Characteristics and Outcome of SARS-CoV-2 Infection in Cancer Patients

  1. Clémence Basse
  2. Sarah Diakite
  3. Vincent Servois
  4. Maxime Frelaut
  5. Aurélien Noret
  6. Audrey Bellesoeur
  7. Pauline Moreau
  8. Marie-Ange Massiani
  9. Anne-Sophie Bouyer
  10. Perrine Vuagnat
  11. Sandra Malak
  12. François-Clément Bidard
  13. Dominique Vanjak
  14. Irène Kriegel
  15. Alexis Burnod
  16. Geoffroy Bilger
  17. Toulsie Ramtohul
  18. Gilles Dhonneur
  19. Carole Bouleuc
  20. Nathalie Cassoux
  21. Institut Curie COVID Group,
  22. Xavier Paoletti
  23. Laurence Bozec
  24. Paul Cottu

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Abstract

Background

Concerns have emerged about the higher risk of fatal coronavirus disease 2019 (COVID-19) in cancer patients. In this article, we review the experience of a comprehensive cancer center.

Methods

A prospective registry was set up at Institut Curie at the beginning of the COVID-19 pandemic. All cancer patients with suspected or proven COVID-19 were entered and actively followed for 28 days.

Results

Among 9842 patients treated at Institut Curie between March 13 and May 1, 2020, 141 (1.4%) were diagnosed with COVID-19, based on reverse transcription polymerase chain reaction testing and/or computerized tomography scan. In line with our case mix, breast cancer (40.4%) was the most common tumor type, followed by hematological and lung malignancies. Patients with active cancer therapy or/and advanced cancer accounted for 87.9% and 68.9% of patients, respectively. At diagnosis, 78.7% of patients had COVID-19–related symptoms, with an extent of lung parenchyma involvement inferior to 50% in 95.8% of patients. Blood count variations and C-reactive protein elevation were the most common laboratory abnormalities. Antibiotics and antiviral agents were administered in 48.2% and 6.4% of patients, respectively. At the time of analysis, 26 patients (18.4%) have died from COVID-19, and 100 (70.9%) were cured. Independent prognostic factors at the time of COVID-19 diagnosis associated with death or intensive care unit admission were extent of COVID-19 pneumonia and decreased O2 saturation.

Conclusions

COVID-19 incidence and presentation in cancer patients appear to be very similar to those in the general population. The outcome of COVID-19 is primarily driven by the initial severity of infection rather than patient or cancer characteristics.

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  1. Version published to 10.1093/jncics/pkaa090
  2. ScreenIT

    SciScore for 10.1101/2020.05.14.20101576: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This registry was approved by the Institut Curie Institutional Review Board (IRB).
    Consent: No documentation or informed consent was required according to French regulations, as this study was strictly observational.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed with SAS v9.4 software.
    SAS
    suggested: (SASqPCR, RRID:SCR_003056)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are limitations to this study. Access to RT-PCR tests differed between the beginning and the end of the cohort registration period, due to limited test availability at the beginning of the registration period (Supplemental Figure S2). It is far too early to evaluate the actual cancer outcome of cancer patients in the COVID-19 era. We are also aware that breast cancer patients may be overrepresented in our cohort, which could contribute to the overall good prognosis of SARS-CoV-2 infection observed in this study. However, our practice is similar to that of other comprehensive cancer centers, and our experience can therefore provide useful information in this specific context. This registry needs to be continued in order to provide more extensive and more robust data. In summary, early reports on cancer and COVID-19, mostly based on hospitalized cancer patients, tended to suggest that cancer patients were more prone to suffer from SARS-CoV-2 infection and experienced a higher mortality rate. Special attention must be paid to patients with lung cancer and hematological malignancies. However, risk factors for COVID-19 mortality are mostly infection-related rather than cancer-related. Overall, our findings from a large prospective cohort of representative cancer patients and treatments, including ambulatory, non-hospitalized patients, strongly suggest that COVID-19 is neither more frequent nor more fatal in cancer patients as a whole. A simple baseline clinical assessment co...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

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  3. Version published to 10.1101/2020.05.14.20101576v1 on medRxiv