Hospital-acquired COVID-19 linked to increased mortality among patients with cancer
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Nosocomial transmission of COVID-19 occurred at high rates among patients with cancer and appeared associated with increased mortality in this population, according to study results presented at AACR Virtual Meeting: COVID-19 and Cancer.
The results reinforced the importance of treating patients with cancer in COVID-free zones, researchers noted.
“We know that patients with cancer have higher mortality rates from COVID-19 compared with the general population, with the most recent studies indicating a mortality rate of 13% in the cancer population,” Arielle Elkrief, MD, oncology fellow at McGill University Health Centre, said during the presentation. “This is important because patients with cancer have high contact with the health care system due to frequent treatments, surveillance visits and hospitalizations for cancer-related complications.”
Previous studies have shown that patients with cancer are more likely to experience severe COVID-19 outcomes. Because of this, cancer centers have established COVID-free zones in which to care for patients. Despite these efforts, nosocomial transmission of the virus likely occurs among patients with cancer.
“In the general population, the incidence of nosocomial transmission of COVID-19 ranges from 7% to 20%,” Elkrief said. “However, the impact of hospital-acquired COVID-19 infection in patients with cancer remains unknown.”
Elkrief and colleagues analyzed 253 patients with cancer with a laboratory-confirmed or presumed diagnosis of COVID-19 to determine the incidence and impact of hospital-acquired COVID-19 and prognostic factors for virus severity in this population .
Researchers identified patients using provincial registries and hospital databases between March 3 and May 23 in the provinces of Quebec and British Columbia and collected information on baseline characteristics, including age, sex, comorbidities, cancer type and type of cancer treatment.
Nearly all the patients (n = 250) were adults, and the majority (n = 236) were Quebec residents.
Incidence of hospital-acquired COVID-19 diagnosed 5 days after hospital admission for an unrelated cause served as the primary endpoint. Death or composite outcomes of severe illness due to COVID-19, such as hospitalization, supplemental oxygen, ICU admission or mechanical ventilation, served as co-primary endpoints.
Among all patients, 90 received active cancer treatment in the 3 months prior to COVID-19 diagnosis.
Median follow-up was 23 days, during which 209 patients (82.6%) required hospitalization. Of those, 38 required admission the ICU and 71 (28%) died.
Forty-seven (19%) had been diagnosed with hospital-acquired COVID-19.
Those infected with COVID-19 at the hospital had shorter median OS than those who acquired the virus in the community (27 days vs. 71 days; HR = 2.2; 95% CI, 1.2-4).
Multivariate analysis showed independent associations between death and hospital-acquired COVID-19, age, ECOG performance status and advanced stage of cancer.
“This is the first report that describes a high rate of hospital-acquired COVID-19 in patients with cancer, and this was associated with high mortality in both univariate and multivariate analyses,” Elkrief said. “Our study reinforces the importance of adherence to stringent infection control guidelines in order to protect vulnerable patients such as those with cancer.”
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Elkrief A, et al. Abstract S12-01. Presented at: American Association for Cancer Research Virtual Meeting: COVID-19 and Cancer; July 20-22, 2020.
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