020) and second (July 2020 to February 2021) major outbreaks. They found that patients diagnosed in the first outbreak were significantly more likely to be aged 65 years or older (60.3% of 1626 vs 56.1% of 1008), have advanced tumors (46.4 vs 56.1%), and have at least two comorbidities (48.8 vs 42.4%) than those diagnosed in the first second outbreak.
There were also more COVID-19 complications (45.4 vs 33.9%), hospitalizations (59.8 vs 42.1%) and anti–COVID-19 therapies used (61.7 vs 49.7%) during the first versus the second outbreak.
During the first outbreak, the 14-day and 3-month CFRs were 25.6% and 37.5%, respectively, which were significantly higher than the corresponding CFRs of 16.2% and 32.1% recorded during the second outbreak.
Furthermore, after adjusting for factors including age, sex, comorbidity, tumor characteristics, anti–COVID-19 and anticancer therapy, and COVID-19 complications, the team observed that patients diagnosed with COVID-19 during the first outbreak had a significant 85% higher risk for death at 14 days and a significant 28% higher risk for death at 3 months than those diagnosed in the second outbreak.
Cortellini and co-authors acknowledge that it is “difficult, if not impossible” to measure the direct impact of improved testing capacity, clinical management, and outcomes of healthcare policies in a multinational registry study.
Nonetheless, they conclude that their findings provide “an important contemporary portrait of the evolving outcomes of COVID-19 in patients with cancer, highlighting the importance of widespread SARS-CoV-2 testing as a strategy to facilitate early diagnosis of COVID-19 and maintain the appropriate therapeutic pathway for patients with cancer despite the ongoing threat of an unresolved global pandemic.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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