Correction: Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score

BackgroundPatients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study.MethodsIn a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets.ResultsWe evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611).ConclusionsSystemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.

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COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic

British Journal of Cancer ◽

10.1038/s41416-021-01324-x ◽

2021 ◽

Author(s):

Alvin J. X. Lee ◽

Karin Purshouse

Keyword(s):

Risk Factors ◽

Performance Status ◽

Poor Performance ◽

Cancer Registries ◽

Adverse Outcomes ◽

Smoking History ◽

Poor Performance Status ◽

International Studies ◽

Patients With Cancer ◽

Increased Risk

AbstractThe SARS-Cov-2 pandemic in 2020 has caused oncology teams around the world to adapt their practice in the aim of protecting patients. Early evidence from China indicated that patients with cancer, and particularly those who had recently received chemotherapy or surgery, were at increased risk of adverse outcomes following SARS-Cov-2 infection. Many registries of cancer patients infected with SARS-Cov-2 emerged during the first wave. We collate the evidence from these national and international studies and focus on the risk factors for patients with solid cancers and the contribution of systemic anti-cancer treatments (SACT—chemotherapy, immunotherapy, targeted and hormone therapy) to outcomes following SARS-Cov-2 infection. Patients with cancer infected with SARS-Cov-2 have a higher probability of death compared with patients without cancer. Common risk factors for mortality following COVID-19 include age, male sex, smoking history, number of comorbidities and poor performance status. Oncological features that may predict for worse outcomes include tumour stage, disease trajectory and lung cancer. Most studies did not identify an association between SACT and adverse outcomes. Recent data suggest that the timing of receipt of SACT may be associated with risk of mortality. Ongoing recruitment to these registries will enable us to provide evidence-based care.

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Oncologist Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network Survey

JCO Oncology Practice ◽

10.1200/op.21.00195 ◽

2021 ◽

pp. OP.21.00195

Author(s):

Amye J. Tevaarwerk ◽

Thevaa Chandereng ◽

Travis Osterman ◽

Waddah Arafat ◽

Jeffrey Smerage ◽

...

Keyword(s):

National Comprehensive Cancer Network ◽

Insurance Coverage ◽

Adverse Outcomes ◽

Advisory Group ◽

Office Visits ◽

Personal Connection ◽

Patients With Cancer ◽

Clinical Scenarios ◽

Cancer Network ◽

Better Than

PURPOSE: The use of telemedicine expanded dramatically in March 2020 following the COVID-19 pandemic. We sought to assess oncologist perspectives on telemedicine's present and future roles (both phone and video) for patients with cancer. METHODS: The National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group formed a Workgroup to assess the state of oncology telemedicine and created a 20-question survey. NCCN EHR Oncology Advisory Group members e-mailed the survey to providers (surgical, hematology, gynecologic, medical, and radiation oncology physicians and clinicians) at their home institution. RESULTS: Providers (N = 1,038) from 26 institutions responded in Summer 2020. Telemedicine (phone and video) was compared with in-person visits across clinical scenarios (n = 766). For reviewing benign follow-up data, 88% reported video and 80% reported telephone were the same as or better than office visits. For establishing a personal connection with patients, 24% and 7% indicated video and telephone, respectively, were the same as or better than office visits. Ninety-three percent reported adverse outcomes attributable to telemedicine visits never or rarely occurred, whereas 6% indicated they occasionally occurred (n = 801). Respondents (n = 796) estimated 46% of postpandemic visits could be virtual, but challenges included (1) lack of patient access to technology, (2) inadequate clinical workflows to support telemedicine, and (3) insurance coverage uncertainty postpandemic. CONCLUSION: Telemedicine appears effective across a variety of clinical scenarios. Based on provider assessment, a substantial fraction of visits for patients with cancer could be effectively and safely conducted using telemedicine. These findings should influence regulatory and infrastructural decisions regarding telemedicine postpandemic for patients with cancer.

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Abstract S01-03: The acute phase response identifies cancer patients with adverse outcomes from SARS-CoV-2 infection as quantified by the OnCovid Inflammatory Score

10.1158/1557-3265.covid-19-21-s01-03 ◽

2021 ◽

Author(s):

Gino M. Dettorre ◽

Saoirse Dolly ◽

Angela Loizidou ◽

John Chester ◽

Amanda Jackson ◽

...

Keyword(s):

Cancer Patients ◽

Acute Phase ◽

Acute Phase Response ◽

Adverse Outcomes ◽

Phase Response ◽

Inflammatory Score

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Troponin I as an Independent Biomarker of Outcome in Children with Systemic Inflammatory Response

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1731432 ◽

2021 ◽

Author(s):

Heitor P. Leite ◽

Rodrigo Medina ◽

Emilio L. Junior ◽

Tulio Konstantyner

Keyword(s):

Inflammatory Response ◽

Chronic Diseases ◽

Troponin I ◽

Elevated Serum ◽

Oxygenation Index ◽

Serum Lactate ◽

Systemic Inflammatory Response ◽

Adverse Outcomes ◽

Critically Ill Children ◽

Logistic Organ Dysfunction

AbstractTroponin I (cTnI) is a biomarker of myocardial injury with implications for clinical outcomes. However, other contributing factors that could affect outcomes have not been uniformly considered in pediatric studies. We tested the hypothesis that there is an association between admission serum cTnI and outcomes in critically ill children taking into account the magnitude of the acute systemic inflammatory response syndrome (SIRS), serum lactate concentrations, and nutritional status of the patient. Second, we tested for potential factors associated with elevated serum cTnI. This was a prospective cohort study in 104 children (median age: 21.3 months) consecutively admitted to a pediatric intensive care unit (PICU) of a teaching hospital with SIRS and without previous chronic diseases. Primary outcome variables were PICU-free days, ventilator-free days, and 30-day mortality. Exposure variables: serum cTnI concentration on admission, revised pediatric index of mortality (PIM2), pediatric logistic organ dysfunction (PELOD-2), hypotensive shock, C-reactive protein, procalcitonin, and serum lactate on admission, and malnutrition. Elevated cTnI (>0.01 μg/L) was observed in 24% of patients, which was associated with the reduction of ventilator-free days (β coefficient = − 4.97; 95% confidence interval [CI]: −8.03; −1.91) and PICU-free days (β coefficient = − 5.76; 95% CI: −8.97; −2.55); all patients who died had elevated serum cTnI. The increase of 0.1 μg/L in cTnI concentration resulted in an elevation of 2 points in the oxygenation index (β coefficient = 2.0; 95% CI: 1.22; 2.78, p < 0.001). The PIM2 score, hypotensive shock in the first 24 hours, and serum lactate were independently associated with elevated cTnI on admission. We conclude that elevated serum cTnI on admission is independently associated with adverse outcomes in children with SIRS and without associated chronic diseases.

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Abstract P537: Reduced Cardiovascular Regenerative Capacity is Associated With Enhanced Inflammatory Response to Acute Psychological Stress

Circulation ◽

10.1161/circ.141.suppl_1.p537 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Zakaria Almuwaqqat ◽

Jeong Hwan Kim ◽

Muhammad Hammadah ◽

Shabatun Islam ◽

Bruno B Lima ◽

...

Keyword(s):

Inflammatory Response ◽

Vascular Function ◽

Mental Stress ◽

Mononuclear Cells ◽

Patient Characteristics ◽

Adverse Outcomes ◽

Regenerative Capacity ◽

Vascular Regeneration ◽

Before And After ◽

Artery Disease

Background: Bone marrow-derived progenitor cells (PCs) are involved in vascular regeneration and correlate with vascular function and cumulative cardiovascular risk. Systemic inflammation is associated with increased mobilization and differentiation of circulating PCs (CPCs) which may ultimately lead to exhaustion of vascular regenerative capacity. Individuals with coronary artery disease (CAD) exhibit a pro-inflammatory response to a mental stress challenge that has been associated with an elevated risk of adverse outcomes. We sought to determine whether subjects with reduced numbers of circulating PCs (CPCs) are at higher risk of a pro-inflammatory response to acute mental stress. Methods: 500 outpatients with stable CAD were enrolled into the Mental Stress Ischemia Prognosis study and underwent a laboratory-based mental stress protocol. Mononuclear cells expressing CD45med, CD34 and CXCR4 epitopes, known to be enriched for hematopoietic PCs, were enumerated using flow cytometry. Interleukin-6 (IL6) and C-Reactive Protein (CRP) levels were measured before and after mental stress. Baseline and changes in IL6 levels were compared across CPC tertiles using linear regression after adjusting for patient characteristics. Results: Mean age was 63± 9 years, 77% male, 70% white. Median CD34+ CPC count was 1.64 (1.02-2.43 cells/μL. CPC levels were not associated with either the baseline IL6 level (Beta= 0.071 95%CI, -0.091, 0.23) or CRP levels (Beta, 0.60, 95%CI, -0.25, 0.44). However, independent of demographics, CAD risk factors and baseline IL6 levels, lower CD34+/CXCR4+ CPC counts were associated with a higher inflammatory response during mental stress, measured as a rise in IL6 level (Beta= -0.11, 95%CI, -0.20, -0.028). Conclusions: Patients with reduced CPC levels have a greater pro-inflammatory response to mental stress. Thus, the observed higher risk in subjects with impaired regenerative capacity might be at least partly due to a higher stress-related pro-inflammatory response.

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SARS-CoV-2 infection in the Italian Veneto region: adverse outcomes in patients with cancer

Nature Cancer ◽

10.1038/s43018-020-0104-9 ◽

2020 ◽

Vol 1 (8) ◽

pp. 784-788 ◽

Cited By ~ 5

Author(s):

Massimo Rugge ◽

Manuel Zorzi ◽

Stefano Guzzinati

Keyword(s):

Adverse Outcomes ◽

Veneto Region ◽

Patients With Cancer

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319O The systemic pro-inflammatory response identifies cancer patients with adverse outcomes from SARS-CoV-2 infection

Annals of Oncology ◽

10.1016/j.annonc.2020.10.313 ◽

2020 ◽

Vol 31 ◽

pp. S1366

Author(s):

G. Dettorre ◽

N. Diamantis ◽

A. Loizidou ◽

M. Piccart ◽

J. Chester ◽

...

Keyword(s):

Inflammatory Response ◽

Cancer Patients ◽

Adverse Outcomes

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Assessment of older patients with cancer: Edmonton Frail Scale (EFS) as a predictor of adverse outcomes in older patients undergoing radiotherapy

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2016.12.006 ◽

2017 ◽

Vol 8 (3) ◽

pp. 206-210 ◽

Cited By ~ 16

Author(s):

Lorna G. Keenan ◽

Michelle O'Brien ◽

Tim Ryan ◽

Mary Dunne ◽

Orla McArdle

Keyword(s):

Older Patients ◽

Adverse Outcomes ◽

Patients With Cancer

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How We Care for an Older Patient With Cancer

Journal of Oncology Practice ◽

10.1200/jop.2016.017608 ◽

2017 ◽

Vol 13 (2) ◽

pp. 95-102 ◽

Cited By ~ 20

Author(s):

Armin Shahrokni ◽

Soo Jung Kim ◽

George J. Bosl ◽

Beatriz Korc-Grodzicki

Keyword(s):

Predictive Models ◽

Older Patients ◽

Process Development ◽

Adverse Outcomes ◽

Added Value ◽

Cancer Center ◽

Multiple Chronic Conditions ◽

Older Patient ◽

Improve Patient Survival ◽

Patients With Cancer

As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient’s needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient’s preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

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