Chemotherapy and COVID-19 Outcomes in Patients With Cancer

PURPOSE Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.

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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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Improving the Pain Experience for Hospitalized Patients With Cancer

10.1188/19.onf.198-207 ◽

2019 ◽

pp. 198-207,

Keyword(s):

Pain Intensity ◽

Hospitalized Patients ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Evidence Based ◽

Pain Experience ◽

Caring Behaviors ◽

Patients With Cancer ◽

Knowledge And Attitudes ◽

Chemotherapy Administration

Purpose: To determine the effect of an evidence-based Pain Stoppers bundled intervention on pain management satisfaction scores and actual pain intensity scores of hospitalized patients with cancer, as well as nurses’ knowledge and attitudes on pain. Participants & Setting: Participants and nurses took part in a preintervention group (n = 173 and 11, respectively) and a postintervention group (n = 157 and 9, respectively) at a National Cancer Institute–designated comprehensive cancer center. Methodologic Approach: A pre- and postintervention design was used. Evidence-based strategies included staff education, improved staff communication, adoption of caring behaviors and timely responses, improved patient education, and efforts to maintain patients’ analgesic levels. Findings: Patient satisfaction with staff improved from preintervention to postintervention. No statistically significant differences were noted in actual pain intensity scores between the groups; however, fewer patients in the postintervention group received chemotherapy within 30 days, and more were admitted for symptom management versus chemotherapy administration. In addition, no difference was noted between RN group scores, although there was statistically significant improvement on individual questions in the postintervention group. Implications for Nursing: Implementation of a Pain Stoppers bundled intervention may be effective in improving the pain experience for hospitalized patients with solid tumor cancers.

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Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

JCO Oncology Practice ◽

10.1200/op.20.01095 ◽

2021 ◽

pp. OP.20.01095

Author(s):

Jessica L. Burris ◽

Tia N. Borger ◽

Brent J. Shelton ◽

Audrey K. Darville ◽

Jamie L. Studts ◽

...

Keyword(s):

Tobacco Use ◽

Cancer Diagnosis ◽

Program Implementation ◽

National Cancer Institute ◽

Retrospective Chart Review ◽

Population Based ◽

Adverse Outcomes ◽

Cancer Center ◽

Patients With Cancer ◽

Tobacco Treatment

PURPOSE: Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute–designated cancer center. METHODS AND MATERIALS: The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS: More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION: Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.

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295. SARS-CoV-2 Infection in a Referral Cancer Center in Mexico City During the First Year of the COVID-19 Pandemic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.497 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S255-S255

Author(s):

Diana Vilar-Compte ◽

Daniel De La Rosa Martinez ◽

Alexandra Martín-Onraet ◽

Carolina Pérez-Jiménez ◽

Beda Islas-Muñoz ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cancer Patients ◽

Metastatic Cancer ◽

Strong Predictor ◽

Invasive Mechanical Ventilation ◽

Adverse Outcomes ◽

Cancer Center ◽

Solid Cancer ◽

Patients With Cancer ◽

Increased Risk

Abstract Background Literature on SARS-CoV-2 infection in cancer patients is scarce in Latin America. This population seems to have a higher risk for adverse outcomes. This study aims to correlate clinical characteristics with outcomes in patients with cancer in a referral center in Mexico. Methods We included patients with cancer and confirmed SARS-CoV-2 infection, from April, 19 to December 30, 2020, at the Instituto Nacional de Cancerología, Mexico. Clinical information was obtained from medical and epidemiological records. We conducted a descriptive analysis. For the association between variables with hospitalization, invasive mechanical ventilation (IMV), and mortality; univariate and multivariate logistic regression was performed; odds ratios and 95% confidence intervals were calculated. Results Four hundred thirty-three patients were included; 268 (62%) were female, the median age was 55 years. One hundred thirty-five (31%), 130 (30%), and 93 (21%) patients had obesity, hypertension, and diabetes mellitus (DM), respectively. Three hundred forty-one (79%) had solid cancer; 82 (19%) hematological malignancy (HM), and 10 (2%) were under evaluation for cancer diagnosis. One hundred seventy (39%) had advanced or metastatic cancer. One hundred ninety-eight (46%) patients were hospitalized. Risk factors were: age (p= 0.001); woman (p=0.019); HM (p=0.050) and advanced or metastatic cancer (p= 0.041). Fourty-five (10%) patients required IMV. Age (p=0.018); DM (p=0.041); C-Reactive Protein (p= 0.002), and LDH (p= 0.033) were associated with invasive mechanical ventilation. Mortality within 30-days after diagnosis was 19% (82 cases). Associated characteristics were: age (p=0.041); lymphocytes (p=0.049); creatinine (p=0.005) and albumin (p=0.001). Conclusion In this study, patients with cancer showed higher mortality, need of hospitalization, and invasive mechanical ventilation compared with groups of patients without cancer. We did not find an increased risk in mortality for hematological malignancies. Although our cohort was younger than others previously reported, age was a strong predictor of adverse outcomes. Variables associated with IMV and death were similar to those previously described in cancer patients with COVID-19. Disclosures All Authors: No reported disclosures

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Thrombosis in the setting of cancer

Hematology ◽

10.1182/asheducation-2016.1.196 ◽

2016 ◽

Vol 2016 (1) ◽

pp. 196-205 ◽

Cited By ~ 22

Author(s):

Michael B. Streiff

Keyword(s):

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Venous Catheter ◽

Patient Characteristics ◽

Adverse Outcomes ◽

Cancer Type ◽

Vte Prophylaxis ◽

Patients With Cancer ◽

First Line Therapy ◽

Cancer Associated Thrombosis

Abstract Venous thromboembolism (VTE) is a common cause of adverse outcomes in patients with cancer. The risk of VTE varies with cancer type, stage and grade, cancer therapy, and supportive care, as well as patient characteristics including age, ethnicity, and inherited and acquired comorbid conditions. VTE prophylaxis should be provided to all hospitalized cancer patients and high-risk outpatients. Low-molecular-weight heparin (LMWH) remains the first-line therapy for VTE in patients with active cancer. Anticoagulation should be continued as long as there is evidence of active disease or patients are receiving cancer treatment. The efficacy of direct oral anticoagulants in the treatment of cancer-associated thrombosis remains incompletely defined. Central venous catheter (CVC)–associated VTE should be treated with anticoagulation alone, unless the CVC is no longer required. Recent studies indicate that anticoagulation may be appropriate for patients with persistent thrombocytopenia or solid tumor brain metastases. Management of recurrent VTE includes the identification of the cause(s) of the recurrence and solutions targeted at addressing the potential precipitants.

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Outcomes of patients with hematologic malignancies and COVID-19: a report from the ASH Research Collaborative Data Hub

Blood Advances ◽

10.1182/bloodadvances.2020003170 ◽

2020 ◽

Vol 4 (23) ◽

pp. 5966-5975 ◽

Cited By ~ 1

Author(s):

William A. Wood ◽

Donna S. Neuberg ◽

J. Colton Thompson ◽

Martin S. Tallman ◽

Mikkael A. Sekeres ◽

...

Keyword(s):

Hematologic Malignancy ◽

Hematologic Malignancies ◽

Adverse Outcomes ◽

Blood Disorders ◽

Patients With Cancer ◽

Non Hodgkin Lymphoma ◽

High Incidence ◽

The World ◽

Report Data ◽

Overall Mortality

Abstract Coronavirus disease 2019 (COVID-19) is an illness resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in late 2019. Patients with cancer, and especially those with hematologic malignancies, may be at especially high risk of adverse outcomes, including mortality resulting from COVID-19 infection. The ASH Research Collaborative COVID-19 Registry for Hematology was developed to study features and outcomes of COVID-19 infection in patients with underlying blood disorders, such as hematologic malignancies. At the time of this report, data from 250 patients with blood cancers from 74 sites around the world had been entered into the registry. The most commonly represented malignancies were acute leukemia (33%), non-Hodgkin lymphoma (27%), and myeloma or amyloidosis (16%). Patients presented with a myriad of symptoms, most frequently fever (73%), cough (67%), dyspnea (50%), and fatigue (40%). Use of COVID-19–directed therapies, such as hydroxychloroquine (n = 76) or azithromycin (n = 59), was common. Overall mortality was 28%. Patients with a physician-estimated prognosis from the underlying hematologic malignancy of <12 months at the time of COVID-19 diagnosis and those with relapsed/refractory disease experienced a higher proportion of moderate/severe COVID-19 disease and death. In some instances, death occurred after a decision was made to forgo intensive care unit admission in favor of a palliative approach. Taken together, these data support the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection. Batch submissions from sites with high incidence of COVID-19 infection are planned to support future analyses.

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

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002277 ◽

2021 ◽

Vol 9 (3) ◽

pp. e002277 ◽

Cited By ~ 1

Author(s):

Gino M Dettorre ◽

Saoirse Dolly ◽

Angela Loizidou ◽

John Chester ◽

Amanda Jackson ◽

...

Keyword(s):

Inflammatory Response ◽

Cancer Progression ◽

Systemic Inflammation ◽

Prognostic Score ◽

Prognostic Index ◽

Glasgow Prognostic Score ◽

Prognostic Nutritional Index ◽

Adverse Outcomes ◽

Patients With Cancer ◽

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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273. Comparative Effectiveness of Ampicillin in the Treatment of Enterococcus faecalis Bloodstream Infections in Patients With Cancer

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.317 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S137-S138

Author(s):

J P Sanchez ◽

German Contreras ◽

Truc T Tran ◽

Shelby Simar ◽

Blake Hanson ◽

...

Keyword(s):

Research Study ◽

Scientific Research ◽

Kidney Injury ◽

Bloodstream Infections ◽

Definitive Treatment ◽

Cancer Center ◽

Future Research ◽

Research Support ◽

Patients With Cancer ◽

Study Investigator

Abstract Background E. faecalis (Efc) isolates are usually susceptible to ampicillin (AMP). AMP-based regimens are the standard of care for enterococcal infections, although other antibiotics are often used as definitive treatment. We thus compared outcomes of patients with cancer and Efc bacteremia treated with AMP-containing (ACR) and non-AMP-containing antibiotic regimens (NACR). Methods A multicenter, prospective, observational cohort study conducted at MD Anderson Cancer Center, Henry Ford Hospital, and Memorial Hermann Health System. Eligible patients were ≥ 18 years old, diagnosed with cancer, and had at least one Efc bloodstream isolate collected from 12/2015 to 12/2018. Patients with polymicrobial infections were excluded. Patients were divided into two groups: i) ACR and ii) NACR. ACR included patients who received AMP at any time during treatment; other antimicrobials were permitted. NACR patients did not receive AMP at any time. The primary outcome compared desirability of outcome ranking (DOOR) between ACR and NACR at day 14. The DOOR consisted of six hierarchical levels: 1 - death; 2 - inpatient without microbiological cure (MC) and with acute kidney injury (AKI); 3 - inpatient without MC and without AKI; 4 - inpatient admitted with MC and with AKI; 5 - inpatient with MC and without AKI; 6 - alive and discharged. Comparison of DOORs between ACR and NACR was performed using inverse probability of treatment weighted (IPTW) ordered logistic regression. Results Seventy-one patients were included (ACR, n = 35; NACR, n = 36). No difference was seen in DOORs at day 14 between ACR and NACR (odds ratio [OR] 1.14, 95% Confidence Interval [CI] 0.45 – 2.92, p=0.78). No difference was observed for all-cause mortality at day 14 (OR 0.6, 95% CI 0.09 – 3.77, p=0.58) or day 30 (OR 0.42, 95% CI 0.09 – 1.94, p=0.27). Patients treated with ACR received a lower median duration of other antibiotics at any point during treatment compared to NACR: daptomycin (2 v 4 days) vancomycin (2 v 4 days), and linezolid (1 v 2 days). Conclusion Patients with cancer and Efc bloodstream infections had similar outcomes when treated with ACR and NACR. ACR were associated with less use of broad-spectrum antimicrobials. Future research should focus on the ecologic impact of use of NACR. Disclosures Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support) Cesar A. Arias, MD, MSc, PhD, FIDSA, Entasis Therapeutics (Scientific Research Study Investigator)MeMed (Scientific Research Study Investigator)Merck (Grant/Research Support)

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Opportunities and Challenges for Analyzing Cancer Data at the Inter- and Intra-Institutional Levels

JCO Precision Oncology ◽

10.1200/po.19.00394 ◽

2020 ◽

pp. 743-756

Author(s):

Julie Wu ◽

Jordan Bryan ◽

Samuel M. Rubinstein ◽

Lucy Wang ◽

Michele Lenoue-Newton ◽

...

Keyword(s):

Clinical Data ◽

Information Exchange ◽

Cancer Center ◽

Bipartite Network ◽

Genotypic Differences ◽

Cancer Type ◽

Sample Type ◽

Metastatic Tumors ◽

Institutional Level ◽

Cancer Data

PURPOSE Our goal was to identify the opportunities and challenges in analyzing data from the American Association of Cancer Research Project Genomics Evidence Neoplasia Information Exchange (GENIE), a multi-institutional database derived from clinically driven genomic testing, at both the inter- and the intra-institutional level. Inter-institutionally, we identified genotypic differences between primary and metastatic tumors across the 3 most represented cancers in GENIE. Intra-institutionally, we analyzed the clinical characteristics of the Vanderbilt-Ingram Cancer Center (VICC) subset of GENIE to inform the interpretation of GENIE as a whole. METHODS We performed overall cohort matching on the basis of age, ethnicity, and sex of 13,208 patients stratified by cancer type (breast, colon, or lung) and sample site (primary or metastatic). We then determined whether detected variants, at the gene level, were associated with primary or metastatic tumors. We extracted clinical data for the VICC subset from VICC’s clinical data warehouse. Treatment exposures were mapped to a 13-class schema derived from the HemOnc ontology. RESULTS Across 756 genes, there were significant differences in all cancer types. In breast cancer, ESR1 variants were over-represented in metastatic samples (odds ratio, 5.91; q < 10−6). TP53 mutations were over-represented in metastatic samples across all cancers. VICC had a significantly different cancer type distribution than that of GENIE but patients were well matched with respect to age, sex, and sample type. Treatment data from VICC was used for a bipartite network analysis, demonstrating clusters with a mix of histologies and others being more histology specific. CONCLUSION This article demonstrates the feasibility of deriving meaningful insights from GENIE at the inter- and intra-institutional level and illuminates the opportunities and challenges of the data GENIE contains. The results should help guide future development of GENIE, with the goal of fully realizing its potential for accelerating precision medicine.

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